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Rohde MD, French B, Stewart TG, Harrell FE. Bayesian transition models for ordinal longitudinal outcomes. Stat Med 2024. [PMID: 38853380 DOI: 10.1002/sim.10133] [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: 12/13/2023] [Revised: 04/22/2024] [Accepted: 05/23/2024] [Indexed: 06/11/2024]
Abstract
Ordinal longitudinal outcomes are becoming common in clinical research, particularly in the context of COVID-19 clinical trials. These outcomes are information-rich and can increase the statistical efficiency of a study when analyzed in a principled manner. We present Bayesian ordinal transition models as a flexible modeling framework to analyze ordinal longitudinal outcomes. We develop the theory from first principles and provide an application using data from the Adaptive COVID-19 Treatment Trial (ACTT-1) with code examples in R. We advocate that researchers use ordinal transition models to analyze ordinal longitudinal outcomes when appropriate alongside standard methods such as time-to-event modeling.
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Affiliation(s)
- Maximilian D Rohde
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Thomas G Stewart
- School of Data Science, University of Virginia, Charlottesville, Virginia, USA
| | - Frank E Harrell
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Molaei E, Molaei A, Hayes AW, Karimi G. Remdesivir: treatment of COVID-19 in special populations. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:3829-3855. [PMID: 38180557 DOI: 10.1007/s00210-023-02927-2] [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: 07/06/2023] [Accepted: 12/23/2023] [Indexed: 01/06/2024]
Abstract
Remdesivir (RDV) is the mainstay antiviral therapy for moderate to severe COVID-19. Although remdesivir was the first drug approved for COVID-19, information about its efficacy and safety profile is limited in a significant segment of the population, such as people with underlying diseases, the elderly, children, and pregnant and lactating women. The efficacy and safety profile of RDV in disease progression, renal impairment, liver impairment, immunosuppression, geriatrics, pediatrics, pregnancy, and breastfeeding in COVID-19 patients was evaluated. The databases searched included Embase, Scopus, and PubMed. Only English language studies enrolling specific subpopulations with COVID-19 and treated with RDV were included. Thirty-nine clinical trials, cohorts, cross-sectional studies, and case series/reports were included. Most supported the benefits of RDV therapy for COVID-19 patients, such as lessening the duration of hospitalization, alleviating respiratory complications, and reducing mortality. Adverse effects of RDV, including liver and kidney impairment, were, for the most part, moderate to mild, supporting the safety profile of RDV therapy. RDV therapy was well tolerated, no new safety signals were detected, and liver function test abnormalities were the most common adverse events. Moreover, RDV, for the most part, was effective in managing the complications of COVID-19 and reducing mortality in these patients, except for patients with kidney impairment. Future studies, including RCTs, should include these subpopulations of patients to avoid delays associated with receiving proper medication through compassionate use programs.
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Affiliation(s)
- Emad Molaei
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Molaei
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - A Wallace Hayes
- University of South Florida College of Public Health, Tampa, FL, USA
- Institute for Integrative Toxicology, Michigan State University, East Lansing, MI, USA
| | - Gholamreza Karimi
- Pharmaceutical Research Center, Institute of Pharmaceutical Technology, Mashhad University of Medical Sciences, Mashhad, Iran.
- Department of Pharmacodynamics and Toxicology, Faculty of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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Blair HA. Remdesivir: A Review in COVID-19. Drugs 2023; 83:1215-1237. [PMID: 37589788 PMCID: PMC10474216 DOI: 10.1007/s40265-023-01926-0] [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: 07/25/2023] [Indexed: 08/18/2023]
Abstract
Remdesivir (Veklury®), a nucleotide analogue prodrug with broad-spectrum antiviral activity, is approved for the treatment of coronavirus disease 2019 (COVID-19), the illness caused by severe acute respiratory syndrome coronavirus 2 infection. Unlike some antivirals, remdesivir has a low potential for drug-drug interactions. In the pivotal ACTT-1 trial in hospitalized patients with COVID-19, daily intravenous infusions of remdesivir significantly reduced time to recovery relative to placebo. Subsequent trials provided additional support for the efficacy of remdesivir in hospitalized patients with moderate or severe COVID-19, with a greater benefit seen in patients with minimal oxygen requirements at baseline. Clinical trials also demonstrated the efficacy of remdesivir in other patient populations, including outpatients at high risk for progression to severe COVID-19, as well as hospitalized paediatric patients. In terms of mortality, results were equivocal. However, remdesivir appeared to have a small mortality benefit in hospitalized patients who were not already being ventilated at baseline. Remdesivir was generally well tolerated in clinical trials, but pharmacovigilance data found an increased risk of hepatic, renal and cardiovascular adverse drug reactions in the real-world setting. In conclusion, remdesivir represents a useful treatment option for patients with COVID-19, particularly those who require supplemental oxygen.
