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Gottlieb RL, Kalil AC. True DisCoVeRy of COVID-19 Disease Burden Versus Speculated Antiviral Cardiovascular Risk Requires a Control Group. Clin Infect Dis 2024; 79:392-394. [PMID: 38552189 DOI: 10.1093/cid/ciae172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/28/2024] [Indexed: 08/17/2024] Open
Affiliation(s)
- Robert L Gottlieb
- Department of Internal Medicine, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas, USA
- Baylor Scott & White Research Institute, Dallas, Texas, USA
- Department of Internal Medicine, Burnett School of Medicine at Texas Christian University (TCU), Fort Worth, Texas, USA
- Department of Internal Medicine, Texas A&M Health Science Center, Dallas, Texas, USA
| | - Andre C Kalil
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
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2
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Molina KC, Webb BJ, Kennerley V, Beaty LE, Bennett TD, Carlson NE, Mayer DA, Peers JL, Russell S, Wynia MK, Aggarwal NR, Ginde AA. Real-world evaluation of early remdesivir in high-risk COVID-19 outpatients during Omicron including BQ.1/BQ.1.1/XBB.1.5. BMC Infect Dis 2024; 24:802. [PMID: 39118052 PMCID: PMC11312999 DOI: 10.1186/s12879-024-09708-z] [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: 09/02/2023] [Accepted: 08/02/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND A trial performed among unvaccinated, high-risk outpatients with COVID-19 during the delta period showed remdesivir reduced hospitalization. We used our real-world data platform to determine the effectiveness of remdesivir on reducing 28-day hospitalization among outpatients with mild-moderate COVID-19 during an Omicron period including BQ.1/BQ.1.1/XBB.1.5. METHODS We did a propensity-matched, retrospective cohort study of non-hospitalized adults with SARS-CoV-2 infection between April 7, 2022, and February 7, 2023. Electronic healthcare record data from a large health system in Colorado were linked to statewide vaccination and mortality data. We included patients with a positive SARS-CoV-2 test or outpatient remdesivir administration. Exclusion criteria were other SARS-CoV-2 treatments or positive SARS-CoV-2 test more than seven days before remdesivir. The primary outcome was all-cause hospitalization up to day 28. Secondary outcomes included 28-day COVID-related hospitalization and 28-day all-cause mortality. RESULTS Among 29,270 patients with SARS-CoV-2 infection, 1,252 remdesivir-treated patients were matched to 2,499 untreated patients. Remdesivir was associated with lower 28-day all-cause hospitalization (1.3% vs. 3.3%, adjusted hazard ratio (aHR) 0.39 [95% CI 0.23-0.67], p < 0.001) than no treatment. All-cause mortality at 28 days was numerically lower among remdesivir-treated patients (0.1% vs. 0.4%; aOR 0.32 [95% CI 0.03-1.40]). Similar benefit of RDV treatment on 28-day all-cause hospitalization was observed across Omicron periods, aOR (95% CI): BA.2/BA2.12.1 (0.77[0.19-2.41]), BA.4/5 (0.50[95% CI 0.50-1.01]), BQ.1/BQ.1.1/XBB.1.5 (0.21[95% CI 0.08-0.57]. CONCLUSION Among outpatients with SARS-CoV-2 during recent Omicron surges, remdesivir was associated with lower hospitalization than no treatment, supporting current National Institutes of Health Guidelines.
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Affiliation(s)
- Kyle C Molina
- Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E. 17th Ave, Aurora, CO, B-215, 80045, USA.
- Department of Pharmacy, Scripps Health, San Diego, CA, 92037, USA.
| | - Brandon J Webb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, 84130, USA
- Division of Infectious Diseases and Geographic Medicine, Stanford Medicine, Palo Alto, CA, 94305, USA
| | - Victoria Kennerley
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, 80045, USA
| | - Laurel E Beaty
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, 80045, USA
| | - Tellen D Bennett
- Departments of Biomedical Informatics and Pediatrics, Colorado Clinical and Translational Sciences Institute, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, 80045, USA
| | - Nichole E Carlson
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, 80045, USA
| | - David A Mayer
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, 80045, USA
| | - Jennifer L Peers
- Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E. 17th Ave, Aurora, CO, B-215, 80045, USA
| | - Seth Russell
- Department of Biomedical Informatics, School of Medicine, University of Colorado, University of Colorado Anschutz Medical Campus, Aurora, US
| | - Matthew K Wynia
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA
- Department of Health Systems Management and Policy, Colorado School of Public Health, University of Colorado Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, 80045, USA
| | - Neil R Aggarwal
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, 12401 E. 17th Ave, Aurora, CO, B-215, 80045, USA.
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3
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Platzer M, Totschnig D, Karolyi M, Clodi-Seitz T, Wenisch C, Zoufaly A. The effect of early remdesivir administration in COVID-19 disease progression in hospitalised patients. Wien Klin Wochenschr 2024; 136:458-464. [PMID: 38884783 PMCID: PMC11327179 DOI: 10.1007/s00508-024-02377-7] [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: 12/22/2023] [Accepted: 04/22/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Antiviral drugs have become crucial in managing COVID-19, reducing complications and mortality. Remdesivir has emerged as an effective therapeutic drug for hospitalized patients at risk of disease progression, especially when alternative treatments are infeasible. While the recommended treatment duration of remdesivir extends up to 7 days post-symptom onset, this study examines how early remdesivir administration impacts clinical outcomes. METHODS We conducted a retrospective analysis using clinical data from consecutively PCR confirmed SARS-CoV‑2 adult patients (≥ 18 years) who received remdesivir during their hospitalization at the department of infectious diseases, Klinik Favoriten in Vienna. The data covered the period from July 1, 2021, to April 31, 2022. Patients were divided into two groups based on the timing of remdesivir administration: an early group (0-3 days since symptom onset) and a late group (≥ 4 days since symptom onset). The primary outcome was in-hospital disease progression, assessed using the WHO COVID-19 Clinical Progression Scale (≥ 1 point increase). Multivariable logistic regression, adjusted for age, sex, SARS-CoV‑2 variant, and COVID-19 vaccination status, was used to assess clinical outcomes. RESULTS In total 219 patients were included of whom 148 (67.6%) were in the early group and 71 (32.4%) were in the late group. The average age was 66.5 (SD: 18.0) years, 68.9% of the patients were vaccinated, and 72.6% had the Omicron virus variant. Late remdesivir administration was associated with a significantly higher probability of needing high-flow oxygen therapy (OR 2.52, 95% CI 1.40-4.52, p = 0.002) and ICU admission (OR 4.34, 95% CI 1.38-13.67, p = 0.012) after adjusting for confounders. In the late group there was a trend towards a higher risk of clinical worsening (OR 2.13, 95% CI 0.98-4.64, p = 0.056) and need for any oxygen therapy (OR 1.85, 95% CI 0.94-3.64, p = 0.074). CONCLUSION Compared to patients who received remdesivir within the first 3 days after symptom onset, administering remdesivir after day 3 in hospitalized COVID-19 patients is associated with higher risk for complications, such as the need for high-flow oxygen therapy and ICU admission.
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Affiliation(s)
- Moritz Platzer
- 4. Med. Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Wiener Gesundheitsverbund, Vienna, Austria
| | - David Totschnig
- 4. Med. Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Wiener Gesundheitsverbund, Vienna, Austria
| | - Mario Karolyi
- 4. Med. Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Wiener Gesundheitsverbund, Vienna, Austria
| | - Tamara Clodi-Seitz
- 4. Med. Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Wiener Gesundheitsverbund, Vienna, Austria
| | - Christoph Wenisch
- 4. Med. Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Wiener Gesundheitsverbund, Vienna, Austria
| | - Alexander Zoufaly
- 4. Med. Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Wiener Gesundheitsverbund, Vienna, Austria.
- Faculty of Medicine, Sigmund Freud University, Vienna, Austria.
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4
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Chung YS, Lam CY, Tan PH, Tsang HF, Wong SCC. Comprehensive Review of COVID-19: Epidemiology, Pathogenesis, Advancement in Diagnostic and Detection Techniques, and Post-Pandemic Treatment Strategies. Int J Mol Sci 2024; 25:8155. [PMID: 39125722 PMCID: PMC11312261 DOI: 10.3390/ijms25158155] [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: 06/14/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
At present, COVID-19 remains a public health concern due to the ongoing evolution of SARS-CoV-2 and its prevalence in particular countries. This paper provides an updated overview of the epidemiology and pathogenesis of COVID-19, with a focus on the emergence of SARS-CoV-2 variants and the phenomenon known as 'long COVID'. Meanwhile, diagnostic and detection advances will be mentioned. Though many inventions have been made to combat the COVID-19 pandemic, some outstanding ones include multiplex RT-PCR, which can be used for accurate diagnosis of SARS-CoV-2 infection. ELISA-based antigen tests also appear to be potential diagnostic tools to be available in the future. This paper also discusses current treatments, vaccination strategies, as well as emerging cell-based therapies for SARS-CoV-2 infection. The ongoing evolution of SARS-CoV-2 underscores the necessity for us to continuously update scientific understanding and treatments for it.
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Affiliation(s)
| | | | | | | | - Sze-Chuen Cesar Wong
- Department of Applied Biology & Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, China; (Y.-S.C.); (C.-Y.L.); (P.-H.T.); (H.-F.T.)
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5
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Zeng Z, Li F, Zhong M, Zhu L, Chen W, Wang X. Effectiveness of the antiviral medications azvudine and nirmatrelvir-ritonavir in treating COVID-19 in patients with hematological malignancies. Clinics (Sao Paulo) 2024; 79:100406. [PMID: 39059144 DOI: 10.1016/j.clinsp.2024.100406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/22/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Patients with Hematological Malignancies (HM) are at a high risk of mortality from Coronavirus disease 2019 (COVID-19). The available antivirals were different between China and other countries. In China, azvudine was obtained for emergency use to treat adult COVID-19 patients with moderate symptoms in July 2022. While nirmatrelvir-ritonavir was well-known and used in many countries. The purpose of the present study was to assess whether there was any difference in the efficacy and safety of the two drugs. METHODS This study was a prospective observational study of patients with HM who developed COVID-19. Patients were divided into three treatment groups: nirmatrelvir-ritonavir, azvudine, and observation. Treatment outcomes, first nucleic acid test negative time, hospitalization time, and the conversion rate of mild or moderate disease to severe disease were recorded. RESULTS First nucleic acid test negative time (23.5 days vs. 34 days, p = 0.015), hospitalization time (p = 0.015), and conversion rate (31.8 % vs. 8 %, p = 0.046) were statistically different between the nirmatrelvir-ritonavir and observation groups. First nucleic acid test negative time (20 days vs. 34 days, p = 0.009) and hospitalization time (p = 0.026) were statistically different between the azvudine and observation groups. ECOG score and liver disease were significantly associated with the conversion rate from mild or moderate disease to severe disease using multivariate analysis (p < 0.05). CONCLUSIONS The authors found no significant differences existed in outcome measures between patients with HM and COVID-19 who were treated with nirmatrelvir-ritonavir or azvudine.
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Affiliation(s)
- Zheng Zeng
- Department of Pharmacy, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Fangyuan Li
- School of Pharmacy, Guilin Medical University, Guilin, China
| | - Mingli Zhong
- School of Pharmacy, Guilin Medical University, Guilin, China
| | - Ling Zhu
- Department of Pharmacy, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Wei Chen
- Department of Pharmacy, Affiliated Hospital of Guilin Medical University, Guilin, China.
| | - Xiaotao Wang
- Department of Hematology, Affiliated Hospital of Guilin Medical University, Guilin, China
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Dampalla CS, Kim Y, Zabiegala A, Howard DJ, Nguyen HN, Madden TK, Thurman HA, Cooper A, Liu L, Battaile KP, Lovell S, Chang KO, Groutas WC. Structure-Guided Design of Potent Coronavirus Inhibitors with a 2-Pyrrolidone Scaffold: Biochemical, Crystallographic, and Virological Studies. J Med Chem 2024; 67:11937-11956. [PMID: 38953866 DOI: 10.1021/acs.jmedchem.4c00551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
Zoonotic coronaviruses are known to produce severe infections in humans and have been the cause of significant morbidity and mortality worldwide. SARS-CoV-2 was the largest and latest contributor of fatal cases, even though MERS-CoV has the highest case-fatality ratio among zoonotic coronaviruses. These infections pose a high risk to public health worldwide warranting efforts for the expeditious discovery of antivirals. Hence, we hereby describe a novel series of inhibitors of coronavirus 3CLpro embodying an N-substituted 2-pyrrolidone scaffold envisaged to exploit favorable interactions with the S3-S4 subsites and connected to an invariant Leu-Gln P2-P1 recognition element. Several inhibitors showed nanomolar antiviral activity in enzyme and cell-based assays, with no significant cytotoxicity. High-resolution crystal structures of inhibitors bound to the 3CLpro were determined to probe and identify the molecular determinants associated with binding, to inform the structure-guided optimization of the inhibitors, and to confirm the mechanism of action of the inhibitors.
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Affiliation(s)
- Chamandi S Dampalla
- Department of Chemistry and Biochemistry, Wichita State University, Wichita, Kansas 67260, United States
| | - Yunjeong Kim
- Department of Diagnostic Medicine & Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas 66506, United States
| | - Alexandria Zabiegala
- Department of Diagnostic Medicine & Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas 66506, United States
| | - Dennis J Howard
- Department of Chemistry and Biochemistry, Wichita State University, Wichita, Kansas 67260, United States
| | - Harry Nhat Nguyen
- Department of Chemistry and Biochemistry, Wichita State University, Wichita, Kansas 67260, United States
| | - Trent K Madden
- Department of Chemistry and Biochemistry, Wichita State University, Wichita, Kansas 67260, United States
| | - Hayden A Thurman
- Department of Chemistry and Biochemistry, Wichita State University, Wichita, Kansas 67260, United States
| | - Anne Cooper
- Protein Structure and X-ray Crystallography Laboratory, The University of Kansas, Lawrence, Kansas 66047, United States
| | - Lijun Liu
- Protein Structure and X-ray Crystallography Laboratory, The University of Kansas, Lawrence, Kansas 66047, United States
| | - Kevin P Battaile
- NYX, New York Structural Biology Center, Upton, New York 11973, United States
| | - Scott Lovell
- Protein Structure and X-ray Crystallography Laboratory, The University of Kansas, Lawrence, Kansas 66047, United States
| | - Kyeong-Ok Chang
- Department of Diagnostic Medicine & Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas 66506, United States
| | - William C Groutas
- Department of Chemistry and Biochemistry, Wichita State University, Wichita, Kansas 67260, United States
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Zou X, Chang K, Fan G, Zheng H, Shen H, Tang L, Yang Y, Wang Y, Zhao L, Lv H, Zhou X, Shen X, Chen L, Tong X, Cao B. Effectiveness and safety of Sanhan Huashi granules versus nirmatrelvir-ritonavir in adult patients with COVID-19: A randomized, open-label, multicenter trial. Sci Bull (Beijing) 2024; 69:1954-1963. [PMID: 38749859 DOI: 10.1016/j.scib.2024.04.040] [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: 12/14/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 07/01/2024]
Abstract
Sanhan Huashi granules (SHG) demonstrated therapeutic effects against coronavirus disease 2019 (COVID-19) in observational studies. In order to compare the effectiveness and safety of SHG and nirmatrelvir-ritonavir in treating adults with mild-to-moderate COVID-19, we conducted a randomized, active-controlled, open-label, multi-center trial conducted between February and July in 2023. The patients were randomized in a 1:1 ratio to the SHG group and the nirmatrelvir-ritonavir group. A total of 400 participants were randomized, among which 200 participants ultimately received SHG and 198 received nirmatrelvir-ritonavir. The primary outcome was time to sustained clinical recovery through day 28. SHG significantly shortened the median time to sustained clinical recovery compared to nirmatrelvir-ritonavir (6.0 (95% CI, 5.0 to 6.0) vs. 8.0 (95% CI, 6.0 to 9.0) d; P = 0.001), particularly for individual symptoms including fever, sore throat, cough and fatigue. No participants in either group died and incidence of severe COVID-19 showed no difference between two groups. Participants who received nirmatrelvir-ritonavir demonstrated a higher rate of virus clearance on day 5 compared to those received SHG (46.4% (95% CI, 39.1 to 53.7) vs. 65.6% (95% CI, 58.3 to 72.4); P < 0.001). Most adverse events were mild in both groups. In summary, SHG was superior to nirmatrelvir-ritonavir in shortening the time to sustained clinical recovery in participants with mild-to-moderate COVID-19, despite a lower virus clearance rate observed after 5 d of treatment (Chinese Clinical Trial Registry Identifier: ChiCTR2300067872).
