|
1
|
Giacomelli A, Ciubotariu CL, Zacheo M, Rabbione A, Pieruzzi M, Barone F, Poloni A, Casalini G, Pozza G, Colaneri M, Passerini M, Ridolfo AL, Gervasoni C, Cattaneo D, Gori A, Antinori S. Mismanagement of SARS-CoV-2 Infection Pre Hospitalisation during the Omicron Era: Antibiotics and Steroids Instead of Early Antivirals. Viruses 2024; 16:1005. [PMID: 39066168 PMCID: PMC11281468 DOI: 10.3390/v16071005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024] Open
Abstract
The aim of this study was to assess the prevalence of inappropriate treatment among hospitalised patients affected by SARS-CoV-2 infection before hospital admission during the Omicron era. This single-centre, retrospective observational study included all the patients hospitalised because of SARS-CoV-2 infection during three periods characterised by the Italian prevalence of an Omicron variant of concern: (1) January-May 2022 (BA.1-BA.2), (2) June-October 2022 (BA.5), and (3) November 2022-March 2023 (BQ.1-XBB). Inappropriate treatment was defined as pre-hospitalisation exposure to antibiotics and/or steroids in the absence of a documented bacterial infection or the need for steroid treatment of an underlying medical condition. A total of 931 subjects were hospitalised: 394 in period 1, 334 in period 2, and 203 in period 3. Of the 157 patients undergoing inappropriate treatment (16.9%), 142 (15.3%) received antibiotics and 52 (5.6%) steroids. The proportion of inappropriately treated patients significantly decreased over time, from 23.1% in period 1 to 11.7% in period 2 and 13.3% in period 3 (p < 0.001), and there was a parallel decrease in antibiotic (p < 0.001) and steroid treatment (p < 0.013). Only 13 subjects (1.4%) received early pre-hospitalisation treatment for SARS-CoV-2. A significant proportion of hospitalised COVID-19 patients were exposed to inappropriate treatment before hospital admission.
Collapse
Affiliation(s)
- Andrea Giacomelli
- Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Via G.B. Grassi 74, 20157 Milan, Italy; (A.G.); (C.L.C.); (M.Z.); (A.R.); (M.P.); (F.B.); (A.P.); (G.P.); (C.G.); (A.G.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (A.L.R.)
| | - Cosmin Lucian Ciubotariu
- Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Via G.B. Grassi 74, 20157 Milan, Italy; (A.G.); (C.L.C.); (M.Z.); (A.R.); (M.P.); (F.B.); (A.P.); (G.P.); (C.G.); (A.G.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (A.L.R.)
| | - Martina Zacheo
- Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Via G.B. Grassi 74, 20157 Milan, Italy; (A.G.); (C.L.C.); (M.Z.); (A.R.); (M.P.); (F.B.); (A.P.); (G.P.); (C.G.); (A.G.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (A.L.R.)
| | - Andrea Rabbione
- Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Via G.B. Grassi 74, 20157 Milan, Italy; (A.G.); (C.L.C.); (M.Z.); (A.R.); (M.P.); (F.B.); (A.P.); (G.P.); (C.G.); (A.G.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (A.L.R.)
| | - Margherita Pieruzzi
- Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Via G.B. Grassi 74, 20157 Milan, Italy; (A.G.); (C.L.C.); (M.Z.); (A.R.); (M.P.); (F.B.); (A.P.); (G.P.); (C.G.); (A.G.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (A.L.R.)
| | - Federico Barone
- Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Via G.B. Grassi 74, 20157 Milan, Italy; (A.G.); (C.L.C.); (M.Z.); (A.R.); (M.P.); (F.B.); (A.P.); (G.P.); (C.G.); (A.G.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (A.L.R.)
| | - Andrea Poloni
- Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Via G.B. Grassi 74, 20157 Milan, Italy; (A.G.); (C.L.C.); (M.Z.); (A.R.); (M.P.); (F.B.); (A.P.); (G.P.); (C.G.); (A.G.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (A.L.R.)
| | - Giacomo Casalini
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (A.L.R.)
| | - Giacomo Pozza
- Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Via G.B. Grassi 74, 20157 Milan, Italy; (A.G.); (C.L.C.); (M.Z.); (A.R.); (M.P.); (F.B.); (A.P.); (G.P.); (C.G.); (A.G.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (A.L.R.)
| | - Marta Colaneri
- II Infectious Diseases Unit, Ospedale Luigi Sacco, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (M.P.)
| | - Matteo Passerini
- II Infectious Diseases Unit, Ospedale Luigi Sacco, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (M.P.)
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20157 Milan, Italy
| | - Anna Lisa Ridolfo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (A.L.R.)
| | - Cristina Gervasoni
- Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Via G.B. Grassi 74, 20157 Milan, Italy; (A.G.); (C.L.C.); (M.Z.); (A.R.); (M.P.); (F.B.); (A.P.); (G.P.); (C.G.); (A.G.)
- Gestione Ambulatoriale Politerapie Outpatient Clinic, ASST Fatebenefratelli Sacco University Hospital, 20154 Milan, Italy;
| | - Dario Cattaneo
- Gestione Ambulatoriale Politerapie Outpatient Clinic, ASST Fatebenefratelli Sacco University Hospital, 20154 Milan, Italy;
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, 20154 Milan, Italy
| | - Andrea Gori
- Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Via G.B. Grassi 74, 20157 Milan, Italy; (A.G.); (C.L.C.); (M.Z.); (A.R.); (M.P.); (F.B.); (A.P.); (G.P.); (C.G.); (A.G.)
- II Infectious Diseases Unit, Ospedale Luigi Sacco, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (M.C.); (M.P.)