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Affiliation(s)
- Hannah A Blair
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
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Akinosoglou K, Rigopoulos EA, Schinas G, Kaiafa G, Polyzou E, Tsoupra S, Tzouvelekis A, Gogos C, Savopoulos C. Remdesivir Use in the Real-World Setting: An Overview of Available Evidence. Viruses 2023; 15:v15051167. [PMID: 37243253 DOI: 10.3390/v15051167] [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: 04/29/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
In the years of Coronavirus Disease 2019 (COVID-19), various treatment options have been utilized. COVID-19 continues to circulate in the global population, and the evolution of the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has posed significant challenges to the treatment and prevention of infection. Remdesivir (RDV), an anti-viral agent with in vitro efficacy against coronaviruses, is a potent and safe treatment as suggested by a plethora of in vitro and in vivo studies and clinical trials. Emerging real-world data have confirmed its effectiveness, and there are currently datasets evaluating its efficacy and safety against SARS-CoV-2 infections in various clinical scenarios, including some that are not in the SmPC recommendations according for COVID-19 pharmacotherapy. Remdesivir increases the chance of recovery, reduces progression to severe disease, lowers mortality rates, and exhibits beneficial post-hospitalization outcomes, especially when used early in the course of the disease. Strong evidence suggests the expansion of remdesivir use in special populations (e.g., pregnancy, immunosuppression, renal impairment, transplantation, elderly and co-medicated patients) where the benefits of treatment outweigh the risk of adverse effects. In this article, we attempt to overview the available real-world data of remdesivir pharmacotherapy. With the unpredictable course of COVID-19, we need to utilize all available knowledge to bridge the gap between clinical research and clinical practice and be sufficiently prepared for the future.
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Affiliation(s)
- Karolina Akinosoglou
- Division of Internal Medicine, University General Hospital of Patras, 265 04 Patras, Greece
- School of Medicine, University of Patras, 265 04 Patras, Greece
| | | | | | - Georgia Kaiafa
- 1st Medical Propedeutic Department of Internal Medicine, AHEPA, University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Eleni Polyzou
- Division of Internal Medicine, University General Hospital of Patras, 265 04 Patras, Greece
- School of Medicine, University of Patras, 265 04 Patras, Greece
| | - Stamatia Tsoupra
- Division of Internal Medicine, University General Hospital of Patras, 265 04 Patras, Greece
- School of Medicine, University of Patras, 265 04 Patras, Greece
| | - Argyrios Tzouvelekis
- School of Medicine, University of Patras, 265 04 Patras, Greece
- Department of Pulmonology, University General Hospital of Patras, 265 04 Patras, Greece
| | | | - Christos Savopoulos
- 1st Medical Propedeutic Department of Internal Medicine, AHEPA, University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
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Hernández-Aceituno A, García-Hernández A, Larumbe-Zabala E. COVID-19 long-term sequelae: Omicron versus Alpha and Delta variants. Infect Dis Now 2023; 53:104688. [PMID: 36858287 PMCID: PMC9970656 DOI: 10.1016/j.idnow.2023.104688] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/10/2023] [Accepted: 02/17/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND The study aimed to assess the association between three predominant SARS-CoV-2 variants (Alpha, Delta, and Omicron) and the risk of developing long COVID (persistence of physical, medical, and cognitive symptoms more than 4 weeks after infection), post-COVID-19 syndrome (symptoms extending beyond 12 weeks), and viral persistence (testing positive beyond 4 weeks despite clinical resolution). METHODS Retrospective study of 325 patients hospitalized for COVID-19 with genomic sequencing information. For each SARS-CoV-2 variant, sample characteristics, frequency of symptoms, and long-term sequelae were compared using Chi-squared test, Fisher's exact test, Kruskal-Wallis test, and Dunn's test as appropriate. Odds ratios (OR) were calculated using logistic regression models to assess the association of risk factors and sequelae. RESULTS The adjusted model showed that the Omicron (vs Alpha) variant (OR, 0.30; 95% CI0.16-0.56), admission to ICU (OR, 1.14; 95% CI 1.05-1.23), and being treated with antiviral or immunomodulatory drugs (OR, 2.01; 95% CI 1.23-3.27) predicted long COVID and post-COVID-19 syndrome. Viral persistence showed no difference between variants. CONCLUSIONS The Omicron variant was associated with significantly lower odds of developing long-term sequelae from COVID-19 compared with previous variants, while severity of illness indicators increased the risk. Vaccination status, age, sex, and comorbidities were not found to predict sequelae development. This information has implications for both health managers and clinicians when deciding on the appropriate clinical management and subsequent outpatient follow-up of these patients. More studies with non-hospitalized patients are still necessary.