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Affiliation(s)
- Xiaohui Zou
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Kang Chang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Guohui Fan
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Clinical Research and Data Management Center of Respiratory Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Huanwei Zheng
- Shijiazhuang Hospital of Traditional Chinese Medicine, Shijiazhuang 050051, China
| | - Hezheng Shen
- Linyi Traditional Chinese Medicine Hospital, Linyi 276000, China
| | - Liang Tang
- Wuxi Traditional Chinese Medicine Hospital, Wuxi 214071, China
| | - Yingying Yang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Traditional Chinese Medicine for Pulmonary Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yeming Wang
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Linhua Zhao
- Institute of Metabolic Diseases, Guang'anmen Hospital of China, Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Hong Lv
- Taicang Traditional Chinese Medicine Hospital, Taicang 215400, China
| | - Xin Zhou
- The First Hospital of Qiqihar, Qiqihar 161005, China
| | - Xiaoming Shen
- The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, China
| | | | - Xiaolin Tong
- Institute of Metabolic Diseases, Guang'anmen Hospital of China, Academy of Chinese Medical Sciences, Beijing 100053, China; National Center for Integrated Traditional Chinese Medicine and Western Medicine, China-Japan Friendship Hospital, Beijing 100029, China.
| | - Bin Cao
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, China.
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8
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Li X, Mi Z, Liu Z, Rong P. SARS-CoV-2: pathogenesis, therapeutics, variants, and vaccines. Front Microbiol 2024; 15:1334152. [PMID: 38939189 PMCID: PMC11208693 DOI: 10.3389/fmicb.2024.1334152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 05/29/2024] [Indexed: 06/29/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in December 2019 with staggering economic fallout and human suffering. The unique structure of SARS-CoV-2 and its underlying pathogenic mechanism were responsible for the global pandemic. In addition to the direct damage caused by the virus, SARS-CoV-2 triggers an abnormal immune response leading to a cytokine storm, culminating in acute respiratory distress syndrome and other fatal diseases that pose a significant challenge to clinicians. Therefore, potential treatments should focus not only on eliminating the virus but also on alleviating or controlling acute immune/inflammatory responses. Current management strategies for COVID-19 include preventative measures and supportive care, while the role of the host immune/inflammatory response in disease progression has largely been overlooked. Understanding the interaction between SARS-CoV-2 and its receptors, as well as the underlying pathogenesis, has proven to be helpful for disease prevention, early recognition of disease progression, vaccine development, and interventions aimed at reducing immunopathology have been shown to reduce adverse clinical outcomes and improve prognosis. Moreover, several key mutations in the SARS-CoV-2 genome sequence result in an enhanced binding affinity to the host cell receptor, or produce immune escape, leading to either increased virus transmissibility or virulence of variants that carry these mutations. This review characterizes the structural features of SARS-CoV-2, its variants, and their interaction with the immune system, emphasizing the role of dysfunctional immune responses and cytokine storm in disease progression. Additionally, potential therapeutic options are reviewed, providing critical insights into disease management, exploring effective approaches to deal with the public health crises caused by SARS-CoV-2.
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Affiliation(s)
- Xi Li
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Ze Mi
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhenguo Liu
- Department of Infectious Disease, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Pengfei Rong
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, China
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Focosi D, Franchini M, Maggi F, Shoham S. COVID-19 therapeutics. Clin Microbiol Rev 2024; 37:e0011923. [PMID: 38771027 PMCID: PMC11237566 DOI: 10.1128/cmr.00119-23] [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] [Indexed: 05/22/2024] Open
Abstract
SUMMARYSince the emergence of COVID-19 in 2020, an unprecedented range of therapeutic options has been studied and deployed. Healthcare providers have multiple treatment approaches to choose from, but efficacy of those approaches often remains controversial or compromised by viral evolution. Uncertainties still persist regarding the best therapies for high-risk patients, and the drug pipeline is suffering fatigue and shortage of funding. In this article, we review the antiviral activity, mechanism of action, pharmacokinetics, and safety of COVID-19 antiviral therapies. Additionally, we summarize the evidence from randomized controlled trials on efficacy and safety of the various COVID-19 antivirals and discuss unmet needs which should be addressed.
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Affiliation(s)
- Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, Pisa, Italy
| | - Massimo Franchini
- Division of Hematology and Transfusion Medicine, Carlo Poma Hospital, Mantua, Italy
| | - Fabrizio Maggi
- National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Shmuel Shoham
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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10
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Li H, Li J, Li J, Li H, Wang X, Jiang J, Lei L, Sun H, Tang M, Dong B, He W, Si S, Hong B, Li Y, Song D, Peng Z, Che Y, Jiang JD. Carrimycin inhibits coronavirus replication by decreasing the efficiency of programmed -1 ribosomal frameshifting through directly binding to the RNA pseudoknot of viral frameshift-stimulatory element. Acta Pharm Sin B 2024; 14:2567-2580. [PMID: 38828157 PMCID: PMC11143517 DOI: 10.1016/j.apsb.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/08/2024] [Accepted: 02/04/2024] [Indexed: 06/05/2024] Open
Abstract
The pandemic of SARS-CoV-2 worldwide with successive emerging variants urgently calls for small-molecule oral drugs with broad-spectrum antiviral activity. Here, we show that carrimycin, a new macrolide antibiotic in the clinic and an antiviral candidate for SARS-CoV-2 in phase III trials, decreases the efficiency of programmed -1 ribosomal frameshifting of coronaviruses and thus impedes viral replication in a broad-spectrum fashion. Carrimycin binds directly to the coronaviral frameshift-stimulatory element (FSE) RNA pseudoknot, interrupting the viral protein translation switch from ORF1a to ORF1b and thereby reducing the level of the core components of the viral replication and transcription complexes. Combined carrimycin with known viral replicase inhibitors yielded a synergistic inhibitory effect on coronaviruses. Because the FSE mechanism is essential in all coronaviruses, carrimycin could be a new broad-spectrum antiviral drug for human coronaviruses by directly targeting the conserved coronaviral FSE RNA. This finding may open a new direction in antiviral drug discovery for coronavirus variants.
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Affiliation(s)
- Hongying Li
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Jianrui Li
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
- Beijing Key Laboratory of Antimicrobial Agents, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Jiayu Li
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Hu Li
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
- Key Laboratory of Biotechnology of Antibiotics, the National Health and Family Planning Commission (NHFPC), Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Xuekai Wang
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Jing Jiang
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Lei Lei
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Han Sun
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Mei Tang
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Biao Dong
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
- Key Laboratory of Biotechnology of Antibiotics, the National Health and Family Planning Commission (NHFPC), Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Weiqing He
- Key Laboratory of Biotechnology of Antibiotics, the National Health and Family Planning Commission (NHFPC), Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Shuyi Si
- Key Laboratory of Biotechnology of Antibiotics, the National Health and Family Planning Commission (NHFPC), Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Bin Hong
- Key Laboratory of Biotechnology of Antibiotics, the National Health and Family Planning Commission (NHFPC), Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Yinghong Li
- Beijing Key Laboratory of Antimicrobial Agents, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Danqing Song
- Beijing Key Laboratory of Antimicrobial Agents, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Zonggen Peng
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
- Beijing Key Laboratory of Antimicrobial Agents, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
- Key Laboratory of Biotechnology of Antibiotics, the National Health and Family Planning Commission (NHFPC), Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Yongsheng Che
- Key Laboratory of Biotechnology of Antibiotics, the National Health and Family Planning Commission (NHFPC), Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
| | - Jian-Dong Jiang
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
- Beijing Key Laboratory of Antimicrobial Agents, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
- Key Laboratory of Biotechnology of Antibiotics, the National Health and Family Planning Commission (NHFPC), Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, China
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11
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Chavda V, Dodiya P, Apostolopoulos V. Adverse drug reactions associated with COVID-19 management. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024:10.1007/s00210-024-03137-0. [PMID: 38743117 DOI: 10.1007/s00210-024-03137-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/30/2024] [Indexed: 05/16/2024]
Abstract
The emergence of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) outbreak, which causes COVID-19, had a devastating impact on both people's lives and the global economy. During the course of the pandemic, the lack of specific drugs or treatments tailored for COVID-19 led to extensive repurposing of existing drugs in the pursuit of effective treatments. Some drug molecules demonstrated efficacy, while others proved ineffective. In this context, the approach of drug repurposing emerged as a novel strategy for combating COVID-19. Repurposed drugs and biologics have shown effectiveness, leading to improved clinical outcomes among patients with COVID-19. Similarly, It is equally important to assess the risk-benefit ratio associated with drugs and biologics adapted for COVID-19 treatment. Herein, we primarily focus on evaluating adverse drug events linked to repurposed COVID-19 medications, repurposed biologics, and COVID-specific drug molecules.
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Affiliation(s)
- Vivek Chavda
- Department of Pharmaceutics and Pharmaceutical Technology, L. M. College of Pharmacy, Ahmedabad, 380009, Gujarat, India.
| | - Payal Dodiya
- Department of Pharmaceutics and Pharmaceutical Technology, L. M. College of Pharmacy, Ahmedabad, 380009, Gujarat, India
| | - Vasso Apostolopoulos
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia.
- Australian Institute for Musculoskeletal Science, Melbourne, VIC, Australia.
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12
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Soriano V, Moreno-Torres V. Oral antivirals for acute symptoms and post-acute sequelae in SARS-CoV-2 infection. THE LANCET. INFECTIOUS DISEASES 2024:S1473-3099(24)00258-5. [PMID: 38710191 DOI: 10.1016/s1473-3099(24)00258-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 05/08/2024]
Affiliation(s)
- Vicente Soriano
- UNIR Health Sciences School and Medical Center, Universidad Internacional de La Rioja, Madrid 28010, Spain.
| | - Víctor Moreno-Torres
- UNIR Health Sciences School and Medical Center, Universidad Internacional de La Rioja, Madrid 28010, Spain; Department of Internal Medicine, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
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13
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Lu H, Zhang G, Mao J, Chen X, Zhan Y, Lin L, Zhang T, Tang Y, Lin F, Zhu F, Lin Y, Zeng Y, Zhang K, Yuan W, Liang Z, Sun R, Huo L, Hu P, Lin Y, Zhuang X, Wei Z, Chen X, Yan W, Yan X, Mu L, Lin Z, Tu X, Tan H, Huang F, Hu Z, Li H, Li G, Fu H, Yang Z, Chen X, Wang FS, Zhong N. Efficacy and safety of GST-HG171 in adult patients with mild to moderate COVID-19: a randomised, double-blind, placebo-controlled phase 2/3 trial. EClinicalMedicine 2024; 71:102582. [PMID: 38618202 PMCID: PMC11015484 DOI: 10.1016/j.eclinm.2024.102582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 04/16/2024] Open
Abstract
Background GST-HG171 is a potent, broad-spectrum, orally bioavailable small-molecule 3C like protease inhibitor that has demonstrated greater potency and efficacy compared to Nirmatrelvir in pre-clinical studies. We aimed to evaluate the efficacy and safety of orally administered GST-HG171 plus Ritonavir in patients with coronavirus disease 2019 (COVID-19) infected with emerging XBB and non-XBB variants. Methods This randomised, double-blind, placebo-controlled phase 2/3 trial was conducted in 47 sites in China among adult patients with mild-to-moderate COVID-19 with symptoms onset ≤72 h. Eligible patients were randomised 1:1 to receive GST-HG171 (150 mg) plus Ritonavir (100 mg) or corresponding placebo tablets twice daily for 5 days, with stratification factors including the risk level of disease progression and vaccination status. The primary efficacy endpoint was time to sustained recovery of clinical symptoms within 28 days, defined as a score of 0 for 11 COVID-19-related target symptoms for 2 consecutive days, assessed in the modified intention-to-treat (mITT) population. This trial was registered at ClinicalTrials.gov (NCT05656443) and Chinese Clinical Trial Registry (ChiCTR2200067088). Findings Between Dec 19, 2022, and May 4, 2023, 1525 patients were screened. Among 1246 patients who underwent randomisation, most completed basic (21.2%) or booster (74.9%) COVID-19 immunization, and most had a low risk of disease progression at baseline. 610 of 617 who received GST-HG171 plus Ritonavir and 603 of 610 who received placebo were included in the mITT population. Patients who received GST-HG171 plus Ritonavir showed shortened median time to sustained recovery of clinical symptoms compared to the placebo group (13.0 days [95.45% confidence interval 12.0-15.0] vs. 15.0 days [14.0-15.0], P = 0.031). Consistent results were observed in both SARS-CoV-2 XBB (45.7%, 481/1053 of mITT population) and non-XBB variants (54.3%, 572/1053 of mITT population) subgroups. Incidence of adverse events was similar in the GST-HG171 plus Ritonavir (320/617, 51.9%) and placebo group (298/610, 48.9%). The most common adverse events in both placebo and treatment groups were hypertriglyceridaemia (10.0% vs. 14.7%). No deaths occurred. Interpretation Treatment with GST-HG171 plus Ritonavir has demonstrated benefits in symptom recovery and viral clearance among low-risk vaccinated adult patients with COVID-19, without apparent safety concerns. As most patients were treated within 2 days after symptom onset in our study, confirming the potential benefits of symptom recovery for patients with a longer duration between symptom onset and treatment initiation will require real-world studies. Funding Fujian Akeylink Biotechnology Co., Ltd.
