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Li Y, Huo S, Yin Z, Tian Z, Huang F, Liu P, Liu Y, Yu F. Retracted and republished from: "The current state of research on influenza antiviral drug development: drugs in clinical trial and licensed drugs". mBio 2024; 15:e0017524. [PMID: 38551343 PMCID: PMC11077966 DOI: 10.1128/mbio.00175-24] [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: 05/09/2024] Open
Abstract
Influenza viruses (IVs) threaten global human health due to the high morbidity, infection, and mortality rates. Currently, the influenza drugs recommended by the Food and Drug Administration are oseltamivir, zanamivir, peramivir, and baloxavir marboxil. These recommended antivirals are currently effective for major subtypes of IVs as the compounds target conserved domains in neuraminidase or polymerase acidic (PA) protein. However, this trend may gradually change due to the selection of antiviral drugs and the natural evolution of IVs. Therefore, there is an urgent need to develop drugs related to the treatment of influenza to deal with the next pandemic. Here, we summarized the cutting-edge research in mechanism of action, inhibitory activity, and clinical efficacy of drugs that have been approved and drugs that are still in clinical trials for influenza treatment. We hope this review will provide up-to-date and comprehensive information on influenza antivirals and generate hypotheses for screens and development of new broad-spectrum influenza drugs in the near future.
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Affiliation(s)
- Yanbai Li
- Hebei Key Laboratory of Analysis and Control of Zoonotic Pathogenic Microorganism, Hebei Wild Animal Health Center, College of Life Sciences, Hebei Agricultural University, Baoding, China
| | - Shanshan Huo
- Hebei Key Laboratory of Analysis and Control of Zoonotic Pathogenic Microorganism, Hebei Wild Animal Health Center, College of Life Sciences, Hebei Agricultural University, Baoding, China
| | - Zhe Yin
- Hebei Key Laboratory of Analysis and Control of Zoonotic Pathogenic Microorganism, Hebei Wild Animal Health Center, College of Life Sciences, Hebei Agricultural University, Baoding, China
| | - Zuguang Tian
- Department of High-Tech Development, Baoding City Science and Technology Bureau, Baoding, China
| | - Fang Huang
- Epidemic Prevention Laboratory, Tongzhou District Center For Animal Disease Control and Prevention, Beijing, China
| | - Peng Liu
- Hebei Key Laboratory of Analysis and Control of Zoonotic Pathogenic Microorganism, Hebei Wild Animal Health Center, College of Life Sciences, Hebei Agricultural University, Baoding, China
| | - Yue Liu
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
| | - Fei Yu
- Hebei Key Laboratory of Analysis and Control of Zoonotic Pathogenic Microorganism, Hebei Wild Animal Health Center, College of Life Sciences, Hebei Agricultural University, Baoding, China
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Han X, Chen L, Guo L, Wu L, Alwalid O, Liu J, Zheng Y, Chen L, Wu W, Li H, Luo Q, Zhao H, Zhang L, Bai Y, Sun B, Sun T, Gui Y, Nie T, Chen L, Yang F, Fan Y, Shi H, Zheng C. Long-term Radiological and Pulmonary Function Abnormalities at 3-year post COVID-19 Hospitalization: A Longitudinal Cohort Study. Eur Respir J 2024:2301612. [PMID: 38387969 DOI: 10.1183/13993003.01612-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/03/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND This study aimed to evaluate the longitudinal progression of residual lung abnormalities (ground-glass opacities, reticulations, and fibrotic-like changes) and pulmonary function, three years following coronavirus disease 2019(COVID-19). METHODS This prospective, longitudinal cohort study enrolled COVID-19 survivors who exhibited residual lung abnormalities upon discharge from two hospitals. Follow-up assessments were conducted at 6 months, 12 months, 2 years, and 3 years post-discharge, and included pulmonary function tests, 6-minute walk distance (6MWD), chest CT scans, and symptom questionnaires. Non-COVID-19 controls were retrospectively recruited for comparative analysis. RESULTS 728 COVID-19 survivors and 792 controls were included. From 6 months to 3 years, there was a gradual improvement in reduced diffusing capacity of the lungs for carbon monoxide (DLCO<80% predicted, 49% versus 38%, p=0.001), 6MWD (496 m versus 510 m, p=0.002) and residual lung abnormalities(46% versus 36%, p<0.001), regardless of the disease severity. Patients with residual lung abnormalities at 3 years more commonly had respiratory symptoms (32% versus 16%, p<0.001), lower 6MWD (494 m versus 510 m, p=0.003), and abnormal DLCO (57% versus 27%, p<0.001) compared to those with complete resolution. Compared to the controls, the proportion of DLCO impairment (38% versus 17%, p<0.001) and respiratory symptoms (23% versus 2.2%, p<0.001) were significantly higher in the matched COVID-19 survivors at the 3-year follow-up. CONCLUSIONS Most patients exhibited improvement in radiological abnormalities and pulmonary function over time following COVID-19. However, more than one-third continued to have persistent lung abnormalities at the 3-year mark, which were associated with respiratory symptoms and reduced diffusion capacity.