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Affiliation(s)
- Ana Hernández-Aceituno
- Dirección General de Salud Pública, Canary Islands, Spain; Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
| | - Abigail García-Hernández
- Dirección General de Salud Pública, Canary Islands, Spain,Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Eneko Larumbe-Zabala
- Dirección General de Salud Pública, Canary Islands, Spain,Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Canary Islands, Spain
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Stevaert A, Groaz E, Naesens L. Nucleoside analogs for management of respiratory virus infections: mechanism of action and clinical efficacy. Curr Opin Virol 2022; 57:101279. [PMID: 36403338 PMCID: PMC9671222 DOI: 10.1016/j.coviro.2022.101279] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/14/2022] [Accepted: 10/20/2022] [Indexed: 11/18/2022]
Abstract
The COVID-19 pandemic has accelerated the development of nucleoside analogs to treat respiratory virus infections, with remdesivir being the first compound to receive worldwide authorization and three other nucleoside analogs (i.e. favipiravir, molnupiravir, and bemnifosbuvir) in the pipeline. Here, we summarize the current knowledge concerning their clinical efficacy in suppressing the virus and reducing the need for hospitalization or respiratory support. We also mention trials of favipiravir and lumicitabine, for influenza and respiratory syncytial virus, respectively. Besides, we outline how nucleoside analogs interact with the polymerases of respiratory viruses, to cause lethal virus mutagenesis or disturbance of viral RNA synthesis. In this way, we aim to convey the key findings on this rapidly evolving class of respiratory virus medication.
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Affiliation(s)
- Annelies Stevaert
- Rega Institute for Medical Research, Department of Microbiology, Immunology and Transplantation, KU Leuven, Herestraat 49 box 1043, B-3000 Leuven, Belgium
| | - Elisabetta Groaz
- Rega Institute for Medical Research, Medicinal Chemistry, KU Leuven, Herestraat 49 box 1041, B-3000 Leuven, Belgium; Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Via Marzolo 5, 35131 Padova, Italy
| | - Lieve Naesens
- Rega Institute for Medical Research, Department of Microbiology, Immunology and Transplantation, KU Leuven, Herestraat 49 box 1043, B-3000 Leuven, Belgium.
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Takeshita Y, Terada J, Hirasawa Y, Kinoshita T, Tajima H, Koshikawa K, Kinouchi T, Isaka Y, Shionoya Y, Fujikawa A, Kato Y, To Y, Tada Y, Tsushima K. Development of a novel score model to predict hyperinflammation in COVID-19 as a forecast of optimal steroid administration timing. Front Med (Lausanne) 2022; 9:935255. [PMID: 36017008 PMCID: PMC9395649 DOI: 10.3389/fmed.2022.935255] [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] [Received: 05/03/2022] [Accepted: 07/15/2022] [Indexed: 12/15/2022] Open
Abstract
ObjectivesThis study aims to create and validate a useful score system predicting the hyper-inflammatory conditions of COVID-19, by comparing it with the modified H-score.MethodsA total of 98 patients with pneumonia (without oxygen therapy) who received initial administration of casirivimab/imdevimab or remdesivir were included in the study. The enrolled patients were divided into two groups: patients who required corticosteroid due to deterioration of pneumonia, assessed by chest X-ray or CT or respiratory failure, and those who did not, and clinical parameters were compared.ResultsSignificant differences were detected in respiratory rate, breaths/min, SpO2, body temperature, AST, LDH, ferritin, and IFN-λ3 between the two groups. Based on the data, we created a corticosteroid requirement score: (1) the duration of symptom onset to treatment initiation ≥ 7 d, (2) the respiratory rate ≥ 22 breaths/min, (3) the SpO2 ≤ 95%, (4) BT ≥ 38.5°C, (5) AST levels ≥ 40 U/L, (6) LDH levels ≥ 340 U/L, (7) ferritin levels ≥ 800 ng/mL, and (8) IFN-λ3 levels ≥ 20 pg/mL. These were set as parameters of the steroid predicting score. Results showed that the area under the curve (AUC) of the steroid predicting score (AUC: 0.792, 95%CI: 0.698–0.886) was significantly higher than that of the modified H-score (AUC: 0.633, 95%CI: 0.502–0.764).ConclusionThe steroid predicting score may be useful to predict the requirement of corticosteroid therapy in patients with COVID-19. The data may provide important information to facilitate a prospective study on a larger scale in this field.