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Affiliation(s)
- Hongzhou Lu
- The Third People's Hospital of Shenzhen, Shenzhen, China
- National Clinical Research Center for Infectious Diseases, Shenzhen, China
| | - George Zhang
- Fujian Akeylink Biotechnology Co., Ltd., Shanghai, China
| | - John Mao
- Fujian Akeylink Biotechnology Co., Ltd., Shanghai, China
| | | | - Yangqing Zhan
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Ling Lin
- Sanya Central Hospital (The Third People's Hospital of Hainan Province), Sanya, China
| | | | - Yanan Tang
- Fujian Akeylink Biotechnology Co., Ltd., Shanghai, China
| | - Feng Lin
- Hainan General Hospital, Haikou, China
| | | | - Yuanlong Lin
- The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Yiming Zeng
- Fujian Medical University 2nd Affiliated Hospital, Fuzhou, China
| | - Kaiyu Zhang
- The First Hospital of Jilin University, Changchun, China
| | - Wenfang Yuan
- Shijiazhuang Fifth Hospital, Shijiazhuang, China
| | - Zhenyu Liang
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Ruilin Sun
- Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Liya Huo
- Nanyang Central Hospital, Nanyang, China
| | - Peng Hu
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yihua Lin
- The First Affiliated Hospital of Xiamen University, Xiamen, China
| | | | | | | | - Wenhao Yan
- Fujian Akeylink Biotechnology Co., Ltd., Shanghai, China
| | - Xiuping Yan
- Fujian Akeylink Biotechnology Co., Ltd., Shanghai, China
| | | | | | | | - Hongshan Tan
- Fujian Akeylink Biotechnology Co., Ltd., Shanghai, China
| | - Fuhu Huang
- Fujian Cosunter Pharmaceutical Co., Ltd., Fuzhou, China
| | - Zhiqiang Hu
- Fujian Cosunter Pharmaceutical Co., Ltd., Fuzhou, China
| | - Hongming Li
- Fujian Cosunter Pharmaceutical Co., Ltd., Fuzhou, China
| | - Guoping Li
- Fujian Cosunter Pharmaceutical Co., Ltd., Fuzhou, China
| | - Haijun Fu
- Shanghai Zenith Medical Research Co., Ltd., Shanghai, China
| | - Zifeng Yang
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Xinwen Chen
- Guangzhou National Laboratory, Guangdong Province, China
| | - Fu-Sheng Wang
- The Fifth Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, China
| | - Nanshan Zhong
- The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
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Smith DRM, Duval A, Grant R, Abbas M, Harbarth S, Opatowski L, Temime L. Predicting consequences of COVID-19 control measure de-escalation on nosocomial transmission and mortality: a modelling study in a French rehabilitation hospital. J Hosp Infect 2024; 147:47-55. [PMID: 38467250 DOI: 10.1016/j.jhin.2024.02.020] [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: 10/30/2023] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Infection control measures are effective for nosocomial COVID-19 prevention but bear substantial health-economic costs, motivating their "de-escalation" in settings at low risk of SARS-CoV-2 transmission. Yet consequences of de-escalation are difficult to predict, particularly in light of novel variants and heterogeneous population immunity. AIM To estimate how infection control measure de-escalation influences nosocomial COVID-19 risk. METHODS An individual-based transmission model was used to simulate SARS-CoV-2 outbreaks and control measure de-escalation in a French long-term care hospital with multi-modal control measures in place (testing and isolation, universal masking, single-occupant rooms). Estimates of COVID-19 case fatality rates (CFRs) from reported outbreaks were used to quantify excess COVID-19 mortality due to de-escalation. RESULTS In a population fully susceptible to infection, de-escalating both universal masking and single rooms resulted in hospital-wide outbreaks of 114 (95% CI: 103-125) excess infections, compared with five (three to seven) excess infections when de-escalating only universal masking or 15 (11-18) when de-escalating only single rooms. When de-escalating both measures and applying CFRs from the first wave of COVID-19, excess patient mortality ranged from 1.57 (1.41-1.71) to 9.66 (8.73-10.57) excess deaths/1000 patient-days. By contrast, when applying CFRs from subsequent pandemic waves and assuming susceptibility to infection among 40-60% of individuals, excess mortality ranged from 0 (0-0) to 0.92 (0.77-1.07) excess deaths/1000 patient-days. CONCLUSIONS The de-escalation of bundled COVID-19 control measures may facilitate widespread nosocomial SARS-CoV-2 transmission. However, excess mortality is probably limited in populations at least moderately immune to infection and given CFRs resembling those estimated during the 'post-vaccine' era.
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Affiliation(s)
- D R M Smith
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - A Duval
- Epidemiology & Modelling of Antibiotic Evasion, Institut Pasteur, Université Paris-Cité, Paris, France; Anti-Infective Evasion & Pharmacoepidemiology, Université Paris-Saclay, UVSQ, INSERM, CESP, Montigny-Le-Bretonneux, France; Laboratoire MESuRS, Conservatoire National des Arts et Métiers, Paris, France
| | - R Grant
- Faculty of Medicine, University of Geneva, Geneva, Switzerland; Infection Control Programme & WHO Collaborating Centre on Infection Prevention and Control and Antimicrobial Resistance, Geneva University Hospitals, Geneva, Switzerland
| | - M Abbas
- Faculty of Medicine, University of Geneva, Geneva, Switzerland; Infection Control Programme & WHO Collaborating Centre on Infection Prevention and Control and Antimicrobial Resistance, Geneva University Hospitals, Geneva, Switzerland; MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - S Harbarth
- Faculty of Medicine, University of Geneva, Geneva, Switzerland; Infection Control Programme & WHO Collaborating Centre on Infection Prevention and Control and Antimicrobial Resistance, Geneva University Hospitals, Geneva, Switzerland
| | - L Opatowski
- Epidemiology & Modelling of Antibiotic Evasion, Institut Pasteur, Université Paris-Cité, Paris, France; Anti-Infective Evasion & Pharmacoepidemiology, Université Paris-Saclay, UVSQ, INSERM, CESP, Montigny-Le-Bretonneux, France
| | - L Temime
- Laboratoire MESuRS, Conservatoire National des Arts et Métiers, Paris, France
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15
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Quercia R, Di Perri G, Pein C, Bodie J, Singh RSP, Hendrick V, Boffito M. Ritonavir: 25 Years' Experience of Concomitant Medication Management. A Narrative Review. Infect Dis Ther 2024; 13:1005-1017. [PMID: 38609668 PMCID: PMC11098990 DOI: 10.1007/s40121-024-00959-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/08/2024] [Indexed: 04/14/2024] Open
Abstract
Ritonavir is a potent inhibitor of the cytochrome P450 3A4 enzyme and is commonly used as a pharmacokinetic (PK) enhancer in antiviral therapies because it increases bioavailability of concomitantly administered antivirals. Decades of experience with ritonavir-enhanced HIV therapies and, more recently, COVID-19 therapies demonstrate that boosting doses of ritonavir are well tolerated, with an established safety profile. The mechanisms of PK enhancement by ritonavir result in the potential for drug-drug interactions (DDIs) with several classes of drugs, thus making co-medication management an important consideration with enhanced antiviral therapies. However, rates of DDIs with contraindicated medications are low, suggesting these risks are manageable by infectious disease specialists who have experience with the use of PK enhancers. In this review, we provide an overview of ritonavir's mechanisms of action and describe approaches and resources available to mitigate adverse events and manage concomitant medication in both chronic and short-term settings.
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Affiliation(s)
- Romina Quercia
- Chief Medical Affairs Office, Pfizer Inc, New York City, NY, USA
| | | | - Carolina Pein
- Chief Medical Affairs Office, Pfizer Inc, New York City, NY, USA.
| | - Jennifer Bodie
- Chief Medical Affairs Office, Pfizer Inc, New York City, NY, USA
| | | | | | - Marta Boffito
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Infectious Diseases, Imperial College London, London, UK
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16
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Zheng Z, Zhou J, Song Y. Safety of RNA-Dependent RNA Polymerase Inhibitors, Molnupiravir and VV116, for Oral Treatment of COVID-19: A Meta-Analysis. IRANIAN JOURNAL OF MEDICAL SCIENCES 2024; 49:275-285. [PMID: 38751873 PMCID: PMC11091272 DOI: 10.30476/ijms.2024.99837.3196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/10/2023] [Accepted: 11/19/2023] [Indexed: 05/18/2024]
Abstract
Background The RNA-dependent RNA polymerase (RdRp) inhibitors, molnupiravir and VV116, have the potential to maximize clinical benefits in the oral treatment of COVID-19. Subjects who consume these drugs may experience an increased incidence of adverse events. This study aimed to evaluate the safety profile of molnupiravir and VV116. Methods A comprehensive search of scientific and medical databases, such as PubMed Central/Medline, Embase, Web of Science, and Cochrane Library, was conducted to find relevant articles in English from January 2020 to June 2023. Any kind of adverse events reported in the study were pooled and analyzed in the drug group versus the control group. Estimates of risk effects were summarized through the random effects model using Review Manager version 5.2, and sensitivity analysis was performed by Stata 17.0 software. Results Fifteen studies involving 32,796 subjects were included. Eleven studies were placebo-controlled, and four were Paxlovid-controlled. Twelve studies reported adverse events for molnupiravir, and three studies described adverse events for VV116. The total odds ratio (OR) for adverse events in the RdRp inhibitor versus the placebo-controlled group was 1.01 (95% CI=0.84-1.22; I2=26%), P=0.88. The total OR for adverse events in the RdRp inhibitor versus the Paxlovid-controlled group was 0.32 (95% CI=0.16-0.65; I2=87%), P=0.002. Individual drug subgroup analysis in the placebo-controlled study showed that compared with the placebo group, a total OR for adverse events was 0.97 (95% CI, 0.85-1.10; I2=0%) in the molnupiravir group and 3.77 (95% CI=0.08-175.77; I2=85%) in the VV116 group. Conclusion The RdRp inhibitors molnupiravir and VV116 are safe for oral treatment of COVID-19. Further evidence is necessary that RdRp inhibitors have a higher safety profile than Paxlovid.
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Affiliation(s)
- Zequn Zheng
- Ningbo Institute of Innovation for Combined Medicine and Engineering, Ningbo Medical Center Lihuili Hospital, Ningbo University, No. 378 Dongqing Road, Yinzhou District, Ningbo
- Department of Cardiology, Shantou University Medical College, Shantou University, Shantou, 515000, China
| | - Jiaozhi Zhou
- Department of Gastroenterology, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Yongfei Song
- Ningbo Institute of Innovation for Combined Medicine and Engineering, Ningbo Medical Center Lihuili Hospital, Ningbo University, No. 378 Dongqing Road, Yinzhou District, Ningbo
- School of Medicine, Ningbo University, Ningbo, 315211, Zhejiang, China
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17
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Chen Y, Li X, Han F, Ji B, Li Y, Yan J, Wang M, Fan J, Zhang S, Lu L, Zou P. The nucleoside analog 4'-fluorouridine suppresses the replication of multiple enteroviruses by targeting 3D polymerase. Antimicrob Agents Chemother 2024:e0005424. [PMID: 38687016 DOI: 10.1128/aac.00054-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/05/2024] [Indexed: 05/02/2024] Open
Abstract
Human enteroviruses are the major pathogens causing hand-foot-and-mouth disease in infants and young children throughout the world, and infection with enterovirus is also associated with severe complications, such as aseptic meningitis and myocarditis. However, there are no antiviral drugs available to treat enteroviruses infection at present. In this study, we found that 4'-fluorouridine (4'-FlU), a nucleoside analog with low cytotoxicity, exhibited broad-spectrum activity against infections of multiple enteroviruses with EC50 values at low micromolar levels, including coxsackievirus A10 (CV-A10), CV-A16, CV-A6, CV-A7, CV-B3, enterovirus A71 (EV-A71), EV-A89, EV-D68, and echovirus 6. With further investigation, the results indicated that 4'-FlU directly interacted with the RNA-dependent RNA polymerase of enterovirus, the 3D pol, and impaired the polymerase activity of 3D pol, hence inhibiting viral RNA synthesis and significantly suppressing viral replication. Our findings suggest that 4'-FlU could be promisingly developed as a broad-spectrum direct-acting antiviral agent for anti-enteroviruses therapy.
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Affiliation(s)
- Yongkang Chen
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), Shanghai Institute of Infectious Disease and Biosecurity, School of Basic Medical Sciences and Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Xiaohong Li
- Clinical Center for BioTherapy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fengyang Han
- Department of Pharmaceutical Sciences and Computational Chemical Genomics Screening Center, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Beihong Ji
- Department of Pharmaceutical Sciences and Computational Chemical Genomics Screening Center, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yuan Li
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), Shanghai Institute of Infectious Disease and Biosecurity, School of Basic Medical Sciences and Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Jingjing Yan
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), Shanghai Institute of Infectious Disease and Biosecurity, School of Basic Medical Sciences and Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Min Wang
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), Shanghai Institute of Infectious Disease and Biosecurity, School of Basic Medical Sciences and Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Jun Fan
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), Shanghai Institute of Infectious Disease and Biosecurity, School of Basic Medical Sciences and Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Shuye Zhang
- Clinical Center for BioTherapy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lu Lu
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), Shanghai Institute of Infectious Disease and Biosecurity, School of Basic Medical Sciences and Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Peng Zou
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), Shanghai Institute of Infectious Disease and Biosecurity, School of Basic Medical Sciences and Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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18
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Moser CB, Li JZ, Hughes MD. Oral Simnotrelvir for Adult Patients with Mild-to-Moderate Covid-19. N Engl J Med 2024; 390:1533-1534. [PMID: 38657253 PMCID: PMC11156227 DOI: 10.1056/nejmc2402378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
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19
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Choi HS, Choi AY, Kopp JB, Winkler CA, Cho SK. Review of COVID-19 Therapeutics by Mechanism: From Discovery to Approval. J Korean Med Sci 2024; 39:e134. [PMID: 38622939 PMCID: PMC11018982 DOI: 10.3346/jkms.2024.39.e134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/18/2024] [Indexed: 04/17/2024] Open
Abstract
The global research and pharmaceutical community rapidly mobilized to develop treatments for coronavirus disease 2019 (COVID-19). Existing treatments have been repurposed and new drugs have emerged. Here we summarize mechanisms and clinical trials of COVID-19 therapeutics approved or in development. Two reviewers, working independently, reviewed published data for approved COVID-19 vaccines and drugs, as well as developmental pipelines, using databases from the following organizations: United States Food and Drug Administration (US-FDA), European Medicines Agency (EMA), Japanese Pharmaceutical and Medical Devices Agency (PMDA), and ClinicalTrials.gov. In all, 387 drugs were found for initial review. After removing unrelated trials and drugs, 66 drugs were selected, including 17 approved drugs and 49 drugs under development. These drugs were classified into six categories: 1) drugs targeting the viral life cycle 2) Anti-severe acute respiratory syndrome coronavirus 2 Monoclonal Antibodies, 3) immunomodulators, 4) anti-coagulants, 5) COVID-19-induced neuropathy drugs, and 6) other therapeutics. Among the 49 drugs under development are the following: 6 drugs targeting the viral life cycle, 12 immunosuppression drugs, 2 immunostimulants, 2 HIF-PHD targeting drugs, 3 GM-CSF targeting drugs, 5 anti-coagulants, 2 COVID-19-induced neuropathy drugs, and 17 others. This review provides insight into mechanisms of action, properties, and indications for COVID-19 medications.
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Affiliation(s)
- Hee Sun Choi
- Department of Pharmacology, Ajou University School of Medicine, Suwon, Korea
| | - A Young Choi
- Department of Pharmacology, Ajou University School of Medicine, Suwon, Korea
| | - Jeffrey B Kopp
- Kidney Disease Section, Kidney Diseases, Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Cheryl A Winkler
- Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, Frederick, MD, USA
| | - Sung Kweon Cho
- Department of Pharmacology, Ajou University School of Medicine, Suwon, Korea
- Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, Frederick, MD, USA.
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20
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Meyerowitz EA, Li Y. Review: The Landscape of Antiviral Therapy for COVID-19 in the Era of Widespread Population Immunity and Omicron-Lineage Viruses. Clin Infect Dis 2024; 78:908-917. [PMID: 37949817 DOI: 10.1093/cid/ciad685] [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: 09/11/2023] [Revised: 11/01/2023] [Accepted: 11/08/2023] [Indexed: 11/12/2023] Open
Abstract
The goals of coronavirus disease 2019 (COVID-19) antiviral therapy early in the pandemic were to prevent severe disease, hospitalization, and death. As these outcomes have become infrequent in the age of widespread population immunity, the objectives have shifted. For the general population, COVID-19-directed antiviral therapy should decrease symptom severity and duration and minimize infectiousness, and for immunocompromised individuals, antiviral therapy should reduce severe outcomes and persistent infection. The increased recognition of virologic rebound following ritonavir-boosted nirmatrelvir (NMV/r) and the lack of randomized controlled trial data showing benefit of antiviral therapy for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection for standard-risk, vaccinated individuals remain major knowledge gaps. Here, we review data for selected antiviral agents and immunomodulators currently available or in late-stage clinical trials for use in outpatients. We do not review antibody products, convalescent plasma, systemic corticosteroids, IL-6 inhibitors, Janus kinase inhibitors, or agents that lack Food and Drug Administration approval or emergency use authorization or are not appropriate for outpatients.