- Centre for Multidisciplinary Research in Health Science (MACH), Università degli Studi di Milano, 20157 Milan, Italy
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Via G.B. Grassi 74, 20157 Milan, Italy; (A.G.); (C.L.C.); (M.Z.); (A.R.); (M.P.); (F.B.); (A.P.); (G.P.); (C.G.); (A.G.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (A.L.R.)
| |
Collapse
|
|
2
|
Hurwitz SJ, De R, LeCher JC, Downs-Bowen JA, Goh SL, Zandi K, McBrayer T, Amblard F, Patel D, Kohler JJ, Bhasin M, Dobosh BS, Sukhatme V, Tirouvanziam RM, Schinazi RF. Why Certain Repurposed Drugs Are Unlikely to Be Effective Antivirals to Treat SARS-CoV-2 Infections. Viruses 2024; 16:651. [PMID: 38675992 PMCID: PMC11053489 DOI: 10.3390/v16040651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Most repurposed drugs have proved ineffective for treating COVID-19. We evaluated median effective and toxic concentrations (EC50, CC50) of 49 drugs, mostly from previous clinical trials, in Vero cells. Ratios of reported unbound peak plasma concentrations, (Cmax)/EC50, were used to predict the potential in vivo efficacy. The 20 drugs with the highest ratios were retested in human Calu-3 and Caco-2 cells, and their CC50 was determined in an expanded panel of cell lines. Many of the 20 drugs with the highest ratios were inactive in human Calu-3 and Caco-2 cells. Antivirals effective in controlled clinical trials had unbound Cmax/EC50 ≥ 6.8 in Calu-3 or Caco-2 cells. EC50 of nucleoside analogs were cell dependent. This approach and earlier availability of more relevant cultures could have reduced the number of unwarranted clinical trials.
Collapse
Affiliation(s)
- Selwyn J. Hurwitz
- Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 1760 Haygood Drive, Atlanta, GA 30322, USA; (S.J.H.); (R.D.); (J.C.L.); (J.A.D.-B.); (S.L.G.); (K.Z.); (T.M.); (F.A.); (D.P.); (J.J.K.)
| | - Ramyani De
- Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 1760 Haygood Drive, Atlanta, GA 30322, USA; (S.J.H.); (R.D.); (J.C.L.); (J.A.D.-B.); (S.L.G.); (K.Z.); (T.M.); (F.A.); (D.P.); (J.J.K.)
| | - Julia C. LeCher
- Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 1760 Haygood Drive, Atlanta, GA 30322, USA; (S.J.H.); (R.D.); (J.C.L.); (J.A.D.-B.); (S.L.G.); (K.Z.); (T.M.); (F.A.); (D.P.); (J.J.K.)
| | - Jessica A. Downs-Bowen
- Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 1760 Haygood Drive, Atlanta, GA 30322, USA; (S.J.H.); (R.D.); (J.C.L.); (J.A.D.-B.); (S.L.G.); (K.Z.); (T.M.); (F.A.); (D.P.); (J.J.K.)
| | - Shu Ling Goh
- Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 1760 Haygood Drive, Atlanta, GA 30322, USA; (S.J.H.); (R.D.); (J.C.L.); (J.A.D.-B.); (S.L.G.); (K.Z.); (T.M.); (F.A.); (D.P.); (J.J.K.)
| | - Keivan Zandi
- Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 1760 Haygood Drive, Atlanta, GA 30322, USA; (S.J.H.); (R.D.); (J.C.L.); (J.A.D.-B.); (S.L.G.); (K.Z.); (T.M.); (F.A.); (D.P.); (J.J.K.)
| | - Tamara McBrayer
- Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 1760 Haygood Drive, Atlanta, GA 30322, USA; (S.J.H.); (R.D.); (J.C.L.); (J.A.D.-B.); (S.L.G.); (K.Z.); (T.M.); (F.A.); (D.P.); (J.J.K.)
| | - Franck Amblard
- Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 1760 Haygood Drive, Atlanta, GA 30322, USA; (S.J.H.); (R.D.); (J.C.L.); (J.A.D.-B.); (S.L.G.); (K.Z.); (T.M.); (F.A.); (D.P.); (J.J.K.)
| | - Dharmeshkumar Patel
- Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 1760 Haygood Drive, Atlanta, GA 30322, USA; (S.J.H.); (R.D.); (J.C.L.); (J.A.D.-B.); (S.L.G.); (K.Z.); (T.M.); (F.A.); (D.P.); (J.J.K.)
| | - James J. Kohler
- Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 1760 Haygood Drive, Atlanta, GA 30322, USA; (S.J.H.); (R.D.); (J.C.L.); (J.A.D.-B.); (S.L.G.); (K.Z.); (T.M.); (F.A.); (D.P.); (J.J.K.)
| | - Manoj Bhasin
- Center for Cystic Fibrosis & Airways Disease Research, Division of Pulmonary, Allergy & Immunology, Cystic Fibrosis and Sleep, Emory University and Children’s Healthcare of Atlanta, 2015 Uppergate Drive, Atlanta, GA 30322, USA; (M.B.); (B.S.D.); (R.M.T.)
| | - Brian S. Dobosh
- Center for Cystic Fibrosis & Airways Disease Research, Division of Pulmonary, Allergy & Immunology, Cystic Fibrosis and Sleep, Emory University and Children’s Healthcare of Atlanta, 2015 Uppergate Drive, Atlanta, GA 30322, USA; (M.B.); (B.S.D.); (R.M.T.)
| | - Vikas Sukhatme
- Morningside Center for Innovative and Affordable Medicine, Departments of Medicine and Hematology and Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Rabindra M. Tirouvanziam
- Center for Cystic Fibrosis & Airways Disease Research, Division of Pulmonary, Allergy & Immunology, Cystic Fibrosis and Sleep, Emory University and Children’s Healthcare of Atlanta, 2015 Uppergate Drive, Atlanta, GA 30322, USA; (M.B.); (B.S.D.); (R.M.T.)
| | - Raymond F. Schinazi
- Center for ViroScience and Cure, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, 1760 Haygood Drive, Atlanta, GA 30322, USA; (S.J.H.); (R.D.); (J.C.L.); (J.A.D.-B.); (S.L.G.); (K.Z.); (T.M.); (F.A.); (D.P.); (J.J.K.)