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Affiliation(s)
- Xiaoyu Han
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province , The People's Republic of China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, The People's Republic of China
- Xiaoyu Han, Lu Chen, LiYan Guo and Linxia Wu contributed equally to this work
| | - Lu Chen
- Department of Radiology, Wuhan Jinyintan Hospital, Tongji Medical College of HuaZhong University of Science and Technology, Wuhan, The People's Republic of China
- Xiaoyu Han, Lu Chen, LiYan Guo and Linxia Wu contributed equally to this work
| | - Liyan Guo
- Department of Function, Wuhan Jinyintan Hospital, Tongji Medical College of HuaZhong University of Science and Technology, Wuhan, The People's Republic of China
- Xiaoyu Han, Lu Chen, LiYan Guo and Linxia Wu contributed equally to this work
| | - Linxia Wu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province , The People's Republic of China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, The People's Republic of China
- Xiaoyu Han, Lu Chen, LiYan Guo and Linxia Wu contributed equally to this work
| | - Osamah Alwalid
- Department of Diagnostic Imaging, Sidra Medicine, Doha, Qatar
| | - Jie Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province , The People's Republic of China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, The People's Republic of China
| | - Yuting Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province , The People's Republic of China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, The People's Republic of China
| | - Leqing Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province , The People's Republic of China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, The People's Republic of China
| | - Wenlong Wu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province , The People's Republic of China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, The People's Republic of China
| | - Hanting Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province , The People's Republic of China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, The People's Republic of China
| | - Qinyue Luo
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province , The People's Republic of China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, The People's Republic of China
| | - Huangxuan Zhao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province , The People's Republic of China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, The People's Republic of China
| | - Lijie Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province , The People's Republic of China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, The People's Republic of China
| | - Yaowei Bai
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province , The People's Republic of China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, The People's Republic of China
| | - Bo Sun
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province , The People's Republic of China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, The People's Republic of China
| | - Tao Sun
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province , The People's Republic of China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, The People's Republic of China
| | - Yuxi Gui
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province , The People's Republic of China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, The People's Republic of China
| | - Tong Nie
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province , The People's Republic of China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, The People's Republic of China
| | - Lei Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province , The People's Republic of China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, The People's Republic of China
| | - Fan Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province , The People's Republic of China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, The People's Republic of China
- Fan Yang, Yanqing Fan, Heshui Shi and Chuansheng Zheng contributed equally to this work
| | - Yanqing Fan
- Department of Radiology, Wuhan Jinyintan Hospital, Tongji Medical College of HuaZhong University of Science and Technology, Wuhan, The People's Republic of China
- Fan Yang, Yanqing Fan, Heshui Shi and Chuansheng Zheng contributed equally to this work
| | - Heshui Shi
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province , The People's Republic of China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, The People's Republic of China
- Fan Yang, Yanqing Fan, Heshui Shi and Chuansheng Zheng contributed equally to this work
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province , The People's Republic of China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, The People's Republic of China
- Fan Yang, Yanqing Fan, Heshui Shi and Chuansheng Zheng contributed equally to this work