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Affiliation(s)
- Eric A Meyerowitz
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Yijia Li
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Yang W, Wang Y, Han D, Tang W, Sun L. Recent advances in application of computer-aided drug design in anti-COVID-19 Virials Drug Discovery. Biomed Pharmacother 2024; 173:116423. [PMID: 38493593 DOI: 10.1016/j.biopha.2024.116423] [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: 12/08/2023] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 03/19/2024] Open
Abstract
Corona Virus Disease 2019 (COVID-19) is a global pandemic epidemic caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), which poses a serious threat to human health worldwide and results in significant economic losses. With the continuous emergence of new virus strains, small molecule drugs remain the most effective treatment for COVID-19. The traditional drug development process usually requires several years; however, the development of computer-aided drug design (CADD) offers the opportunity to develop innovative drugs quickly and efficiently. The literature review describes the general process of CADD, the viral proteins that play essential roles in the life cycle of SARS-CoV-2 and can serve as therapeutic targets, and examples of drug screening of viral target proteins by applying CADD methods. Finally, the potential of CADD in COVID-19 therapy, the deficiency, and the possible future development direction are discussed.
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Affiliation(s)
- Weiying Yang
- Department of Emergency Medicine, First Hospital of Jilin University, Changchun 130021, China
| | - Ye Wang
- School of Life Sciences, Jilin University, Changchun 130012, China
| | - Dongfeng Han
- Department of Emergency Medicine, First Hospital of Jilin University, Changchun 130021, China
| | - Wenjing Tang
- Department of Emergency Medicine, First Hospital of Jilin University, Changchun 130021, China
| | - Lichao Sun
- Department of Emergency Medicine, First Hospital of Jilin University, Changchun 130021, China.
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22
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Jiang M, Gao Y, Hu Z. Pharmacological innovation and clinical value of VV116. THE LANCET. INFECTIOUS DISEASES 2024; 24:e212. [PMID: 38340737 DOI: 10.1016/s1473-3099(24)00009-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Mengxi Jiang
- Department of Pharmacology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Yuan Gao
- Fourth Department of Liver Disease Center, Beijing You'An Hospital, Capital Medical University, Beijing 100069, China
| | - Zhongjie Hu
- Liver Disease Center, Beijing You'An Hospital, Capital Medical University, Beijing 100069, China.
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23
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万 欣, 洪 崇, 王 进, 宋 高, 刘 叔. [3-O-β-chacotriosyl glycyrrhetinic acid derivatives as potential small-molecule SARS-CoV-2 fusion inhibitors against SARS-CoV-2 entry into host cells]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2024; 44:474-483. [PMID: 38597438 PMCID: PMC11006688 DOI: 10.12122/j.issn.1673-4254.2024.03.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Indexed: 04/11/2024]
Abstract
OBJECTIVE To study the inhibitory activities of 3-O-β-chacotriosyl glycyrrhetinic acid derivatives against the entry of SARS-CoV-2 into host cells. METHODS With pentacyclic triterpene saponin glycyrrhizic acid (a natural SARS-CoV-2 entry inhibitor) as the lead compound, a series of 3-O-β-chacotriosyl glycyrrhetinic acid derivatives were designed and synthesized based on hypridization principle, and their inhibitory activities against virus entry were tested in SARS-CoV-2 pseudovirusinfected cells. The antiviral targets of the lead compound 1b was identified by pseudotyped SARS-CoV-2 infection assay and surface plasmon resonance (SPR) assay, and the S protein-mediated cell-cell fusion assay was used to evaluate the effect of 1b on virus-cell membrane fusion. Molecular docking and single amino acid mutagenesis were carried out to analyze the effect of 1b on binding activitiy of S protein. RESULTS The lead compound 1b showed significant inhibitory effect against Omicron pseudovirus with an EC50 value of 3.28 μmol/L (P < 0.05), and had broad-spectrum antiviral activity against other SARS-CoV-2 pseudovirus. Spike-dependent cell-cell fusion assay demonstrated an inhibitory effect of 1b against SARS-CoV-2 S proteinmediated cell-cell fusion. Molecular docking analysis predicted that the lead compound 1b could be well fitted into a cavity between the attachment (S1) and fusion (S2) subunits at the 3-fold axis, where it formed multiple hydrophobic interactions with Glu309, Ser305, Arg765 and Lys964 residues with a KD value of -8.6 kcal/mol. The compound 1b at 10, 5, 2.5 and 1.25 μmol/L showed a significantly reduced inhibitory activity against the pseudovirus with mutated Arg765, Lys964, Glu309 and Leu303 (P < 0.01). CONCLUSION 3-O-β-chacotriosyl glycyrrhetinic acid derivatives are capable of stabilizing spike protein in the pre-fusion step to interfere with the fusion of SARS-CoV-2 with host cell membrane, and can thus serve as potential novel small-molecule SARS-CoV-2 fusion inhibitors.
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Affiliation(s)
- 欣 万
- 惠州卫生职业技术学院药学与检验学院,广东 惠州 516000School of Pharmacy and Laboratory Medicine, Huizhou Health Sciences Polytechnic, Huizhou 516000, China
| | - 崇竣 洪
- 华南农业大学材料与能源学院,广东 广州 510642College of Materials and Energy, South China Agricultural University, Guangzhou 510642, China
| | - 进绅 王
- 南方医科大学药学院,广东 广州 510515School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - 高鹏 宋
- 华南农业大学材料与能源学院,广东 广州 510642College of Materials and Energy, South China Agricultural University, Guangzhou 510642, China
| | - 叔文 刘
- 南方医科大学药学院,广东 广州 510515School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
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24
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Zhou L, Liu R, Pathak H, Wang X, Jeong GH, Kumari P, Kumar M, Yin J. Ubiquitin Ligase Parkin Regulates the Stability of SARS-CoV-2 Main Protease and Suppresses Viral Replication. ACS Infect Dis 2024; 10:879-889. [PMID: 38386664 PMCID: PMC10928718 DOI: 10.1021/acsinfecdis.3c00418] [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: 08/17/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
The highly infectious coronavirus SARS-CoV-2 relies on the viral main protease (Mpro, also known as 3CLpro or Nsp5) to proteolytically process the polyproteins encoded by the viral genome for the release of functional units in the host cells to initiate viral replication. Mpro also interacts with host proteins of the innate immune pathways, such as IRF3 and STAT1, to suppress their activities and facilitate virus survival and proliferation. To identify the host mechanism for regulating Mpro, we screened various classes of E3 ubiquitin ligases and found that Parkin of the RING-between-RING family can induce the ubiquitination and degradation of Mpro in the cell. Furthermore, when the cells undergo mitophagy, the PINK1 kinase activates Parkin and enhances the ubiquitination of Mpro. We also found that elevated expression of Parkin in the cells significantly decreased the replication of SARS-CoV-2 virus. Interestingly, SARS-CoV-2 infection downregulates Parkin expression in the mouse lung tissues compared to healthy controls. These results suggest an antiviral role of Parkin as a ubiquitin ligase targeting Mpro and the potential for exploiting the virus-host interaction mediated by Parkin to treat SARS-CoV-2 infection.
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Affiliation(s)
- Li Zhou
- Department
of Chemistry and Center for Diagnostics and Therapeutics, Georgia State University, Atlanta, Georgia 30303, United States
| | - Ruochuan Liu
- Department
of Chemistry and Center for Diagnostics and Therapeutics, Georgia State University, Atlanta, Georgia 30303, United States
| | - Heather Pathak
- Department
of Biology and Center for Diagnostics and Therapeutics, Georgia State University, Atlanta, Georgia 30303, United States
| | - Xiaoyu Wang
- Department
of Chemistry and Center for Diagnostics and Therapeutics, Georgia State University, Atlanta, Georgia 30303, United States
| | - Geon H. Jeong
- Department
of Chemistry and Center for Diagnostics and Therapeutics, Georgia State University, Atlanta, Georgia 30303, United States
| | - Pratima Kumari
- Department
of Biology and Center for Diagnostics and Therapeutics, Georgia State University, Atlanta, Georgia 30303, United States
| | - Mukesh Kumar
- Department
of Biology and Center for Diagnostics and Therapeutics, Georgia State University, Atlanta, Georgia 30303, United States
| | - Jun Yin
- Department
of Chemistry and Center for Diagnostics and Therapeutics, Georgia State University, Atlanta, Georgia 30303, United States
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25
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Yang Z, Xu Y, Zheng R, Ye L, Lv G, Cao Z, Han R, Li M, Zhu Y, Cao Q, Ding Y, Wang J, Tan Y, Liu F, Wei D, Tan W, Jiang W, Sun J, Sun S, Shao J, Deng Y, Gao W, Wang W, Zhao R, Qiu L, Chen E, Zhang X, Wang S, Ning G, Xu Y, Bi Y. COVID-19 Rebound After VV116 vs Nirmatrelvir-Ritonavir Treatment: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e241765. [PMID: 38477921 PMCID: PMC10938176 DOI: 10.1001/jamanetworkopen.2024.1765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/19/2024] [Indexed: 03/14/2024] Open
Abstract
Importance With the widespread use of anti-SARS-CoV-2 drugs, accumulating data have revealed potential viral load rebound after treatment. Objective To compare COVID-19 rebound after a standard 5-day course of antiviral treatment with VV116 vs nirmatrelvir-ritonavir. Design, Setting, and Participants This is a single-center, investigator-blinded, randomized clinical trial conducted in Shanghai, China. Adult patients with mild-to-moderate COVID-19 and within 5 days of SARS-CoV-2 infection were enrolled between December 20, 2022, and January 19, 2023, and randomly allocated to receive either VV116 or nirmatrelvir-ritonavir. Interventions Participants in the VV116 treatment group received oral 600-mg VV116 tablets every 12 hours on day 1 and 300 mg every 12 hours on days 2 through 5. Participants in the nirmatrelvir-ritonavir treatment group received oral nirmatrelvir-ritonavir tablets with 300 mg of nirmatrelvir plus 100 mg of ritonavir every 12 hours for 5 days. Participants were followed up every other day until day 28 and every week until day 60. Main Outcomes and Measures The primary outcome was viral load rebound (VLR), defined as a half-log increase in viral RNA copies per milliliter compared with treatment completion. Secondary outcomes included a reduction in the cycle threshold value of 1.5 or more, time until VLR, and symptom rebound, defined as an increase of more than 2 points in symptom score compared with treatment completion. The primary outcome and secondary outcomes were analyzed using the full analysis set. Sensitivity analyses were conducted using the per protocol set. Adverse events were analyzed using the safety analysis set. Results The full analysis set included 345 participants (mean [SD] age, 53.2 [16.8] years; 175 [50.7%] were men) who received VV116 (n = 165) or nirmatrelvir-ritonavir (n = 180). Viral load rebound occurred in 33 patients (20.0%) in the VV116 group and 39 patients (21.7%) in the nirmatrelvir-ritonavir group (P = .70). Symptom rebound occurred in 41 of 160 patients (25.6%) in the VV116 group and 40 of 163 patients (24.5%) in the nirmatrelvir-ritonavir group (P = .82). Viral whole-genome sequencing of 24 rebound cases revealed the same lineage at baseline and at viral load rebound in each case. Conclusions and Relevance In this randomized clinical trial of patients with mild-to-moderate COVID-19, viral load rebound and symptom rebound were both common after a standard 5-day course of treatment with either VV116 or nirmatrelvir-ritonavir. Prolongation of treatment duration might be investigated to reduce COVID-19 rebound. Trial Registration Chinese Clinical Trial Registry Identifier: ChiCTR2200066811.
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Affiliation(s)
- Zhitao Yang
- Emergency Department, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Metabolic Diseases (Shanghai), Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission, National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruizhi Zheng
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Metabolic Diseases (Shanghai), Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission, National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Ye
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Metabolic Diseases (Shanghai), Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission, National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gang Lv
- Shanghai Institute of Hematology, National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhujun Cao
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rulai Han
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Metabolic Diseases (Shanghai), Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission, National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mian Li
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Metabolic Diseases (Shanghai), Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission, National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuanyue Zhu
- Department of Geriatrics, Medical Center on Aging, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiuyu Cao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Metabolic Diseases (Shanghai), Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission, National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Ding
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Metabolic Diseases (Shanghai), Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission, National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiqiu Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Metabolic Diseases (Shanghai), Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission, National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Tan
- Shanghai Institute of Hematology, National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Liu
- Shanghai Institute of Hematology, National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dong Wei
- Department of Infectious Diseases, Research Laboratory of Clinical Virology, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Tan
- Department of Infectious Diseases, Research Laboratory of Clinical Virology, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiwei Jiang
- Research and Development Administration Department, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Sun
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shouyue Sun
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Metabolic Diseases (Shanghai), Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission, National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Shao
- Department of Pediatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Deng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiyi Gao
- Division of Medical Affairs, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Metabolic Diseases (Shanghai), Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission, National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ren Zhao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liping Qiu
- Administrative Office, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Erzhen Chen
- Emergency Department, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinxin Zhang
- Department of Infectious Diseases, Research Laboratory of Clinical Virology, National Research Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Clinical Trials Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengyue Wang
- Shanghai Institute of Hematology, National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guang Ning
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Metabolic Diseases (Shanghai), Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission, National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiping Xu
- Clinical Trials Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yufang Bi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Metabolic Diseases (Shanghai), Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission, National Research Center for Translational Medicine, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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26
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Xu ZL, Li CJ, Qian X, Duan H, Zhou J, Zhang QQ, Dong X, Zhao L. A validated LC-MS/MS method for determination of six Anti-SARS-CoV-2 drugs in plasma and its application for a pharmacokinetic study in rats. J Chromatogr B Analyt Technol Biomed Life Sci 2024; 1235:124038. [PMID: 38341953 DOI: 10.1016/j.jchromb.2024.124038] [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: 12/12/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/13/2024]
Abstract
Antiviral treatment for COVID-19 is considered an effective tool in reducing the rate of severe cases and deaths. As of June 2023, a total of six small molecule antiviral drugs have been conditionally approved for marketing by the National Medical Products Administration (NMPA) within China. In this study, a method of HPLC-MS/MS was established and validated for the determination of six small molecule antiviral drugs in plasma using Lamivudine as an internal standard. The chromatographic separation was performed using gradient elution with an ACE 3 C18-PFP column (3.0 mm × 150 mm, 3 μm), and the mobile phase consisted of deionized water and acetonitrile/water (90:10, v/v), both with 10 mmol/L of ammonium acetate and 0.1 % ammonium hydroxide added. Quantitative analysis of the six small molecule drugs was carried out through selective reaction monitoring based on the positive ion spray ionization mode. The method exhibited excellent precision, accuracy, recovery, and linearity, and it was used to determine the pharmacokinetic characteristics in rats. Our work not only established a bioanalytical method for six small molecule antiviral drugs but also provided scientific references for clinical pharmacokinetic studies.
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Affiliation(s)
- Zong-Liang Xu
- School of Medicine, Shanghai University, Shanghai 200444, China; Department of Pharmacy, Shanghai Baoshan Luodian Hospital, Shanghai 201908, China
| | - Cheng-Jian Li
- Department of Pharmacy, Shanghai Baoshan Luodian Hospital, Shanghai 201908, China
| | - Xian Qian
- Department of Pharmacy, Shanghai Baoshan Luodian Hospital, Shanghai 201908, China
| | - Hu Duan
- Department of Pharmacy, Shanghai Baoshan Luodian Hospital, Shanghai 201908, China
| | - Jin Zhou
- Department of Pharmacy, Shanghai Baoshan Luodian Hospital, Shanghai 201908, China
| | - Qian-Qian Zhang
- Department of Pharmacy, Shanghai Baoshan Luodian Hospital, Shanghai 201908, China
| | - Xin Dong
- School of Medicine, Shanghai University, Shanghai 200444, China; Suzhou lnnovation Center of Shanghai University, Suzhou, Jiangsu, China.
| | - Liang Zhao
- Department of Pharmacy, Shanghai Baoshan Luodian Hospital, Shanghai 201908, China.