| |
Collapse
|
|
3
|
Sidorenko VS, Cohen I, Dorjee K, Minetti CA, Remeta DP, Gao J, Potapova I, Wang HZ, Hearing J, Yen WY, Kim HK, Hashimoto K, Moriya M, Dickman KG, Yin X, Garcia-Diaz M, Chennamshetti R, Bonala R, Johnson F, Waldeck AL, Gupta R, Li C, Breslauer KJ, Grollman AP, Rosenquist TA. Mechanisms of antiviral action and toxicities of ipecac alkaloids: Emetine and dehydroemetine exhibit anti-coronaviral activities at non-cardiotoxic concentrations. Virus Res 2024; 341:199322. [PMID: 38228190 PMCID: PMC10831786 DOI: 10.1016/j.virusres.2024.199322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 01/18/2024]
Abstract
The emergence of highly infectious pathogens with their potential for triggering global pandemics necessitate the development of effective treatment strategies, including broad-spectrum antiviral therapies to safeguard human health. This study investigates the antiviral activity of emetine, dehydroemetine (DHE), and congeneric compounds against SARS-CoV-2 and HCoV-OC43, and evaluates their impact on the host cell. Concurrently, we assess the potential cardiotoxicity of these ipecac alkaloids. Significantly, our data reveal that emetine and the (-)-R,S isomer of 2,3-dehydroemetine (designated in this paper as DHE4) reduce viral growth at nanomolar concentrations (i.e., IC50 ∼ 50-100 nM), paralleling those required for inhibition of protein synthesis, while calcium channel blocking activity occurs at elevated concentrations (i.e., IC50 ∼ 40-60 µM). Our findings suggest that the antiviral mechanisms primarily involve disruption of host cell protein synthesis and is demonstrably stereoisomer specific. The prospect of a therapeutic window in which emetine or DHE4 inhibit viral propagation without cardiotoxicity renders these alkaloids viable candidates in strategies worthy of clinical investigation.
Collapse
Affiliation(s)
- Viktoriya S Sidorenko
- Department of Pharmacological Sciences, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Ira Cohen
- Department of Physiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York 11794, USA
| | - Kunchok Dorjee
- Division of Infectious Diseases, John Hopkins School of Medicine, Baltimore, Maryland 21205, USA
| | - Conceição A Minetti
- Department of Chemistry and Chemical Biology, Rutgers - The State University of New Jersey, Piscataway, New Jersey 08854, USA
| | - David P Remeta
- Department of Chemistry and Chemical Biology, Rutgers - The State University of New Jersey, Piscataway, New Jersey 08854, USA
| | - Junyuan Gao
- Department of Physiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York 11794, USA
| | - Irina Potapova
- Department of Physiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York 11794, USA
| | - Hong Zhan Wang
- Department of Physiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York 11794, USA
| | - Janet Hearing
- Department of Microbiology and Immunology, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York 11794, USA
| | - Wan-Yi Yen
- Department of Microbiology and Immunology, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York 11794, USA
| | - Hwan Keun Kim
- Department of Microbiology and Immunology, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York 11794, USA
| | - Keiji Hashimoto
- Department of Pharmacological Sciences, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Masaaki Moriya
- Department of Pharmacological Sciences, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Kathleen G Dickman
- Department of Pharmacological Sciences, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; Department of Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York 11794, USA
| | - Xingyu Yin
- Department of Pharmacological Sciences, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Miguel Garcia-Diaz
- Department of Pharmacological Sciences, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Rajesh Chennamshetti
- Department of Pharmacological Sciences, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Radha Bonala
- Department of Pharmacological Sciences, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Francis Johnson
- Department of Pharmacological Sciences, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; Department of Chemistry, Stony Brook University, Stony Brook, New York 11794, USA
| | - Amanda L Waldeck
- Department of Pharmacological Sciences, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; Department of Pharmacy, Stony Brook University Hospital, Stony Brook, New York 11794, USA
| | - Ramesh Gupta
- ChemMaster International Inc., Happauge, New York 11788, USA
| | - Chaoping Li
- Chemistry Service Unit of Shanghai Haoyuan Chemexpress Co., Ltd., Shanghai, PR China 201203
| | - Kenneth J Breslauer
- Department of Chemistry and Chemical Biology, Rutgers - The State University of New Jersey, Piscataway, New Jersey 08854, USA; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA
| | - Arthur P Grollman
- Department of Pharmacological Sciences, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; Department of Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York 11794, USA
| | - Thomas A Rosenquist
- Department of Pharmacological Sciences, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA.
| |
Collapse
|
|
4
|
Abdel-Salam Elgohary M, Ali A, J Alarfaj S, Shahin H, Ibrahim Zaki A, Medhat Hasan E, Emam Mohamed M, Mahmoud Elkholy A, El-Masry TA, Samir Kamal J, Ali AbdelRahim M, Wageh Saber A, Seadawy MG, Elshishtawy MHM, El-Bouseary MM. Even one dose of tocilizumab could hinder bad prognosis of cytokines storm in COVID-19 patients. Cytokine 2024; 173:156433. [PMID: 37972479 DOI: 10.1016/j.cyto.2023.156433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 08/04/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
Severe COVID-19 pneumonia is a principal cause of death due to cascade of hyper inflammatory condition that leading to lung damage. Therefore, an effective therapy to countercurrent the surge of uncontrolled inflammation is mandatory to propose. Anti-interlukin-6 receptor antagonist monoclonal therapy, tocilizumab (TCZ) showed potential results in COVID-19 patients. This study aimed to emphasize the factors associated with mortality in COVID-19 patients that treated with tocilizumab and may influence the level of serum IL-6. A retrospective cohort study included all patients with clinical parameters that pointed to presence of cytokines storm and treated with one or more doses of TCZ beside the regular protocol of COVID-19 pneumonia. The factors that influence the mortality in addition to the level of serum IL-6 were analyzed. A total of 377 patients were included, 69.5 % of them received only one dose of TCZ which started mainly at the third day of admission. The mortality rate was 29.44 %. Regardless the time of starting TCZ, just one dose was fair enough to prevent bad consequence; OR = 0.04, P = 0.001.However, in spite of protective action of TCZ, older age and female sex were significant risk factors for mortality, P = 0.001 and 0.01 respectively, as well heart disease. Moreover, increasing the level of neutrophil, AST and IL-6 were associated with bad prognosis. In the same line, treatment with ivermectin, chloroquine and remdesivir inversely affect the level of IL-6. Early treatments of COVID-19 pneumonia with at least one dose of tocilizumab minimized the fatality rate.