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Rauch-Kröhnert U, Puccini M, Placzek M, Beyer-Westendorf J, Jakobs K, Friebel J, Hein S, Seidel M, Pieske B, Massberg S, Witzenrath M, Zeiher A, Friede T, Anker SD, Landmesser U. Initial therapeutic anticoagulation with rivaroxaban compared to prophylactic therapy with heparins in moderate to severe COVID-19: results of the COVID-PREVENT randomized controlled trial. Clin Res Cardiol 2023; 112:1620-1638. [PMID: 37407731 PMCID: PMC10584737 DOI: 10.1007/s00392-023-02240-1] [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: 04/01/2023] [Accepted: 05/30/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND COVID-19 is associated with a prothrombotic state. Current guidelines recommend prophylactic anticoagulation upon hospitalization. METHODS COVID-PREVENT, an open-label, multicenter, randomized, clinical trial enrolled patients (≥ 18 years) with moderate to severe COVID-19 and age-adjusted D-dimers > 1.5 upper limit of normal (ULN). The participants were randomly assigned (1:1) to receive either therapeutic anticoagulation with rivaroxaban 20 mg once daily or thromboprophylaxis with a heparin (SOC) for at least 7 days followed by prophylactic anticoagulation with rivaroxaban 10 mg once daily for 28 days or no thromboprophylaxis. The primary efficacy outcome was the D-dimer level and the co-primary efficacy outcome the 7-category ordinal COVID-19 scale by WHO at 7 days post randomization. The secondary outcome was time to the composite event of either venous or arterial thromboembolism, new myocardial infarction, non-hemorrhagic stroke, all-cause death or progression to intubation and invasive ventilation up to 35 days post randomization. RESULTS The primary efficacy outcome D-dimer at 7 days was not different between patients assigned to therapeutic (n = 55) or prophylactic anticoagulation (n = 56) (1.21 mg/L [0.79, 1.86] vs 1.27 mg/L [0.79, 2.04], p = 0.78). In the whole study population D-dimer was significantly lower at 7 days compared to baseline (1.05 mg/L [0.75, 1.48] vs 1.57 mg/L [1.13, 2.19], p < 0.0001). Therapy with rivaroxaban compared to SOC was not associated an improvement on the WHO 7-category ordinal scale at 7 days (p = 0.085). Rivaroxaban improved the clinical outcome measured by the score in patients with a higher baseline D-dimer > 2.0 ULN (exploratory analysis; 0.632 [0.516, 0.748], p = 0.026). The secondary endpoint occurred in 6 patients (10.9%) in the rivaroxaban group and in 12 (21.4%) in the SOC group (time-to-first occurrence of the components of the secondary outcome: HR 0.5; 95% CI 0.15-1.67; p = 0.264). There was no difference in fatal or non-fatal major or clinically relevant non-major bleeding between the groups. CONCLUSIONS Therapeutic anticoagulation with rivaroxaban compared to prophylactic anticoagulation with a heparin did not improve surrogates of clinical outcome in patients with moderate to severe COVID-19. Whether initial rivaroxaban at therapeutic doses might be superior to thromboprophylaxis in patients with COVID-19 and a high risk as defined by D-dimer > 2 ULN needs confirmation in further studies.
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Affiliation(s)
- Ursula Rauch-Kröhnert
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Deutsches Herzzentrum der Charité, Hindenburgdamm 30, 12203, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
- Friede Springer Cardiovascular Prevention Center @ Charite Universitätsmedizin Berlin, Berlin, Germany.
| | - Marianna Puccini
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Deutsches Herzzentrum der Charité, Hindenburgdamm 30, 12203, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Marius Placzek
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Jan Beyer-Westendorf
- Department of Medicine I, Universitätsklinikum "Carl Gustav Carus" Dresden, Dresden, Germany
| | - Kai Jakobs
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Deutsches Herzzentrum der Charité, Hindenburgdamm 30, 12203, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Julian Friebel
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Deutsches Herzzentrum der Charité, Hindenburgdamm 30, 12203, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Selina Hein
- Katholisches Klinikum Koblenz-Montabaur, Koblenz, Germany
| | - Mirko Seidel
- BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - Burkert Pieske
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Heart Center Berlin, Berlin, Germany
- Department of Cardiology Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Steffen Massberg
- Department of Medicine I, LMU Klinikum, Ludwig-Maximilians-Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich, Munich, Germany
| | - Martin Witzenrath
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Zeiher
- Division of Cardiology, Department of Medicine III, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Rhine-Main, Frankfurt, Germany
| | - Tim Friede
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Stefan D Anker
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Deutsches Herzzentrum der Charité, Hindenburgdamm 30, 12203, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
- Friede Springer Cardiovascular Prevention Center @ Charite Universitätsmedizin Berlin, Berlin, Germany.
