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Dai X, Chu X, Qi G, Yuan P, Zhou Y, Xiang H, Shi X. Worldwide Perinatal Intimate Partner Violence Prevalence and Risk Factors for Post-traumatic Stress Disorder in Women: A Systematic Review and Meta-analysis. TRAUMA, VIOLENCE & ABUSE 2024; 25:2363-2376. [PMID: 38001566 DOI: 10.1177/15248380231211950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
Post-traumatic stress disorder (PTSD) in women who have experienced perinatal intimate partner violence (P-IPV) has gradually attracted the attention of psychologists, mental health, and health care professionals. However, a comprehensive understanding of its prevalence and associated risk factors is still lacking. The aim of this systematic review and meta-analysis was to determine the prevalence and explore influencing factors for PTSD in women who have suffered P-IPV. Our study inclusion criteria were: women who experienced IPV in the year before conception, throughout pregnancy, during delivery, and up to 1 year after giving birth for which a quantitative assessment of PTSD was done using validated diagnostic or screening tools. This study searched nine English databases and four Chinese databases. The final analysis included 16 studies, involving 9,098 female subjects. Meta-analysis was performed on the extracted data using the Stata 16.0 software (Stata Corp. LP, College Station, TX, USA).Fixed or random effect models were selected to pool odds ratio (OR) and 95% confidence interval (CI) of PTSD after heterogeneity test. Meta-analysis showed that the pooled prevalence of PTSD in women who suffered P-IPV was 30.0% (95% confidence interval [95% CI] = [22.0%, 37.0%]). Only nine studies described influencing factors for PTSD based on multivariate logistic regression analysis. The five identified influencing factors were: non-immigrants (OR = 2.56; 95% CI [1.29, 5.08]), non-cohabitation (OR = 2.45; [1.35, 4.42]), trauma history (OR = 1.80; [1.18, 2.76]), education below senior high school (OR = 1.32; [0.64, 2.75]), and age 18 to 29 years (OR = 1.06; [0.94, 1.19]). These findings provided a reference value of PTSD prevalence, risk factors, and potential association with P-IPV among women worldwide. However, the geographical coverage of the reviewed studies is limited and epidemiological investigations from more diverse areas are required in the future.
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Affiliation(s)
- Xiu Dai
- Zunyi Medical University, Guizhou, China
| | | | - Guojia Qi
- Zunyi Medical University, Guizhou, China
| | - Ping Yuan
- Zunyi Medical University, Guizhou, China
| | - Yanna Zhou
- Zunyi Medical University, Guizhou, China
| | - Henry Xiang
- The Ohio State University College of Medicine, Columbus, USA
| | - Xiuquan Shi
- Zunyi Medical University, Guizhou, China
- The Ohio State University College of Medicine, Columbus, USA
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Elshiwy K, Amin GEED, Farres MN, Samir R, Allam MF. The role of colchicine in the management of COVID-19: a Meta-analysis. BMC Pulm Med 2024; 24:190. [PMID: 38641775 PMCID: PMC11031948 DOI: 10.1186/s12890-024-03001-0] [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: 07/04/2023] [Accepted: 04/08/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND The Coronavirus disease 2019 (COVID-19) pandemic has robustly affected the global healthcare and economic systems and it was caused by coronavirus-2 (SARS-CoV-2). The clinical presentation of the disease ranges from a flu-like illness to severe pneumonia and death. Till September 2022, the cumulative number of cases exceeded 600 million worldwide and deaths were more than 6 million. Colchicine is an alkaloid drug that is used in many autoinflammatory conditions e.g., gout, familial Mediterranean fever, and Behçet's syndrome. Colchicine inhibits the production of superoxide and the release of interleukins that stimulate the inflammatory cascade. Colchicine decreases the differentiation of myofibroblast and the release of fibrotic mediators including transforming growth factor (TGF-β1) that are related to the fibrosis. Moreover, colchicine has been used to traet viral