Collapse
Affiliation(s)
| | - Asmaa Ali
- Department of Pulmonary Medicine, Abbassia Chest Hospital, MOH, Cairo, Egypt; Department of Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang 212013, PR China.
| | - Sumaiah J Alarfaj
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University. P.O. Box 84428, Riyadh 11671, Saudi Arabia.
| | - Hesham Shahin
- Chest Consultant, Manager of Military Chest Hospital, Cairo, Egypt.
| | | | | | | | | | - Thanaa A El-Masry
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tanta University, Egypt.
| | | | | | - Ashgan Wageh Saber
- Chemistry Laboratory Department, Central Military Laboratories, Cairo, Egypt.
| | - Mohamed G Seadawy
- Biological Prevention Department, Ministry of Defense, Cairo, Egypt.
| | | | - Maisra M El-Bouseary
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Tanta University, Tanta, Egypt.
| |
Collapse
|
|
5
|
Scheim DE, Vottero P, Santin AD, Hirsh AG. Sialylated Glycan Bindings from SARS-CoV-2 Spike Protein to Blood and Endothelial Cells Govern the Severe Morbidities of COVID-19. Int J Mol Sci 2023; 24:17039. [PMID: 38069362 PMCID: PMC10871123 DOI: 10.3390/ijms242317039] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
Consistent with well-established biochemical properties of coronaviruses, sialylated glycan attachments between SARS-CoV-2 spike protein (SP) and host cells are key to the virus's pathology. SARS-CoV-2 SP attaches to and aggregates red blood cells (RBCs), as shown in many pre-clinical and clinical studies, causing pulmonary and extrapulmonary microthrombi and hypoxia in severe COVID-19 patients. SARS-CoV-2 SP attachments to the heavily sialylated surfaces of platelets (which, like RBCs, have no ACE2) and endothelial cells (having minimal ACE2) compound this vascular damage. Notably, experimentally induced RBC aggregation in vivo causes the same key morbidities as for severe COVID-19, including microvascular occlusion, blood clots, hypoxia and myocarditis. Key risk factors for COVID-19 morbidity, including older age, diabetes and obesity, are all characterized by markedly increased propensity to RBC clumping. For mammalian species, the degree of clinical susceptibility to COVID-19 correlates to RBC aggregability with p = 0.033. Notably, of the five human betacoronaviruses, the two common cold strains express an enzyme that releases glycan attachments, while the deadly SARS, SARS-CoV-2 and MERS do not, although viral loads for COVID-19 and the two common cold infections are similar. These biochemical insights also explain the previously puzzling clinical efficacy of certain generics against COVID-19 and may support the development of future therapeutic strategies for COVID-19 and long COVID patients.
Collapse
Affiliation(s)
- David E Scheim
- US Public Health Service, Commissioned Corps, Inactive Reserve, Blacksburg, VA 24060, USA
| | - Paola Vottero
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB T6G 1Z2, Canada
| | - Alessandro D Santin
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, P.O. Box 208063, New Haven, CT 06520, USA
| | | |
Collapse
|
|
6
|
Movahedi Nia Z, Bragazzi NL, Ahamadi A, Asgary A, Mellado B, Orbinski J, Seyyed-Kalantari L, Woldegerima WA, Wu J, Kong JD. Off-label drug use during the COVID-19 pandemic in Africa: topic modelling and sentiment analysis of ivermectin in South Africa and Nigeria as a case study. J R Soc Interface 2023; 20:20230200. [PMID: 37700708 PMCID: PMC10498353 DOI: 10.1098/rsif.2023.0200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/18/2023] [Indexed: 09/14/2023] Open
Abstract
Although rejected by the World Health Organization, the human and even veterinary formulation of ivermectin has widely been used for prevention and treatment of COVID-19. In this work we leverage Twitter to understand the reasons for the drug use from ivermectin supporters, their source of information, their emotions, their gender demographics, and location information, in Nigeria and South Africa. Topic modelling is performed on a Twitter dataset gathered using keywords 'ivermectin' and 'ivm'. A model is fine-tuned on RoBERTa to find the stance of the tweets. Statistical analysis is performed to compare the stance and emotions. Most ivermectin supporters either redistribute conspiracy theories posted by influencers, or refer to flawed studies confirming ivermectin efficacy in vitro. Three emotions have the highest intensity, optimism, joy and disgust. The number of anti-ivermectin tweets has a significant positive correlation with vaccination rate. All the provinces in South Africa and most of the provinces of Nigeria are pro-ivermectin and have higher disgust polarity. This work makes the effort to understand public discussions regarding ivermectin during the COVID-19 pandemic to help policy-makers understand the rationale behind its popularity, and inform more targeted policies to discourage self-administration of ivermectin. Moreover, it is a lesson to future outbreaks.