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Piñana JL, Pérez A, Chorão P, Guerreiro M, García-Cadenas I, Solano C, Martino R, Navarro D. Respiratory virus infections after allogeneic stem cell transplantation: Current understanding, knowledge gaps, and recent advances. Transpl Infect Dis 2023; 25 Suppl 1:e14117. [PMID: 37585370 DOI: 10.1111/tid.14117] [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: 05/01/2023] [Revised: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023]
Abstract
Before the COVID-19 pandemic, common community-acquired seasonal respiratory viruses (CARVs) were a significant threat to the health and well-being of allogeneic hematopoietic cell transplant (allo-HCT) recipients, often resulting in severe illness and even death. The pandemic has further highlighted the significant risk that immunosuppressed patients, including allo-HCT recipients, face when infected with SARS-CoV-2. As preventive transmission measures are relaxed and CARVs circulate again among the community, including in allo-HSCT recipients, it is crucial to understand the current state of knowledge, gaps, and recent advances regarding CARV infection in allo-HCT recipients. Urgent research is needed to identify seasonal respiratory viruses as potential drivers for future pandemics.
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Affiliation(s)
- Jose L Piñana
- Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Ariadna Pérez
- Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Pedro Chorão
- Hematology Division, Hospital universitario y politécnico La Fe, Valencia, Spain
- Instituto de Investigación La Fe, Hospital Universitário y Politécncio La Fe, Valencia, Spain
| | - Manuel Guerreiro
- Hematology Division, Hospital universitario y politécnico La Fe, Valencia, Spain
- Instituto de Investigación La Fe, Hospital Universitário y Politécncio La Fe, Valencia, Spain
| | | | - Carlos Solano
- Hematology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Fundación INCLIVA, Instituto de Investigación Sanitaria Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Rodrigo Martino
- Hematology Division, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - David Navarro
- Microbiology department, Hospital Clinico Universitario de Valencia, Spain
- Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
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Li Y, Huo S, Yin Z, Tian Z, Huang F, Liu P, Liu Y, Yu F. The current state of research on influenza antiviral drug development: drugs in clinical trial and licensed drugs. mBio 2023; 14:e0127323. [PMID: 37610204 PMCID: PMC10653855 DOI: 10.1128/mbio.01273-23] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
Influenza viruses (IVs) threaten global human health due to the high morbidity, infection, and mortality rates. Currently, the influenza drugs recommended by the FDA are oseltamivir, zanamivir, peramivir, and baloxavir marboxil. Notably, owing to the high variability of IVs, no drug exists that can effectively treat all types and subtypes of IVs. Moreover, the current trend of drug resistance is likely to continue as the viral genome is constantly mutating. Therefore, there is an urgent need to develop drugs related to the treatment of influenza to deal with the next pandemic. Here, we summarized the cutting-edge research in mechanism of action, inhibitory activity, and clinical efficacy of drugs that have been approved and drugs that are still in clinical trials for influenza treatment. We hope this review will provide up-to-date and comprehensive information on influenza antivirals and generate hypotheses for screens and development of new broad-spectrum influenza drugs in the near future.