myocarditis caused by CMV or EBV, interstitial pneumonia, and pericarditis resulting from influenza B infection. Additionally, colchicine is considered safe and affordable with wide availability. OBJECTIVE The aim of the current study was to assess the evidence of colchicine effectiveness in COVID-19 treatment. METHODS A comprehensive review of the literature was done till May 2022 and yielded 814 articles after ranking the articles according to authors and year of publication. Only 8 clinical trials and cohort studies fulfilling the inclusion criteria were included for further steps of data collection, analysis, and reporting. RESULTS This meta-analysis involved 16,488 patients; 8146 patients in the treatment group and 8342 patients in the control group. The results showed that colchicine resulted in a significant reduction in the mortality rate among patients received colchicine in comparison with placebo or standard care (RR 0.35, 95%CI: 0.15-0.79). Colchicine resulted in a significant decrease in the need for O2 therapy in patients with COVID-19 (RR 0.07, 95%CI 0.02-0.27, P = 0.000024). However, colchicine had no significant effect on the following outcomes among COVID-19 patients: the need for hospitalization, ICU admission, artificial ventilation, and hospital discharge rate. Among the PCR confirmed COVID-19 patients, colchicine decreased the hospitalization rate (RR 0.75, 95%CI 0.57-0.99, P = 0.042). However, colchicine had no effect on mortality and the need for mechanical ventilation among this subgroup. CONCLUSION Colchicine caused a significant clinical improvement among COVID-19 patients as compared with the standard care or placebo, in terms of the need for O2, and mortality. This beneficial effect could play a role in the management of COVID-19 especially severe cases to decrease need for oxygen and to decrease mortality among these patients.
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Affiliation(s)
- Kholoud Elshiwy
- Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Ghada Essam El-Din Amin
- Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Nazmy Farres
- Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rasha Samir
- Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Farouk Allam
- Department of Family Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Cordoba, 14004, Cordoba, Spain
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Rudroff T. Decoding Post-Viral Fatigue: The Basal Ganglia's Complex Role in Long-COVID. Neurol Int 2024; 16:380-393. [PMID: 38668125 PMCID: PMC11054322 DOI: 10.3390/neurolint16020028] [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: 02/20/2024] [Revised: 03/20/2024] [Accepted: 03/26/2024] [Indexed: 04/29/2024] Open
Abstract
Long-COVID afflicts millions with relentless fatigue, disrupting daily life. The objective of this narrative review is to synthesize current evidence on the role of the basal ganglia in long-COVID fatigue, discuss potential mechanisms, and highlight promising therapeutic interventions. A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science databases. Mounting evidence from PET, MRI, and functional connectivity data reveals basal ganglia disturbances in long-COVID exhaustion, including inflammation, metabolic disruption, volume changes, and network alterations focused on striatal dopamine circuitry regulating motivation. Theories suggest inflammation-induced signaling disturbances could impede effort/reward valuation, disrupt cortical-subcortical motivational pathways, or diminish excitatory input to arousal centers, attenuating drive initiation. Recent therapeutic pilots targeting basal ganglia abnormalities show provisional efficacy. However, heterogeneous outcomes, inconsistent metrics, and perceived versus objective fatigue discrepancies temper insights. Despite the growing research, gaps remain in understanding the precise pathways linking basal ganglia dysfunction to fatigue and validating treatment efficacy. Further research is needed to advance understanding of the basal ganglia's contribution to long-COVID neurological sequelae and offer hope for improving function across the expanding affected population.