Collapse
Affiliation(s)
- Z. Movahedi Nia
- Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), York University, Toronto, Ontario, Canada
- Laboratory for Industrial and Applied Mathematics (LIAM), York University, Toronto, Ontario, Canada
| | - N. L. Bragazzi
- Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), York University, Toronto, Ontario, Canada
- Laboratory for Industrial and Applied Mathematics (LIAM), York University, Toronto, Ontario, Canada
| | - A. Ahamadi
- Advanced Disaster, Emergency and Rapid-response Simulation (ADERSIM), York University, Toronto, Ontario, Canada
- Faculty of Computer Engineering, K.N. Toosi University, Tehran, Iran
| | - A. Asgary
- Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), York University, Toronto, Ontario, Canada
- Advanced Disaster, Emergency and Rapid-response Simulation (ADERSIM), York University, Toronto, Ontario, Canada
| | - B. Mellado
- Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), York University, Toronto, Ontario, Canada
- School of Physics, Institute for Collider Particle Physics, University of the Witwatersrand, Johannesburg, South Africa
| | - J. Orbinski
- Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), York University, Toronto, Ontario, Canada
- Dahdaleh Institute for Global Health Research, York University, Toronto, Ontario, Canada
| | - L. Seyyed-Kalantari
- Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), York University, Toronto, Ontario, Canada
- Department of Electrical Engineering and Computer Science, York University, Toronto, Ontario, Canada
| | - W. A. Woldegerima
- Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), York University, Toronto, Ontario, Canada
- Laboratory for Industrial and Applied Mathematics (LIAM), York University, Toronto, Ontario, Canada
| | - J. Wu
- Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), York University, Toronto, Ontario, Canada
- Laboratory for Industrial and Applied Mathematics (LIAM), York University, Toronto, Ontario, Canada
| | - J. D. Kong
- Africa-Canada Artificial Intelligence and Data Innovation Consortium (ACADIC), York University, Toronto, Ontario, Canada
- Laboratory for Industrial and Applied Mathematics (LIAM), York University, Toronto, Ontario, Canada
| |
Collapse
|
|
7
|
Ibrahim A, Humphries UW, Ngiamsunthorn PS, Baba IA, Qureshi S, Khan A. Modeling the dynamics of COVID-19 with real data from Thailand. Sci Rep 2023; 13:13082. [PMID: 37567888 PMCID: PMC10421938 DOI: 10.1038/s41598-023-39798-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
In recent years, COVID-19 has evolved into many variants, posing new challenges for disease control and prevention. The Omicron variant, in particular, has been found to be highly contagious. In this study, we constructed and analyzed a mathematical model of COVID-19 transmission that incorporates vaccination and three different compartments of the infected population: asymptomatic [Formula: see text], symptomatic [Formula: see text], and Omicron [Formula: see text]. The model is formulated in the Caputo sense, which allows for fractional derivatives that capture the memory effects of the disease dynamics. We proved the existence and uniqueness of the solution of the model, obtained the effective reproduction number, showed that the model exhibits both endemic and disease-free equilibrium points, and showed that backward bifurcation can occur. Furthermore, we documented the effects of asymptomatic infected individuals on the disease transmission. We validated the model using real data from Thailand and found that vaccination alone is insufficient to completely eradicate the disease. We also found that Thailand must monitor asymptomatic individuals through stringent testing to halt and subsequently eradicate the disease. Our study provides novel insights into the behavior and impact of the Omicron variant and suggests possible strategies to mitigate its spread.
Collapse
Affiliation(s)
- Alhassan Ibrahim
- Department of Mathematics, Faculty of Science, King Mongkut's University of Technology, Thonburi (KMUTT), 126 Pracha Uthit Road, Bang Mod, Thung Khru, Bangkok, 10140, Thailand
- Department of Mathematical Sciences, Bayero University, Kano, Nigeria
| | - Usa Wannasingha Humphries
- Department of Mathematics, Faculty of Science, King Mongkut's University of Technology, Thonburi (KMUTT), 126 Pracha Uthit Road, Bang Mod, Thung Khru, Bangkok, 10140, Thailand.
| | - Parinya Sa Ngiamsunthorn
- Department of Mathematics, Faculty of Science, King Mongkut's University of Technology, Thonburi (KMUTT), 126 Pracha Uthit Road, Bang Mod, Thung Khru, Bangkok, 10140, Thailand
| | - Isa Abdullahi Baba
- Department of Mathematics, Faculty of Science, King Mongkut's University of Technology, Thonburi (KMUTT), 126 Pracha Uthit Road, Bang Mod, Thung Khru, Bangkok, 10140, Thailand
- Department of Mathematical Sciences, Bayero University, Kano, Nigeria
| | - Sania Qureshi
- Department of mathematics, Near East University TRNC, Mersin 10, Turkey
- Department of Basic Sciences and Related Studies, Mehran University of Engineering & Technology, Jamshoro, 76062, Pakistan
| | - Amir Khan
- Department of Mathematics and Statistics, University of Swat, Khyber Pakhtunkhwa, kpk, Pakistan
| |
Collapse
|
|
8
|
Chamie JJ, Hibberd JA, Scheim DE. COVID-19 Excess Deaths in Peru's 25 States in 2020: Nationwide Trends, Confounding Factors, and Correlations With the Extent of Ivermectin Treatment by State. Cureus 2023; 15:e43168. [PMID: 37692571 PMCID: PMC10484241 DOI: 10.7759/cureus.43168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction In 2020, nations hastened to contain an emerging COVID-19 pandemic by deploying diverse public health approaches, but conclusive appraisals of the efficacy of these approaches are elusive in most cases. One of the medicines deployed, ivermectin (IVM), a macrocyclic lactone having biochemical activity against SARS-CoV-2 through competitive binding to its spike protein, has yielded mixed results in randomized clinical trials (RCTs) for COVID-19 treatments. In Peru, an opportunity to track the efficacy of IVM with a close consideration of confounding factors was provided through data for excess deaths as correlated with IVM use in 2020, under semi-autonomous policies in its 25 states. Methods To evaluate possible IVM treatment effects, excess deaths as determined from Peruvian national health data were analyzed by state for ages ≥60 in Peru's 25 states. These data were compared with monthly summary data for excess deaths in Peru for the period 2020-2021 as published by the WHO in 2022. To identify potential confounding factors, Google mobility data, population densities, SARS-CoV-2 genetic variations, and seropositivity rates were also examined. Results Reductions in excess deaths over a period of 30 days after peak deaths averaged 74% in the 10 states with the most intensive IVM use. As determined across all 25 states, these reductions in excess deaths correlated closely with the extent of IVM use (p<0.002). During four months of IVM use in 2020, before a new president of Peru restricted its use, there was a 14-fold reduction in nationwide excess deaths and then a 13-fold increase in the two months following the restriction of IVM use. Notably, these trends in nationwide excess deaths align with WHO summary data for the same period in Peru. Conclusions The natural experiment that was put into motion with the authorization of IVM use for COVID-19 in Peru in May 2020, as analyzed using data on excess deaths by locality and by state from Peruvian national health sources, resulted in strong evidence for the drug's effectiveness. Several potential confounding factors, including effects of a social isolation mandate imposed in May 2020, variations in the genetic makeup of the SARS-CoV-2 virus, and differences in seropositivity rates and population densities across the 25 states, were considered but did not appear to have significantly influenced these outcomes.