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Affiliation(s)
- Yanbai Li
- Hebei Key Laboratory of Analysis and Control of Zoonotic Pathogenic Microorganism, Hebei Wild Animal Health Center, College of Life Sciences, Hebei Agricultural University, Baoding, China
| | - Shanshan Huo
- Hebei Key Laboratory of Analysis and Control of Zoonotic Pathogenic Microorganism, Hebei Wild Animal Health Center, College of Life Sciences, Hebei Agricultural University, Baoding, China
| | - Zhe Yin
- Hebei Key Laboratory of Analysis and Control of Zoonotic Pathogenic Microorganism, Hebei Wild Animal Health Center, College of Life Sciences, Hebei Agricultural University, Baoding, China
| | - Zuguang Tian
- Baoding City Science and Technology Bureau, Baoding, China
| | - Fang Huang
- Tongzhou District Center For Animal Disease Control and Prevention, Beijing, China
| | - Peng Liu
- Hebei Key Laboratory of Analysis and Control of Zoonotic Pathogenic Microorganism, Hebei Wild Animal Health Center, College of Life Sciences, Hebei Agricultural University, Baoding, China
| | - Yue Liu
- Department of Biochemistry and Biophysics, University of California, San Francisco, California, USA
| | - Fei Yu
- Hebei Key Laboratory of Analysis and Control of Zoonotic Pathogenic Microorganism, Hebei Wild Animal Health Center, College of Life Sciences, Hebei Agricultural University, Baoding, China
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Mu S, Zou X, Wang Y, Deng X, Cui D, Liu S, Cao B. The combined effect of oseltamivir and favipiravir on influenza a virus evolution in patients hospitalized with severe influenza. Antiviral Res 2023:105657. [PMID: 37369282 DOI: 10.1016/j.antiviral.2023.105657] [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: 03/06/2023] [Revised: 06/14/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023]
Abstract
Our previous study shows favipiravir and oseltamivir combination therapy may accelerate clinical recovery compared to oseltamivir monotherapy in severe influenza, but its effect on virological evolution and resistance mutation against oseltamivir is still unknown. In this study, we collected longitudinal respiratory samples from influenza patients who underwent combination therapy and applied them to next generation sequencing of the whole genome of the influenza A virus (IAV). We also included a cohort untreated with any antivirals to serve as the control. In total, 62 samples from 19 patients treated with combination therapy and 20 samples from 20 patients untreated were successfully sequenced. The nucleotide diversity in the whole genome of IAV in the combination group showed no difference compared to that in the control group (P > 0.05). Moreover, we observed 174 kinds of nonsynonymous nucleotide substitutions in patients with combination therapy, mostly in NA (n = 44) and HA (n = 43). Of them, the G→A transition was the dominant variant type (27%) and 46/174 (26%) was reported to have biological effects, such as increased pathogenicity and polymerase activity. Among the 29 mutations conferring reduction in oseltamivir sensitivity we investigated, H275Y was the only mutation detected in the 4 samples from 1 of 19 patients and demonstrated increasing frequency during the treatment. Mutations conferring favipiravir resistance were not observed. Our studies showed combination therapy of favipiravir and oseltamivir has little effect on virus nucleotide diversity, nor prevents the increase of oseltamivir-resistant variants.
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Affiliation(s)
- Shengrui Mu
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Capital Medical University, Beijing, China; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Xiaohui Zou
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.
| | - Yeming Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Xiaoyan Deng
- Tsinghua University School of Medicine, Beijing, China
| | - Dan Cui
- Harbin Medical University, Harbin, Heilongjiang, China
| | - Shuai Liu
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China; Shandong Key Laboratory of Infectious Respiratory Disease, Jinan, Shandong, China
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Capital Medical University, Beijing, China; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China; Tsinghua University School of Medicine, Beijing, China; Harbin Medical University, Harbin, Heilongjiang, China.
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7
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Ganter B, Zickler M, Huchting J, Winkler M, Lüttjohann A, Meier C, Gabriel G, Beck S. T-705-Derived Prodrugs Show High Antiviral Efficacies against a Broad Range of Influenza A Viruses with Synergistic Effects When Combined with Oseltamivir. Pharmaceutics 2023; 15:1732. [PMID: 37376180 DOI: 10.3390/pharmaceutics15061732] [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: 04/23/2023] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
Emerging influenza A viruses (IAV) bear the potential to cause pandemics with unpredictable consequences for global human health. In particular, the WHO has declared avian H5 and H7 subtypes as high-risk candidates, and continuous surveillance of these viruses as well as the development of novel, broadly acting antivirals, are key for pandemic preparedness. In this study, we sought to design T-705 (Favipiravir) related inhibitors that target the RNA-dependent RNA polymerase and evaluate their antiviral efficacies against a broad range of IAVs. Therefore, we synthesized a library of derivatives of T-705 ribonucleoside analogues (called T-1106 pronucleotides) and tested their ability to inhibit both seasonal and highly pathogenic avian influenza viruses in vitro. We further showed that diphosphate (DP) prodrugs of T-1106 are potent inhibitors of H1N1, H3N2, H5N1, and H7N9 IAV replication. Importantly, in comparison to T-705, these DP derivatives achieved 5- to 10-fold higher antiviral activity and were non-cytotoxic at the therapeutically active concentrations. Moreover, our lead DP prodrug candidate showed drug synergy with the neuraminidase inhibitor oseltamivir, thus opening up another avenue for combinational antiviral therapy against IAV infections. Our findings may serve as a basis for further pre-clinical development of T-1106 prodrugs as an effective countermeasure against emerging IAVs with pandemic potential.