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Affiliation(s)
- Thorsten Rudroff
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA; ; Tel.: +1-(319)-467-0363; Fax: +1-(319)-355-6669
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
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Danjuma MI, Sayed R, Aboughalia M, Hassona A, Elsayed BS, Elshafei M, Elzouki A. Does colchicine reduce mortality in patients with COVID-19 clinical syndrome? An umbrella review of published meta-analyses. Heliyon 2023; 9:e20155. [PMID: 37767472 PMCID: PMC10520783 DOI: 10.1016/j.heliyon.2023.e20155] [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: 04/15/2023] [Revised: 07/25/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Background Despite significant improvements in both treatment and prevention strategies, as well as multiple commissioned reviews, there remains uncertainty regarding the survival benefit of repurposed drugs such as colchicine in patients with Coronavirus Disease 2019 (COVID-19) clinical syndrome. Methods In this umbrella review, we carried out a comprehensive search of PubMed, EMBASE, Cochrane Database of Systematic Reviews, Science Citation Index, and the Database of Abstracts of Reviews of Effectiveness between January 1, 2020 and January 31, 2023 for systematic reviews and meta-analyses evaluating the mortality-reducing benefits of colchicine in patients with COVID-19. This was to ascertain the exact relationship between colchicine exposure and mortality outcomes in these cohorts of patients. We utilized A Measurement Tool to Assess systematic Reviews-2 (AMSTAR-2) to conduct an exhaustive methodological quality and risk of bias assessment of the included reviews. Results We included eighteen meta-analyses (n = 199,932 participants) in this umbrella review. Colchicine exposure was associated with an overall reduction of about 32% in the risk of mortality (odds ratio 0.68, confidence interval [CI] 0.58-0.78; I2 = 94%, p = 0.001). Further examination of pooled estimates of mortality outcomes by the quality effects model (corrected for the methodological quality and risk of bias of the constituent reviews) reported similar point estimates (OR 0.73; CI 0.59 to 0.91; I2 = 94%). Conclusion In a pooled umbrella evaluation of published meta-analyses of COVID-19 patient cohorts, exposure to colchicine was associated with a reduction in overall mortality. Although it remains uncertain if this effect could potentially be attenuated or augmented by COVID-19 vaccination.
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Affiliation(s)
- Mohammed I. Danjuma
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
- Department of Internal Medicine, Weill Cornell College of Medicine, New York, Doha, Qatar
- NHS Grampian (Dr. Grays Hospital), Scotland, UK
| | - Rana Sayed
- Department of Internal Medicine, Qatar University College of Medicine, Doha, Qatar
| | - Maryam Aboughalia
- Department of Internal Medicine, Qatar University College of Medicine, Doha, Qatar
| | - Aseel Hassona
- Department of Internal Medicine, Qatar University College of Medicine, Doha, Qatar
| | - Basant Selim Elsayed
- Department of Internal Medicine, Qatar University College of Medicine, Doha, Qatar
| | | | - Abdelnaser Elzouki
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
- Department of Internal Medicine, Weill Cornell College of Medicine, New York, Doha, Qatar
- Department of Internal Medicine, Qatar University College of Medicine, Doha, Qatar
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Zhang WZ. Uric acid en route to gout. Adv Clin Chem 2023; 116:209-275. [PMID: 37852720 DOI: 10.1016/bs.acc.2023.05.003] [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: 10/20/2023]
Abstract
Gout and hyperuricemia (HU) have generated immense attention due to increased prevalence. Gout is a multifactorial metabolic and inflammatory disease that occurs when increased uric acid (UA) induce HU resulting in monosodium urate (MSU) crystal deposition in joints. However, gout pathogenesis does not always involve these events and HU does not always cause a gout flare. Treatment with UA-lowering therapeutics may not prevent or reduce the incidence of gout flare or gout-associated comorbidities. UA exhibits both pro- and anti-inflammation functions in gout pathogenesis. HU and gout share mechanistic and metabolic connections at a systematic level, as shown by studies on associated comorbidities. Recent studies on the interplay between UA, HU, MSU and gout as well as the development of HU and gout in association with metabolic syndromes, non-alcoholic fatty liver disease (NAFLD), and cardiovascular, renal and cerebrovascular diseases are discussed. This review examines current and potential therapeutic regimens and illuminates the journey from disrupted UA to gout.