Collapse
Affiliation(s)
- Juan J Chamie
- Data Analysis, Independent Data Analyst, Cambridge, USA
| | | | - David E Scheim
- Commissioned Corps, Inactive Reserve, United States Public Health Service, Blacksburg, USA
| |
Collapse
|
|
9
|
Song H, Lei N, Zeng L, Li X, Jiang C, Feng Q, Su Y, Liu J, Mu J. Mendelian randomization analysis identified tumor necrosis factor as being associated with severe COVID-19. Front Pharmacol 2023; 14:1171404. [PMID: 37397483 PMCID: PMC10311560 DOI: 10.3389/fphar.2023.1171404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/02/2023] [Indexed: 07/04/2023] Open
Abstract
Background: Observational studies have shown that anti-tumor necrosis factor (TNF) therapy may be beneficial for patients with coronavirus disease 2019 (COVID-19). Nevertheless, because of the methodological restrictions of traditional observational studies, it is a challenge to make causal inferences. This study involved a two-sample Mendelian randomization analysis to investigate the causal link between nine TNFs and COVID-19 severity using publicly released genome-wide association study summary statistics. Methods: Summary statistics for nine TNFs (21,758 cases) were obtained from a large-scale genome-wide association study. Correlation data between single-nucleotide polymorphisms and severe COVID-19 (18,152 cases vs. 1,145,546 controls) were collected from the COVID-19 host genetics initiative. The causal estimate was calculated by inverse variance-weighted (IVW), MR-Egger, and weighted median methods. Sensitivity tests were conducted to assess the validity of the causal relationship. Results: Genetically predicted TNF receptor superfamily member 6 (FAS) positively correlated with the severity of COVID-19 (IVW, odds ratio = 1.10, 95% confidence interval = 1.01-1.19, p = 0.026), whereas TNF receptor superfamily member 5 (CD40) was protective against severe COVID-19 (IVW, odds ratio = 0.92, 95% confidence interval = 0.87-0.97, p = 0.002). Conclusion: Genetic evidence from this study supports that the increased expression of FAS is associated with the risk of severe COVID-19 and that CD40 may have a potential protective effect against COVID-19.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Yue Su
- Traditional Chinese Medicine and Inflammation Regulation Research Group, School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jibin Liu
- Traditional Chinese Medicine and Inflammation Regulation Research Group, School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jie Mu
- Traditional Chinese Medicine and Inflammation Regulation Research Group, School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| |
Collapse
|
|
10
|
Scheim DE, Aldous C, Osimani B, Fordham EJ, Hoy WE. When Characteristics of Clinical Trials Require Per-Protocol as Well as Intention-to-Treat Outcomes to Draw Reliable Conclusions: Three Examples. J Clin Med 2023; 12:jcm12113625. [PMID: 37297820 DOI: 10.3390/jcm12113625] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/10/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
Under exceptional circumstances, including high rates of protocol non-compliance, per-protocol (PP) analysis can better indicate the real-world benefits of a medical intervention than intention-to-treat (ITT) analysis. Exemplifying this, the first randomized clinical trial (RCT) considered found that colonoscopy screenings were marginally beneficial, based upon ITT analysis, with only 42% of the intervention group actually undergoing the procedure. However, the study authors themselves concluded that the medical efficacy of that screening was a 50% reduction in colorectal cancer deaths among that 42% PP group. The second RCT found a ten-fold reduction in mortality for a COVID-19 treatment drug vs. placebo by PP analysis, but only a minor benefit by ITT analysis. The third RCT, conducted as an arm of the same platform trial as the second RCT, tested another COVID-19 treatment drug and reported no significant benefit by ITT analysis. Inconsistencies and irregularities in the reporting of protocol compliance for this study required consideration of PP outcomes for deaths and hospitalizations, yet the study coauthors refused to disclose them, instead directing inquiring scientists to a data repository which never held the study's data. These three RCTs illustrate conditions under which PP outcomes may differ significantly from ITT outcomes and the need for data transparency when these reported or indicated discrepancies arise.
Collapse
Affiliation(s)
- David E Scheim
- US Public Health Service, Commissioned Corps, Inactive Reserve, Blacksburg, VA 24060, USA
| | - Colleen Aldous
- College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Barbara Osimani
- Center for Philosophy, Science, and Policy, Faculty of Medicine, Marche Polytechnic University, 60121 Ancona, Italy
| | | | - Wendy E Hoy
- Centre of Chronic Disease, Faculty of Medicine, University of Queensland, Brisbane 4072, Australia
| |
Collapse
|
|
11
|
Niranjan V, Uttarkar A, Ramakrishnan A, Muralidharan A, Shashidhara A, Acharya A, Tarani A, Kumar J. De Novo Design of Anti-COVID Drugs Using Machine Learning-Based Equivariant Diffusion Model Targeting the Spike Protein. Curr Issues Mol Biol 2023; 45:4261-4284. [PMID: 37232740 DOI: 10.3390/cimb45050271] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/07/2023] [Accepted: 04/25/2023] [Indexed: 05/27/2023] Open
Abstract
The drug discovery and research for an anti-COVID-19 drug has been ongoing despite repurposed drugs in the market. Over time, these drugs were discontinued due to side effects. The search for effective drugs is still under process. The role of Machine Learning (ML) is critical in the search for novel drug compounds. In the current work, using the equivariant diffusion model, we built novel compounds targeting the spike protein of SARS-CoV-2. Using the ML models, 196 de novo compounds were generated which had no hits on any major chemical databases. These novel compounds fulfilled all the criteria of ADMET properties to be lead-like and drug-like compounds. Of the 196 compounds, 15 were docked with high confidence in the target. These compounds were further subjected to molecular docking, the best compound having an IUPAC name of (4aS,4bR,8aS,8bS)-4a,8a-dimethylbiphenylene-1,4,5,8(4aH,4bH,8aH,8bH)-tetraone and a binding score of -6.930 kcal/mol. The principal compound is labeled as CoECG-M1. Density Function Theory (DFT) and Quantum optimization was carried out along with the study of ADMET properties. This suggests that the compound has potential drug-like properties. The docked complex was further subjected to MD simulations, GBSA, and metadynamics simulations to gain insights into the stability of binding. The model can be in the future modified to improve the positive docking rate.