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Affiliation(s)
- Benedikt Ganter
- Organic Chemistry, Department of Chemistry, Faculty of Sciences, Hamburg University, 20146 Hamburg, Germany
| | - Martin Zickler
- Department for Viral Zoonoses-One Health, Leibniz Institute of Virology, 20251 Hamburg, Germany
| | - Johanna Huchting
- Organic Chemistry, Department of Chemistry, Faculty of Sciences, Hamburg University, 20146 Hamburg, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, 22525 Hamburg, Germany
| | - Matthias Winkler
- Organic Chemistry, Department of Chemistry, Faculty of Sciences, Hamburg University, 20146 Hamburg, Germany
| | - Anna Lüttjohann
- Department for Viral Zoonoses-One Health, Leibniz Institute of Virology, 20251 Hamburg, Germany
| | - Chris Meier
- Organic Chemistry, Department of Chemistry, Faculty of Sciences, Hamburg University, 20146 Hamburg, Germany
- German Center for Infection Research (DZIF), 38124 Braunschweig, Germany
| | - Gülsah Gabriel
- Department for Viral Zoonoses-One Health, Leibniz Institute of Virology, 20251 Hamburg, Germany
- German Center for Infection Research (DZIF), 38124 Braunschweig, Germany
- Institute of Virology, University of Veterinary Medicine Hannover, 30559 Hannover, Germany
| | - Sebastian Beck
- Department for Viral Zoonoses-One Health, Leibniz Institute of Virology, 20251 Hamburg, Germany
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Liu B, Ye W, Zheng Z, Zhou Z. Synthesis, crystal structure and DFT study of ethyl (3aR,7R,7aR)-2,2-dimethyl-7-((methylsulfonyl)oxy)-3a,6,7,7a-tetrahydrobenzo[d][1,3]dioxole-5-carboxylate. J Mol Struct 2023. [DOI: 10.1016/j.molstruc.2023.135214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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9
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Shah PL, Orton CM, Grinsztejn B, Donaldson GC, Crabtree Ramírez B, Tonkin J, Santos BR, Cardoso SW, Ritchie AI, Conway F, Riberio MPD, Wiseman DJ, Tana A, Vijayakumar B, Caneja C, Leaper C, Mann B, Samson A, Bhavsar PK, Boffito M, Johnson MR, Pozniak A, Pelly M, Shabbir N, Connolly S, Cartier A, Jaffer S, Winpenny C, Daby D, Pepper S, Adamson C, Carungcong J, Nundlall K, Fedele S, Samson-Fessale P, Schoolmeesters A, Gomes de Almeida Martins L, Bull R, Correia Da Costa P, Bautista C, Eleanor Flores M, Maheswaran S, Macabodbod L, Houseman R, Svensson ML, Sayan A, Fung C, Garner J, Lai D, Nelson M, Moore L, Gidwani S, Davies G, Ouma B, Salinos C, Salha J, Yassein R, Abbasi A, Oblak M, Steward A, Thankachen M, Barker A, Fernandes C, Beatriz V, Flores L, Soler-Carracedo A, Rocca A, Maheswaran S, Martella C, Lloyd C, Nolan C, Horsford L, Martins L, Thomas L, Winstanley M, Bourke M, Branch N, Orhan O, Morton R, Saunder S, Patil S, Hughes S, Zhe W, De Leon A, Farah A, Rya G, Alizadeh K, Leong K, Trepte L, Goel N, McGown P, Kirwan U, Vilela Baião T, Marins L, Nazer S, Malaguthi de Souza R, Feitosa M, Lessa F, Silva de Magalhães E, Costenaro J, de Cassia Alves Lira R, Carolina A, Cauduro de Castro A, Machado Da Silva A, Kliemann D, De Cassia Alves Lira R, Walker G, Norton D, Lowthorpe V, Ivan M, Lillie P, Easom N, Sierra Madero J, López Iñiguez Á, Patricia Muñuzuri Nájera G, Paola Alarcón Murra C, Alanis Vega A, Muñoz Trejo T, Pérez Rodríguez O. Favipiravir in patients hospitalised with COVID-19 (PIONEER trial): a multicentre, open-label, phase 3, randomised controlled trial of early intervention versus standard care. THE LANCET. RESPIRATORY MEDICINE 2023; 11:415-424. [PMID: 36528039 PMCID: PMC9891737 DOI: 10.1016/s2213-2600(22)00412-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/14/2022] [Accepted: 10/16/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND COVID-19 has overwhelmed health services globally. Oral antiviral therapies are licensed worldwide, but indications and efficacy rates vary. We aimed to evaluate the safety and efficacy of oral favipiravir in patients hospitalised with COVID-19. METHODS We conducted a multicentre, open-label, randomised controlled trial of oral favipiravir in adult patients who were newly admitted to hospital with proven or suspected COVID-19 across five sites in the UK (n=2), Brazil (n=2) and Mexico (n=1). Using a permuted block design, eligible and consenting participants were randomly assigned (1:1) to receive oral favipiravir (1800 mg twice daily for 1 day; 800 mg twice daily for 9 days) plus standard care, or standard care alone. All caregivers and patients were aware of allocation and those analysing data were aware of