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Affiliation(s)
- Wei-Zheng Zhang
- VIDRL, The Peter Doherty Institute, Melbourne, VIC, Australia.
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Danjuma MI, Kaul R, Alyaarabi T, Elsayed B, Elshafei M. Colchicine and mortality outcomes in patients with coronavirus disease (COVID-19). Eur J Intern Med 2023; 112:126-127. [PMID: 36804360 PMCID: PMC9933322 DOI: 10.1016/j.ejim.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 02/18/2023]
Affiliation(s)
- Mohammed I Danjuma
- Department of Internal Medicine, Hamad Medical Corporation, Doha Qatar; Department of Internal Medicine, Weill Cornell College of Medicine, New York, and Doha Qatar.
| | - Ridhima Kaul
- Department of Internal Medicine, Weill Cornell College of Medicine, New York, and Doha Qatar
| | - Tamader Alyaarabi
- Department of Internal Medicine, Qatar University College of Medicine
| | - Basant Elsayed
- Department of Internal Medicine, Qatar University College of Medicine
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Zhang L, Dong Y, Lu Y, Mo R, He Q. Photolysis and cytotoxicity of the potentially toxic composition of daylily flower: colchicine. JOURNAL OF FOOD MEASUREMENT AND CHARACTERIZATION 2023. [PMCID: PMC9909145 DOI: 10.1007/s11694-023-01844-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The photolysis of colchicine under ultraviolet and visible light irradiation was studied by ultraviolet (UV) scanning and HPLC-MS. The photoproduct was proposed and the cytotoxicity change before and after irradiation was investigated. Results showed that both ultraviolet and visible light irradiation could effectively degrade colchicine into deacetamido-lumicolchicine. The process conformed to first-order kinetics, in which a high degradation rate (K = 0.5862 h− 1) was observed when colchicine was dissolved in ethanol and irradiated by UV light. Cell viability and cell cycle studies proved that a photolysis treatment of colchicine could weaken the cytotoxicity effectively. Colchicine inhibited the division of BRL 3 A cells in G2/M phase with an IC50 value of 0.48 µg/mL, while the toxic effect could be reduced significantly with IC50 2.1 µg/mL when colchicine was exposed to UV irradiation. Results are beneficial to the toxicity elimination of colchicine in the processing of daylily flower in food industry, and can also provide photochemistry reference for colchicine-related studies.
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Affiliation(s)
- Lin Zhang
- College of Biomass Science and Engineering, Sichuan University, 610065 Chengdu, P. R. China
| | - Yi Dong
- College of Biomass Science and Engineering, Sichuan University, 610065 Chengdu, P. R. China
| | - Yunhao Lu
- School of Food and Biological Engineering, Chengdu University, 610106 Chengdu, P. R. China
| | - Rui Mo
- College of Biomass Science and Engineering, Sichuan University, 610065 Chengdu, P. R. China
| | - Qiang He
- College of Biomass Science and Engineering, Sichuan University, 610065 Chengdu, P. R. China
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Eikelboom JW, Jolly SS, Belley-Cote EP, Whitlock RP, Rangarajan S, Xu L, Heenan L, Bangdiwala SI, Luz Diaz M, Diaz R, Yusufali A, Kumar Sharma S, Tarhuni WM, Hassany M, Avezum A, Harper W, Wasserman S, Almas A, Drapkina O, Felix C, Lopes RD, Berwanger O, Lopez-Jaramillo P, Anand SS, Bosch J, Choudhri S, Farkouh ME, Loeb M, Yusuf S. Colchicine and the combination of rivaroxaban and aspirin in patients hospitalised with COVID-19 (ACT): an open-label, factorial, randomised, controlled trial. THE LANCET. RESPIRATORY MEDICINE 2022; 10:1169-1177. [PMID: 36228641 PMCID: PMC9635892 DOI: 10.1016/s2213-2600(22)00298-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND COVID-19 disease is accompanied by a dysregulated immune response and hypercoagulability. The Anti-Coronavirus Therapies (ACT) inpatient trial aimed to evaluate anti-inflammatory therapy with colchicine and antithrombotic therapy with the combination of rivaroxaban and aspirin for prevention of disease progression in patients hospitalised with COVID-19. METHODS The ACT inpatient, open-label, 2 × 2 factorial, randomised, controlled trial