Collapse
Affiliation(s)
- Vidya Niranjan
- Department of Biotechnology, R V College of Engineering, Mysuru Road, Kengeri, Bangalore 560059, Karnataka, India
| | - Akshay Uttarkar
- Department of Biotechnology, R V College of Engineering, Mysuru Road, Kengeri, Bangalore 560059, Karnataka, India
| | - Ananya Ramakrishnan
- Department of Biotechnology, R V College of Engineering, Mysuru Road, Kengeri, Bangalore 560059, Karnataka, India
| | - Anagha Muralidharan
- Department of Biotechnology, R V College of Engineering, Mysuru Road, Kengeri, Bangalore 560059, Karnataka, India
| | - Abhay Shashidhara
- Department of Biotechnology, R V College of Engineering, Mysuru Road, Kengeri, Bangalore 560059, Karnataka, India
| | - Anushri Acharya
- Department of Biotechnology, R V College of Engineering, Mysuru Road, Kengeri, Bangalore 560059, Karnataka, India
| | - Avila Tarani
- Department of Biotechnology, R V College of Engineering, Mysuru Road, Kengeri, Bangalore 560059, Karnataka, India
| | - Jitendra Kumar
- Bangalore Bioinnovation Centre (BBC), Helix Biotech Park, Electronics City Phase 1, Bengaluru 560100, Karnataka, India
| |
Collapse
|
|
12
|
Das S. Editorial: Medication safety in COVID-19 management, Volume II. Front Pharmacol 2023; 14:1175152. [PMID: 36969864 PMCID: PMC10034399 DOI: 10.3389/fphar.2023.1175152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/11/2023] Open
Affiliation(s)
- Saibal Das
- Indian Council of Medical Research—Centre for Ageing and Mental Health, Kolkata, India
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Saibal Das,
| |
Collapse
|
|
13
|
Djulbegovic B, Hozo I, Lizarraga D, Thomas J, Barbee M, Shah N, Rubeor T, Dale J, Reiser J, Guyatt G. Evaluation of a fast-and-frugal clinical decision algorithm ('pathways') on clinical outcomes in hospitalised patients with COVID-19 treated with anticoagulants. J Eval Clin Pract 2023; 29:3-12. [PMID: 36229950 PMCID: PMC9840687 DOI: 10.1111/jep.13780] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/26/2022] [Accepted: 10/02/2022] [Indexed: 01/27/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES Critics have charged that evidence-based medicine (EBM) overemphasises algorithmic rules over unstructured clinical experience and intuition, but the role of structured decision support systems in improving health outcomes remains uncertain. We aim to assess if delivery of anticoagulant prophylaxis in hospitalised patients with COVID-19 according to an algorithm based on evidence-based clinical practice guideline (CPG) improved clinical outcomes compared with administration of anticoagulant treatment given at individual practitioners' discretion. METHODS An observational design consisting of the analysis of all acutely ill, consecutive patients (n = 1783) with confirmed COVID-19 diagnosis admitted between 10 March 2020 to 11 January 2022 to an US academic center. American Society of Haematology CPG for anticoagulant prophylaxis in hospitalised patients with COVID-19 was converted into a clinical pathway and translated into fast-and-frugal decision (FFT) tree ('algorithm'). We compared delivery of anticoagulant prophylaxis in hospitalised patients with COVID-19 according to the FFT algorithm with administration of anticoagulant treatment given at individual practitioners' discretion. RESULTS In an adjusted analysis, using combination of Lasso (least absolute shrinkage and selection operator) and propensity score based weighting [augmented inverse-probability weighting] statistical techniques controlling for cluster data, the algorithm did not reduce death, venous thromboembolism, or major bleeding, but helped avoid longer hospital stay [number of patients needed to be treated (NNT) = 40 (95% CI: 23-143), indicating that for every 40 patients (23-143) managed on FFT algorithm, one avoided staying in hospital longer than 10 days] and averted admission to intensive-care unit (ICU) [NNT = 19 (95% CI: 13-40)]. All model's selected covariates were well balanced. The results remained robust to sensitivity analyses used to test the stability of the findings. CONCLUSIONS When delivered using a structured FFT algorithm, CPG shortened the hospital stay and help avoided admission to ICU, but it did not affect other relevant outcomes.
Collapse
Affiliation(s)
- Benjamin Djulbegovic
- Department of Computational & Quantitative Medicine, City of Hope, Beckman Research Institute, Duarte, California, USA.,Division of Health Analytics, Beckman Research Institute, Duarte, California, USA.,Evidence-Based Medicine & Comparative Effectiveness Research, Beckman Research Institute, Duarte, California, USA
| | - Iztok Hozo
- Department of Mathematics, Indiana University, Gary, Indiana, USA
| | - David Lizarraga
- Department of Computational & Quantitative Medicine, City of Hope, Beckman Research Institute, Duarte, California, USA.,Division of Health Analytics, Beckman Research Institute, Duarte, California, USA.,Evidence-Based Medicine & Comparative Effectiveness Research, Beckman Research Institute, Duarte, California, USA
| | - Joseph Thomas
- Rush University Medical Center (RUMC), Chicago, Illinois, USA.,Division of Hospital Medicine, Department of Hospital Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael Barbee
- Rush University Medical Center (RUMC), Chicago, Illinois, USA.,Division of Hospital Medicine, Department of Hospital Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Nupur Shah
- Rush University Medical Center (RUMC), Chicago, Illinois, USA.,Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Tyler Rubeor
- Rush University Medical Center (RUMC), Chicago, Illinois, USA
| | - Jordan Dale
- Houston Methodist Academic Institute, Houston, Texas, USA
| | - Jochen Reiser
- Rush University Medical Center (RUMC), Chicago, Illinois, USA.,Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
|
14
|