the treatment groups. The prespecified primary outcome was the time from randomisation to recovery, censored at 28 days, which was assessed using an intention-to-treat approach. Post-hoc analyses were used to assess the efficacy of favipiravir in patients aged younger than 60 years, and in patients aged 60 years and older. The trial was registered with clinicaltrials.gov, NCT04373733. FINDINGS Between May 5, 2020 and May 26, 2021, we assessed 503 patients for eligibility, of whom 499 were randomly assigned to favipiravir and standard care (n=251) or standard care alone (n=248). There was no significant difference between those who received favipiravir and standard care, relative to those who received standard care alone in time to recovery in the overall study population (hazard ratio [HR] 1·06 [95% CI 0·89-1·27]; n=499; p=0·52). Post-hoc analyses showed a faster rate of recovery in patients younger than 60 years who received favipiravir and standard care versus those who had standard care alone (HR 1·35 [1·06-1·72]; n=247; p=0·01). 36 serious adverse events were observed in 27 (11%) of 251 patients administered favipiravir and standard care, and 33 events were observed in 27 (11%) of 248 patients receiving standard care alone, with infectious, respiratory, and cardiovascular events being the most numerous. There was no significant between-group difference in serious adverse events per patient (p=0·87). INTERPRETATION Favipiravir does not improve clinical outcomes in all patients admitted to hospital with COVID-19, however, patients younger than 60 years might have a beneficial clinical response. The indiscriminate use of favipiravir globally should be cautioned, and further high-quality studies of antiviral agents, and their potential treatment combinations, are warranted in COVID-19. FUNDING LifeArc and CW+.
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Affiliation(s)
- Pallav L Shah
- Chelsea & Westminster NHS Foundation Trust, London, UK,Department of Respiratory Medicine, Royal Brompton Hospital, London, UK,National Heart and Lung Institute, Imperial College London, London, UK,Correspondence to: Prof Pallav L Shah, Chelsea & Westminster NHS Foundation Trust, London SW10 9NH, UK
| | - Christopher M Orton
- Chelsea & Westminster NHS Foundation Trust, London, UK,Department of Respiratory Medicine, Royal Brompton Hospital, London, UK,National Heart and Lung Institute, Imperial College London, London, UK
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Gavin C Donaldson
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - James Tonkin
- Chelsea & Westminster NHS Foundation Trust, London, UK,Department of Respiratory Medicine, Royal Brompton Hospital, London, UK,National Heart and Lung Institute, Imperial College London, London, UK
| | - Breno R Santos
- Departamento de Infectología, Hospital Nossa Senhora da Conceição–Grupo Hospitalar Conceição, Porto Alegre, Brazil
| | - Sandra W Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Andrew I Ritchie
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK,National Heart and Lung Institute, Imperial College London, London, UK
| | - Francesca Conway
- Chelsea & Westminster NHS Foundation Trust, London, UK,Department of Respiratory Medicine, Royal Brompton Hospital, London, UK,National Heart and Lung Institute, Imperial College London, London, UK
| | - Maria P D Riberio
- Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Dexter J Wiseman
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK,National Heart and Lung Institute, Imperial College London, London, UK
| | - Anand Tana
- Chelsea & Westminster NHS Foundation Trust, London, UK,Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Bavithra Vijayakumar
- Chelsea & Westminster NHS Foundation Trust, London, UK,Department of Respiratory Medicine, Royal Brompton Hospital, London, UK,National Heart and Lung Institute, Imperial College London, London, UK
| | - Cielito Caneja
- Chelsea & Westminster NHS Foundation Trust, London, UK,Department of Respiratory Medicine, Royal Brompton Hospital, London, UK,National Heart and Lung Institute, Imperial College London, London, UK
| | - Craig Leaper
- Chelsea & Westminster NHS Foundation Trust, London, UK
| | - Bobby Mann
- Chelsea & Westminster NHS Foundation Trust, London, UK
| | - Anda Samson
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Pankaj K Bhavsar
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Marta Boffito
- Chelsea & Westminster NHS Foundation Trust, London, UK,National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Anton Pozniak