was done at 62 clinical centres in 11 countries. Patients aged at least 18 years with symptomatic, laboratory confirmed COVID-19 who were within 72 h of hospitalisation or worsening clinically if already hospitalised were randomly assigned (1:1) to receive colchicine 1·2 mg followed by 0·6 mg 2 h later and then 0·6 mg twice daily for 28 days versus usual care; and in a second (1:1) randomisation, to the combination of rivaroxaban 2·5 mg twice daily plus aspirin 100 mg once daily for 28 days versus usual care. Investigators and patients were not masked to treatment allocation. The primary outcome, assessed at 45 days in the intention-to-treat population, for the colchicine randomisation was the composite of the need for high-flow oxygen, mechanical ventilation, or death; and for the rivaroxaban plus aspirin randomisation was the composite of major thrombosis (myocardial infarction, stroke, acute limb ischaemia, or pulmonary embolism), the need for high-flow oxygen, mechanical ventilation, or death. The trial is registered at www. CLINICALTRIALS gov, NCT04324463 and is ongoing. FINDINGS Between Oct 2, 2020, and Feb 10, 2022, at 62 sites in 11 countries, 2749 patients were randomly assigned to colchicine or control and the combination of rivaroxaban and aspirin or to the control. 2611 patients were included in the analysis of colchicine (n=1304) versus control (n=1307); 2119 patients were included in the analysis of rivaroxaban and aspirin (n=1063) versus control (n=1056). Follow-up was more than 98% complete. Overall, 368 (28·2%) of 1304 patients allocated to colchicine and 356 (27·2%) of 1307 allocated to control had a primary outcome (hazard ratio [HR] 1·04, 95% CI 0·90-1·21, p=0·58); and 281 (26·4%) of 1063 patients allocated to the combination of rivaroxaban and aspirin and 300 (28·4%) of 1056 allocated to control had a primary outcome (HR 0·92, 95% CI 0·78-1·09, p=0·32). Results were consistent in subgroups defined by vaccination status, disease severity at baseline, and timing of randomisation in relation to onset of symptoms. There was no increase in the number of patients who had at least one serious adverse event for colchicine versus control groups (87 [6·7%] of 1304 vs 90 [6·9%] of 1307) or with rivaroxaban and aspirin versus control groups (85 [8·0%] vs 91 [8·6%]). Among patients assigned to colchicine, 8 (0·61%) had adverse events that led to discontinuation of study drug, mostly gastrointestinal in nature. 17 (1·6%) patients assigned to the combination of rivaroxaban and aspirin had bleeding compared with seven (0·66%) of those allocated to control (p=0·042); the number of serious bleeding events was two (0·19%) versus six (0·57%), respectively (p=0·18). No patients assigned to rivaroxaban and aspirin had serious adverse events that led to discontinuation of study drug. INTERPRETATION Among patients hospitalised with COVID-19, neither colchicine nor the combination of rivaroxaban and aspirin prevent disease progression or death. FUNDING Canadian Institutes for Health Research, Bayer, Population Health Research Institute, Hamilton Health Sciences Research Institute, Thistledown Foundation. TRANSLATIONS For the Portuguese, Russian and Spanish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- John W Eikelboom
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada,Department of Medicine, McMaster University, Hamilton, ON, Canada,Correspondence to: Prof John W Eikelboom, Population Health Research Institute, Hamilton, ON L8L 2X2, Canada
| | - Sanjit S Jolly
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Emilie P Belley-Cote
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Richard P Whitlock
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada,Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada
| | - Lizhen Xu
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada
| | - Laura Heenan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada
| | - Shrikant I Bangdiwala
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada
| | - Maria Luz Diaz
- Estudios Clínicos Latino América, Instituto Cardiovascular de Rosario, Rosario, Argentina
| | - Rafael Diaz
- Estudios Clínicos Latino América, Instituto Cardiovascular de Rosario, Rosario, Argentina