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27
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Brogna C, Montano L, Zanolin ME, Bisaccia DR, Ciammetti G, Viduto V, Fabrowski M, Baig AM, Gerlach J, Gennaro I, Bignardi E, Brogna B, Frongillo A, Cristoni S, Piscopo M. A retrospective cohort study on early antibiotic use in vaccinated and unvaccinated COVID-19 patients. J Med Virol 2024; 96:e29507. [PMID: 38504586 DOI: 10.1002/jmv.29507] [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: 09/22/2023] [Revised: 02/14/2024] [Accepted: 02/23/2024] [Indexed: 03/21/2024]
Abstract
The bacteriophage behavior of SARS-CoV-2 during the acute and post-COVID-19 phases appears to be an important factor in the development of the disease. The early use of antibiotics seems to be crucial to inhibit disease progression-to prevent viral replication in the gut microbiome, and control toxicological production from the human microbiome. To study the impact of specific antibiotics on recovery from COVID-19 and long COVID (LC) taking into account: vaccination status, comorbidities, SARS-CoV-2 wave, time of initiation of antibiotic therapy and concomitant use of corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs). A total of 211 COVID-19 patients were included in the study: of which 59 were vaccinated with mRNA vaccines against SARS-CoV-2 while 152 were unvaccinated. Patients were enrolled in three waves: from September 2020 to October 2022, corresponding to the emergence of the pre-Delta, Delta, and Omicron variants of the SARS-CoV-2 virus. The three criteria for enrolling patients were: oropharyngeal swab positivity or fecal findings; moderate symptoms with antibiotic intake; and measurement of blood oxygen saturation during the period of illness. The use of antibiotic combinations, such as amoxicillin with clavulanic acid (875 + 125 mg tablets, every 12 h) plus rifaximin (400 mg tablets every 12 h), as first choice, as suggested from the previous data, or azithromycin (500 mg tablets every 24 h), plus rifaximin as above, allows healthcare professionals to focus on the gut microbiome and its implications in COVID-19 disease during patient care. The primary outcome measured in this study was the estimated average treatment effect, which quantified the difference in mean recovery between patients receiving antibiotics and those not receiving antibiotics at 3 and 9 days after the start of treatment. In the analysis, both vaccinated and unvaccinated groups had a median illness duration of 7 days (interquartile range [IQR] 6-9 days for each; recovery crude hazard ratio [HR] = 0.94, p = 0.700). The median illness duration for the pre-Delta and Delta waves was 8 days (IQR 7-10 days), while it was shorter, 6.5 days, for Omicron (IQR 6-8 days; recovery crude HR = 1.71, p < 0.001). These results were confirmed by multivariate analysis. Patients with comorbidities had a significantly longer disease duration: median 8 days (IQR 7-10 days) compared to 7 days (IQR 6-8 days) for those without comorbidities (crude HR = 0.75, p = 0.038), but this result was not confirmed in multivariate analysis as statistical significance was lost. Early initiation of antibiotic therapy resulted in a significantly shorter recovery time (crude HR = 4.74, p < 0.001). Concomitant use of NSAIDs did not reduce disease duration and in multivariate analysis prolonged the disease (p = 0.041). A subgroup of 42 patients receiving corticosteroids for a median of 3 days (IQR 3-6 days) had a longer recovery time (median 9 days, IQR 8-10 days) compared to others (median 7 days, IQR 6-8 days; crude HR = 0.542, p < 0.001), as confirmed also by the adjusted HR. In this study, a statistically significant reduction in recovery time was observed among patients who received early antibiotic treatment. Early initiation of antibiotics played a crucial role in maintaining higher levels of blood oxygen saturation. In addition, it is worth noting that a significant number of patients who received antibiotics in the first 3 days and for a duration of 7 days, during the acute phase did not develop LC.
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Affiliation(s)
- Carlo Brogna
- Craniomed Group Srl. Research Facility, Bresso, Italy
| | - Luigi Montano
- Andrology Unit and Service of Lifestyle Medicine in Uro-Andrology, Local Health Authority (ASL), Salerno, Italy
| | | | | | - Gianluca Ciammetti
- Otorhinolaryngology Unit, Hospital Ferdinando Veneziale Isernia, Regional Health Authority of Molise, Italy
| | | | - Mark Fabrowski
- Department of Emergency Medicine, Royal Sussex County Hospital, University Hospitals Sussex, Brighton, UK
| | - Abdul M Baig
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Iapicca Gennaro
- Pineta Grande Hospital Group, Department of Urology, Santa Rita Clinic, Atripalda, Italy
| | | | - Barbara Brogna
- Department of Radiology, Moscati Hospital, Avellino, Italy
| | | | | | - Marina Piscopo
- Department of Biology, University of Naples Federico II, Naples, Italy
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Romaszko-Wojtowicz A, Tokarczyk-Malesa K, Doboszyńska A, Glińska-Lewczuk K. Impact of COVID-19 on antibiotic usage in primary care: a retrospective analysis. Sci Rep 2024; 14:4798. [PMID: 38413799 PMCID: PMC10899221 DOI: 10.1038/s41598-024-55540-5] [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: 09/10/2023] [Accepted: 02/24/2024] [Indexed: 02/29/2024] Open
Abstract
The COVID-19 pandemic has contributed to many changes in the medical practice, including a wider access to tele-consultations. It not only influenced the type of treatment but also shed light on mistakes often made by doctors, such as the abuse of antibiotics. This study aimed to evaluate the antibiotic treatment, and the impact of the COVID-19 pandemic on antibiotic prescribing during a GP's visit. The retrospective medical history analysis involved data from a first-contact medical center (Pantamed, Olsztyn, Poland), from 1 January 2018 to 31 May 2023. Quantities of prescribed antibiotics were assessed and converted into the so-called active list for a given working day of adult patients (> 18 years of age). Statistical analysis based on collective data was performed. During the COVID-19 pandemic, a decline in the number of medical consultations has been observed, both remotely via tele-medicine and in personal appointments, compared to the data from before the pandemic: n = 95,251 versus n = 79,619. Also, during the COVID-19 pandemic, there was a decrease in the total amount of prescribed antibiotics relative to the data before the pandemic (2.44 vs. 4.54; p > 0.001). The decrease in the quantities of prescribed antibiotics did not depend on the way doctor consultations were provided. The COVID-19 pandemic has contributed to changing the family doctors' management of respiratory infections. The ability to identify the etiological agent-the SARS-COV2 virus-contributed to the reduction of the antibiotics use.
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Affiliation(s)
- Anna Romaszko-Wojtowicz
- Department of Pulmonology, School of Public Health, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Jagiellońska 78, 10-357, Olsztyn, Poland.
| | - K Tokarczyk-Malesa
- Department of Family Medicine and Infectious Diseases, Collegium Medicum, School of Medicine, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Anna Doboszyńska
- Department of Pulmonology, School of Public Health, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Jagiellońska 78, 10-357, Olsztyn, Poland
| | - K Glińska-Lewczuk
- Department of Water Resources, Climatology and Environmental Management, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
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McCarthy MW. Simnotrelvir as a potential treatment for COVID-19. Expert Opin Pharmacother 2024; 25:233-237. [PMID: 38393345 DOI: 10.1080/14656566.2024.2323597] [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: 01/21/2024] [Accepted: 02/22/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Simnotrelvir is a selective 3-chymotrypsin-like oral protease inhibitor with activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). AREAS COVERED On 18 January 2024, results of a double-blind, randomized, placebo-controlled trial of simnotrelvir as a treatment for mild-to moderate COVID-19-were published, indicating the drug, when given in combination with ritonavir, shortened the time to resolution of symptoms. EXPERT OPINION Treatment options for most outpatients with mild-to-moderate COVID-19 are limited. The protease inhibitor nirmatrelvir in combination with ritonavir has proven effective in patients who are high risk for progression to severe COVID-19, but there are no approved therapies for standard-risk patients, who now comprise the majority of the population. Simnotrelvir appears to be effective in standard-risk patients, including those who have completed primary vaccination against COVID-19 and have received a booster dose. This manuscript examines the rationale for the development of simnotrelvir and explores how this drug may be used in the future to treat COVID-19.
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Idris A, Supramaniam A, Tayyar Y, Kelly G, McMillan NAJ, Morris KV. An intranasally delivered ultra-conserved siRNA prophylactically represses SARS-CoV-2 infection in the lung and nasal cavity. Antiviral Res 2024; 222:105815. [PMID: 38246206 DOI: 10.1016/j.antiviral.2024.105815] [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: 09/24/2023] [Revised: 12/15/2023] [Accepted: 01/17/2024] [Indexed: 01/23/2024]
Abstract
There remains a striking overall mortality burden of COVID-19 worldwide. Given the waning effectiveness of current SARS-CoV-2 antivirals due to the rapid emergence of new variants of concern (VOC), we employed a direct-acting molecular therapy approach using gene silencing RNA interference (RNAi) technology. In this study, we developed and screened several ultra-conserved small-interfering RNAs (siRNAs) before selecting one potent siRNA candidate for pre-clinical in vivo testing. This non-immunostimulatory, anti-SARS-CoV-2 siRNA candidate maintains its antiviral activity against all tested SARS-CoV-2 VOC and works effectively as a single agent. For the first time, significant antiviral effects in both the lungs and nasal cavities of SARS-CoV-2 infected mice were observed when this siRNA candidate was delivered intranasally (IN) as a prophylactic agent with the aid of lipid nanoparticles (LNPs). Importantly, a pre-exposure prophylactic IN-delivered anti-SARS-CoV-2 siRNA antiviral that can ameliorate viral replication in the nasal cavity could potentially prevent aerosol spread of respiratory viruses. An IN delivery approach would allow for the development of a direct-acting nasal spray approach that could be self-administered prophylactically.
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Affiliation(s)
- Adi Idris
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; School of Pharmacy and Medical Science, Griffith University, Southport, Queensland, Australia; Centre for Immunlogy and Infection Control, School of Biomedical Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
| | - Aroon Supramaniam
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; School of Pharmacy and Medical Science, Griffith University, Southport, Queensland, Australia
| | - Yaman Tayyar
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; School of Pharmacy and Medical Science, Griffith University, Southport, Queensland, Australia; Prorenata Biotech, Molendinar, Queensland, Australia
| | - Gabrielle Kelly
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; School of Pharmacy and Medical Science, Griffith University, Southport, Queensland, Australia
| | - Nigel A J McMillan
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; School of Pharmacy and Medical Science, Griffith University, Southport, Queensland, Australia
| | - Kevin V Morris
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; School of Pharmacy and Medical Science, Griffith University, Southport, Queensland, Australia; Centre for Genomics and Personalized Health, School of Biomedical Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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31
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Fan X, Dai X, Ling Y, Wu L, Tang L, Peng C, Huang C, Liu H, Lu H, Shen X, Zhang W, Wang F, Li G, Li M, Huang Y, Zhang H, Li M, Ren F, Li Y, Liu C, Zhou Z, Sun W, Yi Y, Zhou D, Gao H, Pan Q, Liu H, Zhao J, Ding Z, Ma Y, Li W, Wang Q, Wang X, Bai Y, Jiang X, Ma J, Xie B, Zhang K, Li L. Oral VV116 versus placebo in patients with mild-to-moderate COVID-19 in China: a multicentre, double-blind, phase 3, randomised controlled study. THE LANCET. INFECTIOUS DISEASES 2024; 24:129-139. [PMID: 38006892 DOI: 10.1016/s1473-3099(23)00577-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Spread of SARS-CoV-2 led to a global pandemic, and there remains unmet medical needs in the treatment of Omicron infections. VV116, an oral antiviral agent that has potent activity against SARS-CoV-2, was compared with a placebo in this phase 3 study to investigate its efficacy and safety in patients with mild-to-moderate COVID-19. METHODS This multicentre, double-blind, phase 3, randomised controlled study enrolled adults in hospitals for infectious diseases and tertiary general hospitals in China. Eligible patients were randomly assigned in a 1:1 ratio using permuted block randomisation to receive oral VV116 (0·6 g every 12 h on day 1 and 0·3 g every 12 h on days 2-5) or oral placebo (on the same schedule as VV116) for 5 days. Randomisation stratification factors included SARS-CoV-2 vaccination status and the presence of high-risk factors for progression to severe COVID-19. Inclusion criteria were a positive SARS-CoV-2 test, an initial onset of COVID-19 symptoms 3 days or less before the first study dose, and a score of 2 or more for any target COVID-19-related symptoms in the 24 h before the first dose. Patients who had severe or critical COVID-19 or who had taken any antiviral drugs were excluded from the study. The primary endpoint was the time to clinical symptom resolution for 2 consecutive days. Efficacy analyses were performed on a modified intention-to-treat population, comprising all patients who received at least one dose of VV116 or placebo, tested positive for SARS-CoV-2 nucleic acid, and did not test positive for influenza virus before the first dose. Safety analyses were done on all participants who received at least one dose of VV116 or placebo. This study was registered with ClinicalTrials.gov, NCT05582629, and has been completed. FINDINGS A total of 1369 patients were randomly assigned to treatment groups and 1347 received either VV116 (n=674) or placebo (n=673). At the interim analysis, VV116 was superior to placebo in reducing the time to sustained clinical symptom resolution among 1229 patients (hazard ratio [HR] 1·21, 95% CI 1·04-1·40; p=0·0023). At the final analysis, a substantial reduction in time to sustained clinical symptom resolution was observed for VV116 compared with placebo among 1296 patients (HR 1·17, 95% CI 1·04-1·33; p=0·0009), consistent with the interim analysis. The incidence of adverse events was similar between groups (242 [35·9%] of 674 patients vs 283 [42·1%] of 673 patients). INTERPRETATION Among patients with mild-to-moderate COVID-19, VV116 significantly reduced the time to sustained clinical symptom resolution compared with placebo, with no observed safety concerns. FUNDING Shanghai Vinnerna Biosciences, Shanghai Science and Technology Commission, and the National Key Research and Development Program of China. TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Xiaohong Fan
- Shanghai Public Health Clinical Center, Shanghai, China
| | - Xiahong Dai
- Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, Zhejiang Province, China
| | - Yun Ling
- Shanghai Public Health Clinical Center, Shanghai, China
| | - Lihua Wu
- Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, Zhejiang Province, China
| | - Lingling Tang
- Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, Zhejiang Province, China
| | | | - Chaolin Huang
- Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Hongyan Liu
- The Sixth People's Hospital of Shenyang, Shenyang, China
| | - Hongzhou Lu
- Shenzhen Third People's Hospital, Shenzhen, China
| | - Xinghua Shen
- The Fifth People's Hospital of Suzhou, Suzhou, China
| | - Wei Zhang
- The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Furong Wang
- The Fourth Hospital in Inner Mongolia, Inner Mongolia, China
| | - Guangming Li
- The Sixth People's Hospital of Zhengzhou, Zhengzhou, China
| | - Ming Li
- Tonghua Central Hospital, Tonghua, China
| | | | | | - Minghui Li
- Shaoxing People's Hospital, Shaoxing, China
| | - Fei Ren
- Xi'an Chest Hospital, Xi'an, China
| | - Yuanyuan Li
- The Eighth Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Chenfan Liu
- Shandong Public Health Clinical Center, Jinan, China
| | - Zhiguo Zhou
- The First Hospital of Changsha, Changsha, China
| | - Wei Sun
- People's Hospital of Chongqing Banan District, Chongqing, China
| | | | - Daming Zhou
- Jiangsu Taizhou People's Hospital, Taizhou, China
| | - Hainv Gao
- Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, Zhejiang Province, China
| | - Qi Pan
- Qingdao Central Hospital, Qingdao, China
| | - Hongde Liu
- Shijiazhuang Fifth Hospital, Shijiazhuang, China
| | - Jiang Zhao
- Nanyang Central Hospital, Nanyang, China
| | - Zhen Ding
- Binhu Hospital of Hefei City, Hefei, China
| | - Yingmin Ma
- Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wei Li
- The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Quanhong Wang
- The Fourth People's Hospital of Taiyuan, Taiyuan, China
| | - Xicheng Wang
- Yunnan Provincial Infectious Disease Hospital, Kunming, China
| | - Yichun Bai
- Guang'an People's Hospital, Guang'an, China
| | | | - Juan Ma
- Shanghai Junshi Bioscience, Shanghai, China
| | | | - Kui Zhang
- Shanghai Junshi Bioscience, Shanghai, China
| | - Lanjuan Li
- Shulan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, Zhejiang Province, China; State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
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32
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Meyerowitz EA, Scott J, Richterman A, Male V, Cevik M. Clinical course and management of COVID-19 in the era of widespread population immunity. Nat Rev Microbiol 2024; 22:75-88. [PMID: 38114838 DOI: 10.1038/s41579-023-01001-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/21/2023]
Abstract
The clinical implications of COVID-19 have changed since SARS-CoV-2 first emerged in humans. The current high levels of population immunity, due to prior infection and/or vaccination, have been associated with a vastly decreased overall risk of severe disease. Some people, particularly those with immunocompromising conditions, remain at risk for severe outcomes. Through the course of the pandemic, variants with somewhat different symptom profiles from the original SARS-CoV-2 virus have emerged. The management of COVID-19 has also changed since 2020, with the increasing availability of evidence-based treatments in two main classes: antivirals and immunomodulators. Selecting the appropriate treatment(s) for patients with COVID-19 requires a deep understanding of the evidence and an awareness of the limitations of applying data that have been largely based on immune-naive populations to patients today who most likely have vaccine-derived and/or infection-derived immunity. In this Review, we provide a summary of the clinical manifestations and approaches to caring for adult patients with COVID-19 in the era of vaccine availability and the dominance of the Omicron subvariants, with a focus on the management of COVID-19 in different patient groups, including immunocompromised, pregnant, vaccinated and unvaccinated patients.