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Affiliation(s)
- Yuichiro Takeshita
- Department of Pulmonary Medicine, International University of Health and Welfare Narita Hospital, Narita, Japan
- *Correspondence: Yuichiro Takeshita
| | - Jiro Terada
- Department of Pulmonary Medicine, International University of Health and Welfare Narita Hospital, Narita, Japan
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasutaka Hirasawa
- Department of Pulmonary Medicine, International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Taku Kinoshita
- Department of Pulmonary Medicine, International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Hiroshi Tajima
- Department of Pulmonary Medicine, International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Ken Koshikawa
- Department of Pulmonary Medicine, International University of Health and Welfare Narita Hospital, Narita, Japan
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Toru Kinouchi
- Department of Pulmonary Medicine, International University of Health and Welfare Narita Hospital, Narita, Japan
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuri Isaka
- Department of Pulmonary Medicine, International University of Health and Welfare Narita Hospital, Narita, Japan
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yu Shionoya
- Department of Pulmonary Medicine, International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Atsushi Fujikawa
- Department of Pulmonary Medicine, International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Yasuyuki Kato
- Department of Infectious Disease, International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Yasuo To
- Department of Pulmonary Medicine, International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Yuji Tada
- Department of Pulmonary Medicine, International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Kenji Tsushima
- Department of Pulmonary Medicine, International University of Health and Welfare Narita Hospital, Narita, Japan
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Butt B, Hussain T, Jarrar M, Khalid K, Albaker W, Ambreen A, Waheed Y. Efficacy and Safety of Remdesivir in COVID-19 Positive Dialysis Patients. Antibiotics (Basel) 2022; 11:antibiotics11020156. [PMID: 35203759 PMCID: PMC8868295 DOI: 10.3390/antibiotics11020156] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/20/2022] [Accepted: 01/22/2022] [Indexed: 02/07/2023] Open
Abstract
(1) Background: Immune compromised hemodialysis patients are more likely to develop COVID-19 infections, which increase the risk of mortality. The benefits of Remdesivir, despite less literature support on its effectiveness in dialysis patients due to renal toxicity, can outweigh the risks if prescribed early. The aim of this study was to evaluate the efficacy of Remdesivir on the 30-day in-hospital clinical outcome of hemodialysis population with COVID-19 infection and safety endpoints of adverse events. (2) Study design: A prospective quasi-experimental study design was used in the study. (3) Methods: The sample population consisted of 83 dialysis patients with COVID-19 who were administered Remdesivir at a dose of 100 mg before hemodialysis, as per hospital protocol. After the treatment with Remdesivir, we assessed the outcomes across two endpoints, namely primary (surviving vs. dying) as well as clinical and biochemical changes (ferritin, liver function test, C-reactive protein, oxygen requirements, and lactate dehydrogenase levels) and secondary (adverse effects, such as diarrhea, rise in ALT). In Kaplan-Meier analysis, the survival probabilities were compared between patients who received Remdesivir within 48 h of diagnosis and those who received it after 48 h. Cox regression analysis was employed to determine the predictors of outcome. (4) Results: Of the 83 patients, 91.5% survived and 8.4% died. Remdesivir administration did not reduce the death rate overall. Hospital stays were shorter (p = 0.03) and a nasopharyngeal swab for COVID-19 was negative earlier (p = 0.001) in survivors who had received Remdesivir within 48 h of diagnosis compared to those who had received Remdesivir after 48 h. The only variables linked to the 30-day mortality were serum CRP (p = 0.028) and TLC (p = 0.013). No major adverse consequences were observed with Remdesivir. (5) Conclusions: Remdesivir has the potential to shorten the recovery time for dialysis patients if taken within 48 h of onset of symptoms, without any adverse effects.
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Affiliation(s)
- Batool Butt
- Department of Medicine, Foundation University Islamabad, Islamabad 44000, Pakistan;
| | - Tajamul Hussain
- Research Chair for Biomedical Application of Nanomaterials, Biochemistry Department, College of Science, King Saud University, Riyadh 11451, Saudi Arabia;
- Center of Excellence in Biotechnology Research, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mu’taman Jarrar
- Vice Deanship for Quality and Development, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia;
- Medical Education Department, King Fahd Hospital of the University, Al-Khobar 34445, Saudi Arabia
| | - Kashaf Khalid
- Multidisciplinary Laboratory, Foundation University Islamabad, Islamabad 44000, Pakistan;
| | - Waleed Albaker
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia;
| | - Asma Ambreen
- Department of Medicine, Fauji Foundation Hospital, Rawalpindi 45000, Pakistan;
| | - Yasir Waheed
- Multidisciplinary Laboratory, Foundation University Islamabad, Islamabad 44000, Pakistan;
- Correspondence:
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