Efficacy and safety of selective serotonin reuptake inhibitors in COVID-19 management: a systematic review and meta-analysis. Clin Microbiol Infect 2023; 29:578-586. [PMID: 36657488 PMCID: PMC9841740 DOI: 10.1016/j.cmi.2023.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/21/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND The efficacy of selective serotonin reuptake inhibitors (SSRIs) in the treatment of acute COVID-19 is still under investigation, with conflicting results reported from randomized controlled trials (RCTs). Different dosing regimens may have contributed to the contradictory findings. OBJECTIVES To evaluate the efficacy and safety of SSRIs and the effect of different dosing regimens on the treatment of acute COVID-19. DATA SOURCES Seven databases were searched from January 2020 to December 2022. Trial registries, previous reviews, and preprint servers were hand-searched. STUDY ELIGIBILITY CRITERIA RCTs and observational studies with no language restrictions. PARTICIPANTS COVID-19 inpatients/outpatients. INTERVENTIONS SSRIs prescribed after diagnosis were compared against a placebo or standard of care. ASSESSMENT OF RISK OF BIAS Risk of bias was rated using the revised Cochrane Risk of Bias Tool for Randomized Trials version 2.0 and Risk of Bias in Non-Randomized Studies of Interventions. METHODS OF DATA SYNTHESIS Outcomes were mortality, hospitalization, composite of hospitalization/emergency room visits, hypoxemia, requirement for supplemental oxygen, ventilator support, and serious adverse events. RCT data were pooled in random-effects meta-analyses. Observational findings were narratively described. Subgroup analyses were performed on the basis of SSRI dose, and sensitivity analyses were performed excluding studies with a high risk of bias. The Grading of Recommendations, Assessment, Development and Evaluations framework was used to assess the quality of evidence. RESULTS Six RCTs (N = 4197) and five observational studies (N = 1156) were included. Meta-analyses associated fluvoxamine with reduced mortality (risk ratio, 0.72; 95% CI, 0.63-0.82) and hospitalization (risk ratio, 0.79; 95% CI, 0.64-0.99) on the basis of moderate quality of evidence. Medium-dose fluvoxamine (100 mg twice a day) was associated with reduced mortality, hospitalization, and composite of hospitalization/emergency room visits, but low-dose fluvoxamine (50 mg twice a day) was not. Fluvoxamine was not associated with increased serious adverse events. Observational studies support the use of fluvoxamine and highlight fluoxetine as a possible alternative to SSRIs for the treatment of COVID-19. DISCUSSION Fluvoxamine remains a candidate pharmacotherapy for treating COVID-19 in outpatients. Medium-dose fluvoxamine may be preferable over low-dose fluvoxamine.
Collapse
|
|
15
|
SARS-CoV-2 Spike Protein Induces Hemagglutination: Implications for COVID-19 Morbidities and Therapeutics and for Vaccine Adverse Effects. Int J Mol Sci 2022; 23:ijms232415480. [PMID: 36555121 PMCID: PMC9779393 DOI: 10.3390/ijms232415480] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/02/2022] [Accepted: 12/03/2022] [Indexed: 12/13/2022] Open
Abstract
Experimental findings for SARS-CoV-2 related to the glycan biochemistry of coronaviruses indicate that attachments from spike protein to glycoconjugates on the surfaces of red blood cells (RBCs), other blood cells and endothelial cells are key to the infectivity and morbidity of COVID-19. To provide further insight into these glycan attachments and their potential clinical relevance, the classic hemagglutination (HA) assay was applied using spike protein from the Wuhan, Alpha, Delta and Omicron B.1.1.529 lineages of SARS-CoV-2 mixed with human RBCs. The electrostatic potential of the central region of spike protein from these four lineages was studied through molecular modeling simulations. Inhibition of spike protein-induced HA was tested using the macrocyclic lactone ivermectin (IVM), which is indicated to bind strongly to SARS-CoV-2 spike protein glycan sites. The results of these experiments were, first, that spike protein from these four lineages of SARS-CoV-2 induced HA. Omicron induced HA at a significantly lower threshold concentration of spike protein than the three prior lineages and was much more electropositive on its central spike protein region. IVM blocked HA when added to RBCs prior to spike protein and reversed HA when added afterward. These results validate and extend prior findings on the role of glycan bindings of viral spike protein in COVID-19. They furthermore suggest therapeutic options using competitive glycan-binding agents such as IVM and may help elucidate rare serious adverse effects (AEs) associated with COVID-19 mRNA vaccines, which use spike protein as the generated antigen.
Collapse
|
|
16
|
Ceramella J, Iacopetta D, Sinicropi MS, Andreu I, Mariconda A, Saturnino C, Giuzio F, Longo P, Aquaro S, Catalano A. Drugs for COVID-19: An Update. Molecules 2022; 27:8562. [PMID: 36500655 PMCID: PMC9740261 DOI: 10.3390/molecules27238562] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was the seventh known human coronavirus, and it was identified in Wuhan, Hubei province, China, in 2020. It caused the highly contagious disease called coronavirus disease 2019 (COVID-19), declared a global pandemic by the World Health Organization (WHO) on 11 March 2020. A great number of studies in the search of new therapies and vaccines have been carried out in these three long years, producing a series of successes; however, the need for more effective vaccines, therapies and other solutions is still being pursued. This review represents a tracking shot of the current pharmacological therapies used for the treatment of COVID-19.
Collapse
Affiliation(s)
- Jessica Ceramella
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, 87036 Rende, Italy
| | - Domenico Iacopetta
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, 87036 Rende, Italy
| | - Maria Stefania Sinicropi
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, 87036 Rende, Italy
| | - Inmaculada Andreu
- Departamento de Química, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain
- Unidad Mixta de Investigación UPV-IIS La Fe, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell 106, 46026 Valencia, Spain
| | | | - Carmela Saturnino
- Department of Science, University of Basilicata, 85100 Potenza, Italy
| | - Federica Giuzio
- Department of Science, University of Basilicata, 85100 Potenza, Italy
| | - Pasquale Longo
- Department of Chemistry and Biology, University of Salerno, Via Giovanni Paolo II, 132, 84084 Fisciano, Italy
| | - Stefano Aquaro
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Arcavacata di Rende, 87036 Rende, Italy
| | - Alessia Catalano
- Department of Pharmacy-Drug Sciences, University of Bari “Aldo Moro”, 70126 Bari, Italy
| |
Collapse
|
|
17
|
Why Are We Still Talking about Ivermectin? Editorial Note on Stone et al. Changes in SpO2 on Room Air for 34 Severe COVID-19 Patients after Ivermectin-Based Combination Treatment. Biologics 2022. [DOI: 10.3390/biologics2030016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this issue of Biologics, we publish an article describing a surprising clinical effect of the anti-helminthic drug ivermectin on patients with COVID-19 [...]
Collapse
|