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Affiliation(s)
- Eric A Meyerowitz
- Division of Infectious Diseases, Montefiore Medical Center, Bronx, NY, USA
| | - Jake Scott
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Aaron Richterman
- Division of Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria Male
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Muge Cevik
- Division of Infection and Global Health Research, School of Medicine, University of St Andrews, St Andrews, UK.
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33
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Rodríguez-Artalejo FJ, Ruiz-Galiana J, Cantón R, De Lucas Ramos P, García-Botella A, García-Lledó A, Hernández-Sampelayo T, Gómez-Pavón J, González Del Castillo J, Martín-Delgado MC, Martín Sánchez FJ, Martínez-Sellés M, Molero García JM, Moreno Guillén S, García de Viedma D, Bouza E. COVID-19: On the threshold of the fifth year. The situation in Spain. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2024; 37:17-28. [PMID: 38009431 PMCID: PMC10874674 DOI: 10.37201/req/123.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/17/2023] [Indexed: 11/28/2023]
Abstract
Despite having emerged from pandemic status, the incidence of COVID-19 episodes has recently increased in Spain, including pediatric cases and admissions to Intensive Care Units. Several recombinant variants are circulating among us, particularly XBB arising from two Omicron BA.2 sublineages with mutations in the genes encoding the spicule proteins that could increase binding to the ACE2 receptor and be more prone to immune escape. Faced with these, 3 pharmaceutical companies have developed vaccines adapted to the XBB.1.5 sublineage that are already available for administration in our setting with risks that should not be different from those of previous mRNA vaccines and with clearly favorable benefit/risk ratios. They should be applied to patients with potential for poor COVID-19 evolution and to collectives that have a particular relationship of proximity with them. Their application should be understood not only from a perspective of individual convenience but also from that of collective responsibility. The most convenient seems to be a simultaneous immunization of COVID-19 and influenza in our environment. In the therapeutic aspect, there is little to expect right now from antisera, but the already known antiviral drugs are still available and indicated, although their efficacy will have to be reevaluated due to their impact on populations that are mostly immunized and with a better prognosis than in the past. In our opinion, it is necessary to continue to make a reasonable and timely use of masks and other non-pharmacological means of protection.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas del Hospital General Universitario Gregorio Marañón, Universidad Complutense. CIBERES. Ciber de Enfermedades Respiratorias. Madrid, Spain.
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Gottlieb RL, Paredes R. Oral and intravenous 1'-cyano-substituted adenosine-like antivirals for early COVID-19. THE LANCET. INFECTIOUS DISEASES 2024; 24:108-110. [PMID: 38006893 DOI: 10.1016/s1473-3099(23)00633-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 11/27/2023]
Affiliation(s)
- Robert L Gottlieb
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX 75246, USA; Baylor Scott & White Research Institute, Dallas, TX, USA; Texas A&M Health Science Center, Dallas, TX, USA; Burnett School of Medicine at TCU, Fort Worth, TX, USA.
| | - Roger Paredes
- Department of Infectious Diseases & Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain; IrsiCaixa AIDS Research Institute, Badalona, Catalonia, Spain; Center for Global Health & Diseases, Department of Pathology, Case Western Reserve University, Cleveland, OH, USA
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35
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Andrews HS, Herman JD, Gandhi RT. Treatments for COVID-19. Annu Rev Med 2024; 75:145-157. [PMID: 37722709 DOI: 10.1146/annurev-med-052422-020316] [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] [Indexed: 09/20/2023]
Abstract
The treatment for COVID-19 has evolved rapidly since the start of the pandemic and now consists mainly of antiviral and immunomodulatory agents. Antivirals, such as remdesivir and nirmatrelvir-ritonavir, have proved to be most useful earlier in illness (e.g., as outpatient therapy) and for less severe disease. Immunomodulatory therapies, such as dexamethasone and interleukin-6 or Janus kinase inhibitors, are most useful in severe disease or critical illness. The role of anti-SARS-CoV-2 monoclonal antibodies has diminished because of the emergence of viral variants that are not anticipated to be susceptible to these treatments, and there still is not a consensus on the use of convalescent plasma. COVID-19 has been associated with increased rates of venous thromboembolism, but the role of antithrombotic therapy is limited. Multiple investigational agents continue to be studied, which will alter current treatment paradigms as new data are released.
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Affiliation(s)
- Hayden S Andrews
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; ,
| | - Jonathan D Herman
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA;
- Ragon Institute of Mass General, MIT, and Harvard, Cambridge, Massachusetts, USA
| | - Rajesh T Gandhi
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; ,
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36
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Sun Z, Zhang L, Wang R, Wang Z, Liang X, Gao J. Identification of shared pathogenetic mechanisms between COVID-19 and IC through bioinformatics and system biology. Sci Rep 2024; 14:2114. [PMID: 38267482 PMCID: PMC10808107 DOI: 10.1038/s41598-024-52625-z] [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: 09/22/2023] [Accepted: 01/22/2024] [Indexed: 01/26/2024] Open
Abstract
COVID-19 increased global mortality in 2019. Cystitis became a contributing factor in SARS-CoV-2 and COVID-19 complications. The complex molecular links between cystitis and COVID-19 are unclear. This study investigates COVID-19-associated cystitis (CAC) molecular mechanisms and drug candidates using bioinformatics and systems biology. Obtain the gene expression profiles of IC (GSE11783) and COVID-19 (GSE147507) from the Gene Expression Omnibus (GEO) database. Identified the common differentially expressed genes (DEGs) in both IC and COVID-19, and extracted a number of key genes from this group. Subsequently, conduct Gene Ontology (GO) functional enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis on the DEGs. Additionally, design a protein-protein interaction (PPI) network, a transcription factor gene regulatory network, a TF miRNA regulatory network, and a gene disease association network using the DEGs. Identify and extract hub genes from the PPI network. Then construct Nomogram diagnostic prediction models based on the hub genes. The DSigDB database was used to forecast many potential molecular medicines that are associated with common DEGs. Assess the precision of hub genes and Nomogram models in diagnosing IC and COVID-19 by employing Receiver Operating Characteristic (ROC) curves. The IC dataset (GSE57560) and the COVID-19 dataset (GSE171110) were selected to validate the models' diagnostic accuracy. A grand total of 198 DEGs that overlapped were found and chosen for further research. FCER1G, ITGAM, LCP2, LILRB2, MNDA, SPI1, and TYROBP were screened as the hub genes. The Nomogram model, built using the seven hub genes, demonstrates significant utility as a diagnostic prediction model for both IC and COVID-19. Multiple potential molecular medicines associated with common DEGs have been discovered. These pathways, hub genes, and models may provide new perspectives for future research into mechanisms and guide personalised and effective therapeutics for IC patients infected with COVID-19.
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Affiliation(s)
- Zhenpeng Sun
- Department of Urology, Qingdao Municipal Hospital, No.5, Donghai Middle Road, Shinan District, Qingdao, 266001, Shandong, China
- Qingdao Medical College, Qingdao University, Qingdao, China
| | - Li Zhang
- Institute of Systems Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- Suzhou Institute of Systems Medicine, Suzhou, China
| | - Ruihong Wang
- Department of Outpatient, Qingdao Central Hospital, Qingdao University, Qingdao, China
| | - Zheng Wang
- Zhucheng People's Hospital, Zhucheng, China
| | - Xin Liang
- Department of Urology, Qingdao Municipal Hospital, No.5, Donghai Middle Road, Shinan District, Qingdao, 266001, Shandong, China
| | - Jiangang Gao
- Department of Urology, Qingdao Municipal Hospital, No.5, Donghai Middle Road, Shinan District, Qingdao, 266001, Shandong, China.
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37
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Cao B, Wang Y, Lu H, Huang C, Yang Y, Shang L, Chen Z, Jiang R, Liu Y, Lin L, Peng P, Wang F, Gong F, Hu H, Cheng C, Yao X, Ye X, Zhou H, Shen Y, Liu C, Wang C, Yi Z, Hu B, Xu J, Gu X, Shen J, Xu Y, Zhang L, Fan J, Tang R, Wang C. Oral Simnotrelvir for Adult Patients with Mild-to-Moderate Covid-19. N Engl J Med 2024; 390:230-241. [PMID: 38231624 PMCID: PMC11156186 DOI: 10.1056/nejmoa2301425] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND Simnotrelvir is an oral 3-chymotrypsin-like protease inhibitor that has been found to have in vitro activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and potential efficacy in a phase 1B trial. METHODS In this phase 2-3, double-blind, randomized, placebo-controlled trial, we assigned patients who had mild-to-moderate coronavirus disease 2019 (Covid-19) and onset of symptoms within the past 3 days in a 1:1 ratio to receive 750 mg of simnotrelvir plus 100 mg of ritonavir or placebo twice daily for 5 days. The primary efficacy end point was the time to sustained resolution of symptoms, defined as the absence of 11 Covid-19-related symptoms for 2 consecutive days. Safety and changes in viral load were also assessed. RESULTS A total of 1208 patients were enrolled at 35 sites in China; 603 were assigned to receive simnotrelvir and 605 to receive placebo. Among patients in the modified intention-to-treat population who received the first dose of trial drug or placebo within 72 hours after symptom onset, the time to sustained resolution of Covid-19 symptoms was significantly shorter in the simnotrelvir group than in the placebo group (180.1 hours [95% confidence interval {CI}, 162.1 to 201.6] vs. 216.0 hours [95% CI, 203.4 to 228.1]; median difference, -35.8 hours [95% CI, -60.1 to -12.4]; P = 0.006 by Peto-Prentice test). On day 5, the decrease in viral load from baseline was greater in the simnotrelvir group than in the placebo group (mean difference [±SE], -1.51±0.14 log10 copies per milliliter; 95% CI, -1.79 to -1.24). The incidence of adverse events during treatment was higher in the simnotrelvir group than in the placebo group (29.0% vs. 21.6%). Most adverse events were mild or moderate. CONCLUSIONS Early administration of simnotrelvir plus ritonavir shortened the time to the resolution of symptoms among adult patients with Covid-19, without evident safety concerns. (Funded by Jiangsu Simcere Pharmaceutical; ClinicalTrials.gov number, NCT05506176.).
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Affiliation(s)
- Bin Cao
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Yeming Wang
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Hongzhou Lu
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Chaolin Huang
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Yumei Yang
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Lianhan Shang
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Zhu Chen
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Rongmeng Jiang
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Yihe Liu
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Ling Lin
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Ping Peng
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Fuxiang Wang
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Fengyun Gong
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Honglin Hu
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Cong Cheng
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Xiangyang Yao
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Xianwei Ye
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Hourong Zhou
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Yinzhong Shen
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Chenfan Liu
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Chunying Wang
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Zhennan Yi
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Bijie Hu
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Jiuyang Xu
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Xiaoying Gu
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Jingshan Shen
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Yechun Xu
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Leike Zhang
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Jia Fan
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Renhong Tang
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
| | - Chen Wang
- From the Departments of Pulmonary and Critical Care Medicine (B.C., Y.W., L.S., J.X., Chen Wang) and Clinical Research and Data Management (X.G.), Institute of Respiratory Medicine in the Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Changping Laboratory (B.C., Chen Wang), the Department of Medicine, Non-oncology, Jiangsu Simcere Pharmaceutical (Y.Y.), Clinical and Research Center of Infectious Diseases Beijing Ditan Hospital, Capital Medical University (R.J.), and Chinese Academy of Medical Sciences and Peking Union Medical College (Chen Wang), Beijing, the Department of Infectious Diseases, Third People's Hospital of Shenzhen, National Clinical Research Center for Infectious Diseases, Shenzhen (H.L., F.W.), Jin Yin-tan Hospital (C.H., F.G.) and Wuhan Institute of Virology, Chinese Academy of Sciences (L.Z.), Wuhan, the Public Health Clinical Center of Chengdu, Chengdu (Z.C.), Tianjin First Central Hospital, Tianjin (Y.L.), the Department of Cardiology, Hainan Third People's Hospital, Sanya (L.L.), the Department of Respiratory Medicine, Guangzhou Eighth People's Hospital, Guangzhou (P.P.), the Department of Clinical Statistics and Data Management, Jiangsu Simcere Pharmaceutical (H.H.), the Department of Infection and Immunity, Shanghai Public Health Clinical Center (Y.S.), and the Department of Infectious Diseases, Zhongshan Hospital (B.H.), Fudan University, State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences (J.S., Y.X.), and the Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion of the Ministry of Education (J.F.), Shanghai, the Second Hospital of Nanjing (C.C.), Jiangsu Simcere Pharmaceutical (R.T.), and State Key Laboratory of Neurology and Oncology Drug Development (R.T.), Nanjing, the First Affiliated Hospital of Xiamen University, Xiamen (X. Yao), Guizhou Provincial People's Hospital, Guiyang (X. Ye, H.Z.), the Second Department of Infection, Shandong Public Health Clinical Center, Jinan (C.L.), Xuzhou Infectious Diseases Hospital, Xuzhou (Chunying Wang), and Central People's Hospital of Zhanjiang, Zhanjiang (Z.Y.) - all in China
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Su P, Yang CX, Wang XG. Azvudine versus paxlovid for oral treatment of COVID-19 in Chinese patients. BMC Infect Dis 2024; 24:44. [PMID: 38172735 PMCID: PMC10765622 DOI: 10.1186/s12879-023-08828-2] [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: 06/26/2023] [Accepted: 11/14/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE To explore the effect of azvudine as compared to paxlovid for oral treatment of hospitalized patients with SARS-CoV-2 infection. METHODS We analyzed data from a cohort of patients with SARS-CoV-2 infection in Shandong provincial hospital between February 15 and March 15, 2023. The primary outcome was time to sustained clinical recovery through Day 28 and secondary outcomes included the percentage of participants who died from any cause by Day 28, the average hospitilization time and expenses, the changes in liver and kidney function and adverse events. The Kaplan-Meier method and Cox regression model was used for statistical analysis. RESULTS There was no significant difference between azvudine and paxlovid in terms of time to sustained clinical recovery (p = 0.429) and death rates (p = 0.687). As for hospitalization time and fee, no significant differences were observed between azvudine group and paxlovid group (Hospitalization time: p = 0.633; Hospitalization fee: p = 0.820). In addition, there were no significant differences in the effects of the two drugs on liver and kidney function (p > 0.05). CONCLUSION Among adults who were hospitalised with SARS-CoV-2 infection, azvudine was noninferior to paxlovid in terms of time to sustained clinical recovery, death rates, hospitalization time and cost, with few safety concerns. TRIAL REGISTRATION ChiCTR2300071309; Registered 11 May 2023. LEVEL OF EVIDENCE Level III; Retrospective cohort study.