| | - Afzalhussein Yusufali
- Hatta Hospital, Dubai Medical College, Dubai Health Authority, Dubai, United Arab Emirates
| | | | - Wadea M Tarhuni
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada,Department of Medicine, Western University, Clinical Skills Building London, ON, Canada,Windsor Cardiac Centre, Windsor, ON, Canada
| | - Mohamed Hassany
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - William Harper
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada
| | - Sean Wasserman
- Wellcome Centre for Infectious Diseases Research in Africa, Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa,Division of Infectious Diseases and HIV Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Aysha Almas
- Section of Internal Medicine, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Oxana Drapkina
- National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia
| | - Camilo Felix
- Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Ecuador
| | - Renato D Lopes
- Division of Cardiology, Duke University Medical Center, Duke Clinical Research Institute, NC, USA
| | | | | | - Sonia S Anand
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jackie Bosch
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada,School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | | | - Michael E Farkouh
- Peter Munk Cardiac Centre, University of Toronto, Toronto, ON, Canada
| | - Mark Loeb
- Departments of Pathology and Molecular Medicine and Health Evidence Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada,Department of Surgery, McMaster University, Hamilton, ON, Canada
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FRAGILE-COLCOVID19: A Clinical Trial Based on Early Administration of an Oral Combination of Colchicine and Prednisone in Elderly Patients with COVID-19 in Geriatric Facilities. Clin Drug Investig 2022; 42:949-964. [PMID: 36173596 PMCID: PMC9521010 DOI: 10.1007/s40261-022-01201-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Unprotected and fragile elderly people in nursing homes experienced the highest mortality rates during the initial coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVE Our aim was to study the role of two oral anti-inflammatory drugs, colchicine and prednisone, in elderly patients with COVID-19 in geriatric centers. METHODS A phase II/III, randomized, controlled, multicenter clinical trial was performed in a geriatric population comparing the efficacy and safety of an oral combination of prednisone (60 mg/day for 3 days) and colchicine (at loading doses of 1-1.5 mg/day for 3 days, followed by 0.5 mg/day for 11 days) with the standard treatment, based on intravenous dexamethasone. Primary endpoints assessed the efficacy in reducing death or the modified endpoint death/therapeutic failure to the study drugs over a 28-day period, while secondary endpoints included safety, laboratory changes, and additional therapies used. RESULTS Fifty-four patients (35 female/19 male) were enrolled, 25 (46.3%) of whom were allocated to the experimental arm and 29 (53.7%) to the control arm. At day 28, no differences in deaths were observed. The combination of mortality or therapeutic failure occurred in 12 (45.13%) patients receiving dexamethasone and 6 (28.13%) patients receiving colchicine/prednisone, resulting in a reduction of risk difference (RD) of - 17% (p = 0.17), with an average reduction of 39% (risk ratio [RR] 0.61) in patients receiving colchicine/prednisone (p = 0.25). Control patients received higher amounts of additional glucocorticoids (p = 0.0095) over a longer time frame (p = 0.0003). Colchicine/prednisone significantly reduced ferritin levels at day 14, as well as D-dimer and lactate dehydrogenase (LDH) levels at day 28. Adverse events were similar in both groups. CONCLUSIONS The combination colchicine/prednisone compared with intravenous dexamethasone has shown a remarkable trend to increase disease survival over a 28-day period in elderly patients requiring oxygen therapy in geriatric centers, without safety issues. CLINICAL TRIAL REGISTRY Clinical Trials Registration Number: NCT04492358.
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