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Affiliation(s)
- Peng Su
- Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Cong-Xian Yang
- Department of Pain Management, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
| | - Xing-Guang Wang
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
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Zou G, Cao S, Gao Z, Yie J, Wu JZ. Current state and challenges in respiratory syncytial virus drug discovery and development. Antiviral Res 2024; 221:105791. [PMID: 38160942 DOI: 10.1016/j.antiviral.2023.105791] [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: 11/21/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
Human respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections (LRTI) in young children and elderly people worldwide. Recent significant progress in our understanding of the structure and function of RSV proteins has led to the discovery of several clinical candidates targeting RSV fusion and replication. These include both the development of novel small molecule interventions and the isolation of potent monoclonal antibodies. In this review, we summarize the state-of-the-art of RSV drug discovery, with a focus on the characteristics of the candidates that reached the clinical stage of development. We also discuss the lessons learned from failed and discontinued clinical developments and highlight the challenges that remain for development of RSV therapies.
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Affiliation(s)
- Gang Zou
- Shanghai Ark Biopharmaceutical Co., Ltd, Shanghai, 201203, China.
| | - Sushan Cao
- Shanghai Ark Biopharmaceutical Co., Ltd, Shanghai, 201203, China
| | - Zhao Gao
- Shanghai Ark Biopharmaceutical Co., Ltd, Shanghai, 201203, China
| | - Junming Yie
- Shanghai Ark Biopharmaceutical Co., Ltd, Shanghai, 201203, China
| | - Jim Zhen Wu
- Shanghai Ark Biopharmaceutical Co., Ltd, Shanghai, 201203, China
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Gallucci L, Bazire J, Davidson AD, Shytaj IL. Broad-spectrum antiviral activity of two structurally analogous CYP3A inhibitors against pathogenic human coronaviruses in vitro. Antiviral Res 2024; 221:105766. [PMID: 38042417 DOI: 10.1016/j.antiviral.2023.105766] [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: 08/23/2023] [Revised: 11/19/2023] [Accepted: 11/24/2023] [Indexed: 12/04/2023]
Abstract
Coronaviruses pose a permanent risk of outbreaks, with three highly pathogenic species and strains (SARS-CoV, MERS-CoV, SARS-CoV-2) having emerged in the last twenty years. Limited antiviral therapies are currently available and their efficacy in randomized clinical trials enrolling SARS-CoV-2 patients has not been consistent, highlighting the need for more potent treatments. We previously showed that cobicistat, a clinically approved inhibitor of Cytochrome P450-3A (CYP3A), has direct antiviral activity against early circulating SARS-CoV-2 strains in vitro and in Syrian hamsters. Cobicistat is a derivative of ritonavir, which is co-administered as pharmacoenhancer with the SARS-CoV-2 protease inhibitor nirmatrelvir, to inhibit its metabolization by CPY3A and preserve its antiviral efficacy. Here, we used automated image analysis for a screening and parallel comparison of the anti-coronavirus effects of cobicistat and ritonavir. Our data show that both drugs display antiviral activity at low micromolar concentrations against multiple SARS-CoV-2 variants in vitro, including epidemiologically relevant Omicron subvariants. Despite their close structural similarity, we found that cobicistat is more potent than ritonavir, as shown by significantly lower EC50 values in monotherapy and higher levels of viral suppression when used in combination with nirmatrelvir. Finally, we show that the antiviral activity of both cobicistat and ritonavir is maintained against other human coronaviruses, including HCoV-229E and the highly pathogenic MERS-CoV. Overall, our results demonstrate that cobicistat has more potent anti-coronavirus activity than ritonavir and suggest that dose adjustments could pave the way to the use of both drugs as broad-spectrum antivirals against highly pathogenic human coronaviruses.
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Affiliation(s)
- Lara Gallucci
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - James Bazire
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Andrew D Davidson
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK.
| | - Iart Luca Shytaj
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK.
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Chen PY, Wang JT, Chang SC. Antiviral therapy of coronavirus disease 2019 (COVID-19). J Formos Med Assoc 2024; 123 Suppl 1:S47-S54. [PMID: 37661527 DOI: 10.1016/j.jfma.2023.08.029] [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: 02/13/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/05/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has reached a turning point. The non-pharmaceutical interventions for preventing COVID-19 are lifting. Vaccination uptake is increasing in general, but this strategy is continuously challenged by the rapid evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Of note, the Omicron subvariants spread globally for at least one year, and the most recently developed subvariants show strong immune evasion to preexisting immunity, either from previous infection, vaccination or both. Therefore, early and appropriate antiviral agents to treat patients at risk for severe COVID-19 or death is crucial to decrease morbidities and mortalities, to restore the healthcare capacities and to facilitate a return to the new normal. Current antiviral therapy for COVID-19 consist of neutralizing monoclonal antibodies (mAbs) and direct antiviral agents. Each agent has been proved for early ambulatory treatment of COIVD-19, but suffer from variable effectiveness and limitations due to patients' comorbidities, drug properties, or antiviral resistance. Besides, some specific mAbs are indicated for prophylaxis of COVID-19 before or after close contact with confirmed COVID-19 patients. This review article summarizes the evidence and unmet needs of the currently available antiviral agents for management of COVID-19 in the context of the Omicron subvariants.
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Affiliation(s)
- Pao-Yu Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jann-Tay Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; National Institutes of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan.
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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Lv B, Gao X, Zeng G, Guo H, Li F. Safety Profile of Paxlovid in the Treatment of COVID-19. Curr Pharm Des 2024; 30:666-675. [PMID: 38415446 DOI: 10.2174/0113816128280987240214103432] [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: 11/02/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND With the urgent and widespread application of Paxlovid, a novel antiviral drug for Coronavirus Disease 2019 (COVID-19) in clinical practice, concerns regarding its actual efficacy and safety have emerged. In order to provide more evidence to support its clinical application, we sought to perform a descriptive analysis of cases who experienced at least one Paxlovid-related adverse event (AEs) and reported to the FDA Adverse Event Reporting System (FAERS) in the post-marketing period. METHODS Individual adverse event reports between January 1, 2022 and September 30, 2022, were downloaded from the FAERS website. We completed a descriptive study about the safety of Paxlovid in the treatment of COVID-19. Further, we also analyzed the onset time of Paxlovid-related AEs. RESULTS As of 30 September 2022, 16,529 de-duplicated cases were submitted to the FDA, and 5,860 (35.45%) were female. The average age was 58.38 years (S.D. 15.50). Most reports (12,390, 74.96%) were submitted by consumers and 1,436 (8.68%) concerned serious outcomes. The most frequently reported AEs were disease recurrence (7,724, 16.23%), dysgeusia (2,877, 6.05%), and diarrhoea (1,448, 3.04%). The median onset time of Paxlovid-related AEs was 8 days (interquartile range,1-10 days), and most of the cases (2,629, 19.12%) occurred on the day after Paxlovid initiation. CONCLUSION This study indicates that the most common AEs reported with Paxlovid in post-marketing experience are consistent with the safety assessment of antiviral drugs. Even without emerging apparent safety concerns, the incidence of serious outcomes was unexpectedly high, and a few cases of potential new AEs occurred.
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Affiliation(s)
- Bing Lv
- Department of Emergency, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Xin Gao
- Department of Urology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Guoqiang Zeng
- Department of Urology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Hui Guo
- Department of Urology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Faping Li
- Department of Urology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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Patterson LD, Dubansky BD, Dubansky BH, Stone S, Kumar M, Rice CD. Generation and Characterization of a Multi-Functional Panel of Monoclonal Antibodies for SARS-CoV-2 Research and Treatment. Viruses 2023; 16:64. [PMID: 38257764 PMCID: PMC10821318 DOI: 10.3390/v16010064] [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: 12/02/2023] [Revised: 12/21/2023] [Accepted: 12/29/2023] [Indexed: 01/24/2024] Open
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic caused by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) is an ongoing threat to global public health. To this end, intense efforts are underway to develop reagents to aid in diagnostics, enhance preventative measures, and provide therapeutics for managing COVID-19. The recent emergence of SARS-CoV-2 Omicron variants with enhanced transmissibility, altered antigenicity, and significant escape of existing monoclonal antibodies and vaccines underlines the importance of the continued development of such agents. The SARS-CoV-2 spike protein and its receptor binding domain (RBD) are critical to viral attachment and host cell entry and are primary targets for antibodies elicited from both vaccination and natural infection. In this study, mice were immunized with two synthetic peptides (Pep 1 and Pep 2) within the RBD of the original Wuhan SARS-CoV-2, as well as the whole RBD as a recombinant protein (rRBD). Hybridomas were generated, and a panel of three monoclonal antibodies, mAb CU-P1-1 against Pep 1, mAb CU-P2-20 against Pep 2, and mAb CU-28-24 against rRBD, was generated and further characterized. These mAbs were shown by ELISA to be specific for each immunogen/antigen. Monoclonal antibody CU-P1-1 has limited applicability other than in ELISA approaches and basic immunoblotting. Monoclonal antibody CU-P2-20 is shown to be favorable for ELISA, immunoblotting, and immunohistochemistry (IHC), however, not live virus neutralization. In contrast, mAb CU-28-24 is most effective at live virus neutralization as well as ELISA and IHC. Moreover, mAb CU-28-24 is active against rRBD proteins from Omicron variants BA.2 and BA.4.5 as determined by ELISA, suggesting this mAb may neutralize live virus of these variants. Each of the immunoglobulin genes has been sequenced using Next Generation Sequencing, which allows the expression of respective recombinant proteins, thereby eliminating the need for long-term hybridoma maintenance. The synthetic peptides and hybridomas/mAbs and quantitative antigen-binding data are under the intellectual property management of the Clemson University Research Foundation, and the three CDRs have been submitted as an invention disclosure for further patenting and commercialization.
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Affiliation(s)
- Lila D. Patterson
- Department of Biological Sciences, Clemson University, Clemson, SC 29634, USA;
| | - Benjamin D. Dubansky
- Department of Biological and Agricultural Engineering, Louisiana State University, Baton Rouge, LA 70802, USA;
| | - Brooke H. Dubansky
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, USA;
| | - Shannon Stone
- Department of Biology, Georgia State University, Atlanta, GA 30303, USA; (S.S.); (M.K.)
| | - Mukesh Kumar
- Department of Biology, Georgia State University, Atlanta, GA 30303, USA; (S.S.); (M.K.)
| | - Charles D. Rice
- Department of Biological Sciences, Clemson University, Clemson, SC 29634, USA;
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Xu J, Song J, Xie Z, Yang J, Wu D, Liu F, Zhao Y, Zang H, Zhao Y. Impact of Paxlovid on in-hospital outcomes and post-COVID-19 condition in adult patients infected with SARS-CoV-2 Omicron variant: A non-randomized controlled clinical trial. Medicine (Baltimore) 2023; 102:e36714. [PMID: 38134107 PMCID: PMC10735069 DOI: 10.1097/md.0000000000036714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Nirmatrelvir plus ritonavir (Paxlovid) have been used in the treatment of adult patients with mild-to-moderate coronavirus disease 2019 (COVID-19). This study aimed to evaluate the impact of Paxlovid on in-hospital outcomes and post-COVID-19 condition in Chinese adult patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant. METHODS This non-randomized clinical controlled trial recruited patients infected with SARS-CoV-2 Omicron variant from the designated hospital for treating COVID-19 between November 5 and November 28, 2022, in Shijiazhuang, China. Participants were administered Paxlovid (300 mg of nirmatrelvir and 100 mg of ritonavir orally) or standard treatment. The primary outcome was the nucleic acid shedding time and post-COVID-19 condition. RESULTS A total of 320 patients infected with SARS-CoV-2 Omicron variant were included, with mean age of 29.10 ± 7.34 years old. Two hundred patients received Paxlovid. Compared to patients in the standard treatment group, those in Paxlovid group had a significantly shorter nucleic acid shedding time (3.26 ± 1.80 vs 7.75 ± 3.68 days, P < .001), shorter days until negative swab test (1.74 ± 1.15 vs 5.33 ± 2.91, P < .001), shorter days of first symptoms resolution (4.86 ± 1.62 vs 7.45 ± 2.63, P < .001), higher in nucleic acid test negative rate within 3 days [138 (70.77%) vs 14 (11.67%), P < .001], higher negative rate within 5 days [174 (89.23%) vs 26 (21.67%), P < .001], negative rate within 7 days [185 (94.87%) vs 78 (65.00%), P < .001], and were less likely to have post-COVID-19 condition [32 (18.60%) vs 30 (31.57%), P = .016]. There was no significant difference in duration of post-COVID-19 condition (43.00 ± 26.00 vs 49.00 ± 26.34 days, P = .354) between the 2 groups. CONCLUSION Compared to standard treatment, Paxlovid significantly reduced nucleic acid shedding time, days until negative swab test, and days of first symptoms resolution, as well as improved nucleic acid test negative rate and post-COVID-19 condition.
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Affiliation(s)
- Jianchao Xu
- Hebei University of Chinese Medicine, Shijiazhuang, China
- Shijiazhuang People’s Hospital, Shijiazhuang, China
| | - Jinzhong Song
- Hebei University of Chinese Medicine, Shijiazhuang, China
- The Traditional Chinese Medicine Hospital of Shijiazhuang, Shijiazhuang, China
| | - Ziyu Xie
- Hebei Medical University, Shijiazhuang, China
| | - Jie Yang
- Hebei General Hospital, Shijiazhuang, China
| | - Di Wu
- The Traditional Chinese Medicine Hospital of Shijiazhuang, Shijiazhuang, China
| | - Fengshuang Liu
- Hebei Academy of Chinese Medical Sciences, Shijiazhuang, China
| | - Yinuo Zhao
- School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Hongmin Zang
- The Traditional Chinese Medicine Hospital of Shijiazhuang, Shijiazhuang, China
| | - Yubin Zhao
- Hebei University of Chinese Medicine, Shijiazhuang, China
- Shijiazhuang People’s Hospital, Shijiazhuang, China
- North China University of Science and Technology, Tangshan, China
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Arutyunova E, Belovodskiy A, Chen P, Khan MB, Joyce M, Saffran H, Lu J, Turner Z, Bai B, Lamer T, Young HS, Vederas J, Tyrrell DL, Lemieux MJ, Nieman JA. The Effect of Deuteration and Homologation of the Lactam Ring of Nirmatrelvir on Its Biochemical Properties and Oxidative Metabolism. ACS BIO & MED CHEM AU 2023; 3:528-541. [PMID: 38144257 PMCID: PMC10739250 DOI: 10.1021/acsbiomedchemau.3c00039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 12/26/2023]
Abstract
This study explores the relationship between structural alterations of nirmatrelvir, such as homologation and deuteration, and metabolic stability of newly synthesized derivatives. We developed a reliable synthetic protocol toward dideutero-nirmatrelvir and its homologated analogues with high isotopic incorporation. Deuteration of the primary metabolic site of nirmatrelvir provides a 3-fold improvement of its human microsomal stability but is accompanied by an increased metabolism rate at secondary sites. Homologation of the lactam ring allows the capping group modification to decrease and delocalize the molecule's lipophilicity, reducing the metabolic rate at secondary sites. The effect of deuteration was less pronounced for the 6-membered lactam than for its 5-membered analogue in human microsomes, but the trend is reversed in the case of mouse microsomes. X-ray data revealed that the homologation of the lactam ring favors the orientation of the drug's nitrile warhead for interaction with the catalytic sulfur of the SARS-CoV-2 Mpro, improving its binding. Comparable potency against SARS-CoV-2 Mpro from several variants of concern and selectivity over human cysteine proteases cathepsin B, L, and S was observed for the novel deuterated/homologated derivative and nirmatrelvir. Synthesized compounds displayed a large interspecies variability in hamster, rat, and human hepatocyte stability assays. Overall, we aimed to apply a rational approach in changing the physicochemical properties of the drug to refine its biochemical and biological parameters.
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Affiliation(s)
- Elena Arutyunova
- Department
of Biochemistry, University of Alberta, Edmonton, AB T6G 2H7, Canada
- Li
Ka Shing Institute of Virology, University
of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Alexandr Belovodskiy
- Li Ka
Shing Applied Virology Institute, University
of Alberta, Edmonton, AB T6G 2E1, Canada
- Department
of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Pu Chen
- Department
of Biochemistry, University of Alberta, Edmonton, AB T6G 2H7, Canada
- Li
Ka Shing Institute of Virology, University
of Alberta, Edmonton, AB T6G 2E1, Canada
| | | | - Michael Joyce
- Li
Ka Shing Institute of Virology, University
of Alberta, Edmonton, AB T6G 2E1, Canada
- Department
of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Holly Saffran
- Li
Ka Shing Institute of Virology, University
of Alberta, Edmonton, AB T6G 2E1, Canada
- Department
of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Jimmy Lu
- Department
of Biochemistry, University of Alberta, Edmonton, AB T6G 2H7, Canada
- Li
Ka Shing Institute of Virology, University
of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Zoe Turner
- Department
of Biochemistry, University of Alberta, Edmonton, AB T6G 2H7, Canada
| | - Bing Bai
- Li Ka
Shing Applied Virology Institute, University
of Alberta, Edmonton, AB T6G 2E1, Canada
- Department
of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Tess Lamer
- Department
of Chemistry, University of Alberta, Edmonton, AB T6G 2G2, Canada
| | - Howard S. Young
- Department
of Biochemistry, University of Alberta, Edmonton, AB T6G 2H7, Canada
| | - John
C. Vederas
- Department
of Chemistry, University of Alberta, Edmonton, AB T6G 2G2, Canada
| | - D. Lorne Tyrrell
- Li
Ka Shing Institute of Virology, University
of Alberta, Edmonton, AB T6G 2E1, Canada
- Li Ka
Shing Applied Virology Institute, University
of Alberta, Edmonton, AB T6G 2E1, Canada
- Department
of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - M. Joanne Lemieux
- Department
of Biochemistry, University of Alberta, Edmonton, AB T6G 2H7, Canada
- Li
Ka Shing Institute of Virology, University
of Alberta, Edmonton, AB T6G 2E1, Canada
| | - James A. Nieman
- Li Ka
Shing Applied Virology Institute, University
of Alberta, Edmonton, AB T6G 2E1, Canada
- Department
of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB T6G 2E1, Canada
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Zhang S, Li J, Xu R, Chen Q, Sun G, Lin Y, Cao Y, Chen Y, Geng C, Teng Y, Nie J, Li X, Xu G, Liu X, Jin F, Fan Z, Luo T, Liu H, Wang FS, Jiang Z. Safety of COVID-19 Vaccination in Patients With Breast Cancer: Cross-Sectional Study in China. JMIR Public Health Surveill 2023; 9:e46009. [PMID: 38060302 PMCID: PMC10739232 DOI: 10.2196/46009] [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: 01/25/2023] [Revised: 07/26/2023] [Accepted: 10/31/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND The widespread use of vaccines against the novel coronavirus disease (COVID-19) has become one of the most effective means to establish a population immune barrier. Patients with cancer are vulnerable to COVID-19 infection, adverse events, and high mortality, and should be the focus of epidemic prevention and treatment. However, real-world data on the safety of vaccines for patients with breast cancer are still scarce. OBJECTIVE This study aims to compare the safety of COVID-19 vaccines between patients vaccinated before or after being diagnosed with breast cancer. METHODS Patients with breast cancer who sought medical advice from October 2021 to December 2021 were screened. Those who received COVID-19 vaccines were enrolled in this study to analyze the safety of the vaccines. The primary outcome was patient-reported adverse events (AEs). All events after vaccine injection were retrospectively documented from the patients. RESULTS A total of 15,455 patients with breast cancer from 41 hospitals in 20 provinces in China were screened, and 5766 patients who received COVID-19 vaccines were enrolled. Of those enrolled, 45.1% (n=2599) of patients received vaccines before breast cancer diagnosis, 41.3% (n=2379) were vaccinated after diagnosis, and 13.6% (n=784) did not known the accurate date of vaccination or cancer diagnosis. Among the patients vaccinated after diagnosis, 85.4% (n=2032) were vaccinated 1 year after cancer diagnosis and 95.4% (n=2270) were vaccinated during early-stage cancer. Of all 5766 vaccinated patients, 93.9% (n=5415) received an inactivated vaccine, 3.7% (n=213) received a recombinant subunit vaccine, and 2.4% (n=138) received other vaccines, including adenovirus and mRNA vaccines. In the first injection of vaccines, 24.4% (n=10, 95% CI 11.2-37.5) of patients who received an adenovirus vaccine reported AEs, compared to only 12.5% (n=677, 95% CI 11.6-13.4) of those who received an inactivated vaccine. Patients with metastatic breast cancer reported the highest incidence of AEs (n=18, 16.5%, 95% CI 9.5-23.5). Following the second injection, patients who received an inactivated vaccine (n=464, 8.7%, 95% CI 8.0-9.5) and those who received a recombinant vaccine (n=25, 8.7%, 95% CI 5.5-12.0) reported the same incidence of AEs. No significant differences in patient-reported AEs were found between the healthy population and patients with breast cancer (16.4% vs 16.9%, respectively); the most common AEs were local pain (11.1% vs 9.1%, respectively), fatigue (5.5% vs 6.3%, respectively), and muscle soreness (2.3% vs 3.6%, respectively). The type of vaccine and time window of vaccination had little impact on patient-reported AEs. CONCLUSIONS Compared with patients vaccinated before breast cancer diagnosis, there were no significant differences in patient-reported AEs in the patients vaccinated after diagnosis. Thus, it is safe for patients with breast cancer, especially for those in the early stage, to receive COVID-19 vaccines. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2200055509; https://tinyurl.com/33zzj882.
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Affiliation(s)
- Shaohua Zhang
- Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jianbin Li
- Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
- Beijing Institute of Biotechnology, Academy of Military Medical Sciences, Beijing, China
| | - Ruonan Xu
- Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Qianjun Chen
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangdong, China
| | - Gang Sun
- Cancer Hospital Affiliated to Xinjiang Medical University, Xinjiang, China
| | - Ying Lin
- The First Affiliated Hospital of Sun Yat-sen University, Guangdong, China
| | - Yali Cao
- Nanchang Third Hospital, Jiangxi, China
| | - Yiding Chen
- The Second Affiliated Hospital of Medical College of Zhejiang University, Zhejiang, China
| | - Cuizhi Geng
- Fourth Hospital of Hebei Medical University, Hebei, China
| | - Yuee Teng
- The First Hospital of China Medical University, Liaoning, China
| | | | | | | | - Xinlan Liu
- General Hospital of Ningxia Medical University, Ningxia, China
| | - Feng Jin
- The First Hospital of China Medical University, Liaoning, China
| | - Zhimin Fan
- The First Hospital of Jilin University, Jilin, China
| | - Ting Luo
- Sichuan Uniersity Huaxi Campus, Sichuan, China
| | - Hong Liu
- Tumor Hospital of Tianjin Medical University, Tianjin, China
| | - Fu-Sheng Wang
- Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zefei Jiang
- Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
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Zhou S, Wang K, Hu Z, Chen T, Dong Y, Gao R, Wu M, Li Y, Ji X. Design, synthesis, and structure-activity relationships of a novel class of quinazoline derivatives as coronavirus inhibitors. Eur J Med Chem 2023; 261:115831. [PMID: 37813064 DOI: 10.1016/j.ejmech.2023.115831] [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: 07/31/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/11/2023]
Abstract
There remain great unmet needs to treat coronavirus infections in clinic, and the development of novel antiviral agents is highly demanded. In this work, a phenotypic screening against our in-house compound library identified several cajanine derivatives with moderate antiviral activity against HCoV-OC43. Based on the scaffold of cajanine, a series of quinazoline derivatives were designed employing a scaffold-hopping strategy. After an iterative structural optimization campaign, several quinazoline derivatives with potent antiviral efficacy (EC50: ∼0.1 μM) and high selectivity (SI > 1000) were successfully identified. The preliminary mechanism of action study indicated that such quinazoline derivatives functioned at the early stage of infection. In aggregate, this work delivered a new chemical type of coronavirus inhibitors, which could be employed not only for further development of antiviral drugs but also as important chemical tools to delineate the target of action.
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Affiliation(s)
- Shengchao Zhou
- College of Pharmaceutical Science, Soochow University, Suzhou, Jiangsu, 15021, China
| | - Kun Wang
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ziwei Hu
- College of Pharmaceutical Science, Soochow University, Suzhou, Jiangsu, 15021, China
| | - Tao Chen
- College of Pharmaceutical Science, Soochow University, Suzhou, Jiangsu, 15021, China
| | - Yao Dong
- College of Pharmaceutical Science, Soochow University, Suzhou, Jiangsu, 15021, China
| | - Rongmei Gao
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengyuan Wu
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuhuan Li
- CAMS Key Laboratory of Antiviral Drug Research, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Xingyue Ji
- College of Pharmaceutical Science, Soochow University, Suzhou, Jiangsu, 15021, China.
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Lan Q, Yan Y, Zhang G, Xia S, Zhou J, Lu L, Jiang S. Clinical development of antivirals against SARS-CoV-2 and its variants. CURRENT RESEARCH IN MICROBIAL SCIENCES 2023; 6:100208. [PMID: 38149085 PMCID: PMC10750039 DOI: 10.1016/j.crmicr.2023.100208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
The unceasing global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) calls for the development of novel therapeutics. Although many newly developed antivirals and repurposed antivirals have been applied to the treatment of coronavirus disease 2019 (COVID-19), antivirals showing satisfactory clinical efficacy are few in number. In addition, the loss of sensitivity to variants of concern (VOCs) and lack of oral bioavailability have also limited the clinical application of some antivirals. These facts remind us to develop more potent and broad-spectrum antivirals with better pharmacokinetic/pharmacodynamic properties to fight against infections from SARS-CoV-2, its variants, and other human coronaviruses (HCoVs). In this review, we summarize the latest advancements in the clinical development of antivirals against infections by SARS-CoV-2 and its variants.
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Affiliation(s)
- Qiaoshuai Lan
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Shanghai Frontiers Science Center of Pathogenic Microbes and Infection, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
- Centre for Virology, Vaccinology and Therapeutics, Hong Kong Science and Technology Park, Hong Kong, China
| | - Yan Yan
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Shanghai Frontiers Science Center of Pathogenic Microbes and Infection, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
| | - Guangxu Zhang
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Shanghai Frontiers Science Center of Pathogenic Microbes and Infection, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
| | - Shuai Xia
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Shanghai Frontiers Science Center of Pathogenic Microbes and Infection, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
| | - Jie Zhou
- Centre for Virology, Vaccinology and Therapeutics, Hong Kong Science and Technology Park, Hong Kong, China
- Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong, China
| | - Lu Lu
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Shanghai Frontiers Science Center of Pathogenic Microbes and Infection, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
| | - Shibo Jiang
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Shanghai Frontiers Science Center of Pathogenic Microbes and Infection, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
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Bischof E. Mitigating COVID-19 Mortality and Morbidity in China's Aging Population: A Focus on Available Medications and Future Developments. Aging Dis 2023; 14:1967-1976. [PMID: 37199593 PMCID: PMC10676792 DOI: 10.14336/ad.2023.0318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/18/2023] [Indexed: 05/19/2023] Open
Abstract
The COVID-19 pandemic, often referred to as the geropandemic, has put immense pressure on global healthcare systems worldwide, leading to a rush in the development and approval of medications for the treatment of the viral infection. Clinical trials on efficacy and safety had a limited spectrum on inclusion and endpoints because of the urgent need for fast results. The chronologically and biologically aged population is especially at risk for severe or lethal disease, as well as treatment-associated toxicity. In China, the growing elderly population segment has been a focus in public health measurements of COVID-19, guiding towards herd immunity with a mild variant, thus minimizing overall deaths and morbidity. While the COVID-19 pandemic has now been reclassified and the virus weakened, there is a clear need for novel therapies to protect the elderly. This paper reviews the current safety and efficacy of available COVID-19 medications in China, with a specific focus on 3CL protease inhibitors and the aging population. The current COVID wave in China has demonstrated a significant impact on the elderly and the need for new drugs that are effective at low doses and can be used alone, without harmful side effects, generation of viral resistance, and drug-drug interactions. The rush to develop and approve COVID-19 medications has brought up important questions about the balance between speed and caution, resulting in a pipeline of novel therapies now moving through clinical trials, including third-generation 3CL protease inhibitors. A majority of those therapeutics are being developed in China.
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Affiliation(s)
- Evelyne Bischof
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Department of Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
- Shanghai University of Medicine and Health Sciences, Shanghai, China.
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He W, Xu K, Ni L, Wu J, Zhang Y, Miao K, Wang L, Wang DW. Myocardial injury and related mortality in hospitalized patients with COVID-19 during the Omicron pandemic: new perspectives and insights. Virol Sin 2023; 38:940-950. [PMID: 37839550 PMCID: PMC10786663 DOI: 10.1016/j.virs.2023.10.005] [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: 07/04/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023] Open
Abstract
Myocardial injury is one of the most common comorbidity in SARS-CoV-2 infected patients, and has poor prognosis. However, the incidence of myocardial injury in patients with SARS-CoV-2 infection has not been sufficiently investigated during the Omicron wave. We conducted a retrospective study of 2690 patients with confirmed SARS-CoV-2 Omicron infection from Tongji Hospital. The results indicated that the myocardial injury accounted for 30.8% of the total patients with SARS-CoV-2 infection and was associated with higher in-hospital mortality than those without injury before and after propensity score matching (PSM) [adjusted hazard ratio (HR), 10.61; 95% confidence interval (CI), 7.76-14.51; P < 0.001; adjusted HR, 2.70; 95% CI, 1.86-3.93; P < 0.001; respectively]. Further, the levels of cytokines (IL-1β, IL-6, IL-10, and TNF-α) in patients with myocardial injury were higher than those without injury, and the higher levels of cytokines in the myocardial injury group were associated with increased mortality. Administration of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB) could significantly reduce the mortality in patients with myocardial injury (adjusted HR, 0.52; 95% CI, 0.38-0.71; P < 0.001). Additionally, the level of angiotensin II increased in patients with SARS-CoV-2 infection was even higher in myocardial injury group compared to those without injury. Collectively, the study summarized the clinical characteristic and outcome of SARS-CoV-2 infected patients with myocardial injury during the Omicron wave in China, and validated the protective role of ACEI/ARB in improving the survival of those with myocardial injury.
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Affiliation(s)
- Wu He
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, China
| | - Ke Xu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, China
| | - Li Ni
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, China
| | - Junfang Wu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, China
| | - Yuxuan Zhang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, China
| | - Kun Miao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, China
| | - Luyun Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, 430030, China.
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