- Chelsea & Westminster NHS Foundation Trust, London, UK,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Pelly
- Chelsea & Westminster NHS Foundation Trust, London, UK
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Kumari R, Sharma SD, Kumar A, Ende Z, Mishina M, Wang Y, Falls Z, Samudrala R, Pohl J, Knight PR, Sambhara S. Antiviral Approaches against Influenza Virus. Clin Microbiol Rev 2023; 36:e0004022. [PMID: 36645300 PMCID: PMC10035319 DOI: 10.1128/cmr.00040-22] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Preventing and controlling influenza virus infection remains a global public health challenge, as it causes seasonal epidemics to unexpected pandemics. These infections are responsible for high morbidity, mortality, and substantial economic impact. Vaccines are the prophylaxis mainstay in the fight against influenza. However, vaccination fails to confer complete protection due to inadequate vaccination coverages, vaccine shortages, and mismatches with circulating strains. Antivirals represent an important prophylactic and therapeutic measure to reduce influenza-associated morbidity and mortality, particularly in high-risk populations. Here, we review current FDA-approved influenza antivirals with their mechanisms of action, and different viral- and host-directed influenza antiviral approaches, including immunomodulatory interventions in clinical development. Furthermore, we also illustrate the potential utility of machine learning in developing next-generation antivirals against influenza.
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Affiliation(s)
- Rashmi Kumari
- Immunology and Pathogenesis Branch, Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Department of Anesthesiology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Suresh D. Sharma
- Immunology and Pathogenesis Branch, Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amrita Kumar
- Immunology and Pathogenesis Branch, Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zachary Ende
- Immunology and Pathogenesis Branch, Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education (ORISE), CDC Fellowship Program, Oak Ridge, Tennessee, USA
| | - Margarita Mishina
- Immunology and Pathogenesis Branch, Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yuanyuan Wang
- Biotechnology Core Facility Branch, Division of Scientific Resources, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Association of Public Health Laboratories, Silver Spring, Maryland, USA
| | - Zackary Falls
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Ram Samudrala
- Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Jan Pohl
- Biotechnology Core Facility Branch, Division of Scientific Resources, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paul R. Knight
- Department of Anesthesiology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Suryaprakash Sambhara
- Immunology and Pathogenesis Branch, Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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11
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Potential Anti-SARS-CoV-2 Prodrugs Activated by Phosphorylation and Their Role in the Aged Population. Molecules 2023; 28:molecules28052332. [PMID: 36903575 PMCID: PMC10004871 DOI: 10.3390/molecules28052332] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
The COVID-19 pandemic has flared across every part of the globe and affected populations from different age groups differently. People aged from 40 to 80 years or older are at an increased risk of morbidity and mortality due to COVID-19. Therefore, there is an urgent requirement to develop therapeutics to decrease the risk of the disease in the aged population. Over the last few years, several prodrugs have demonstrated significant anti-SARS-CoV-2 effects in in vitro assays, animal models, and medical practice. Prodrugs are used to enhance drug delivery by improving pharmacokinetic parameters, decreasing toxicity, and attaining site specificity. This article discusses recently explored prodrugs such as remdesivir, molnupiravir, favipiravir, and 2-deoxy-D-glucose (2-DG) and their implications in the aged population, as well as investigating recent clinical trials.
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12
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Jones JC, Yen HL, Adams P, Armstrong K, Govorkova EA. Influenza antivirals and their role in pandemic preparedness. Antiviral Res 2023; 210:105499. [PMID: 36567025 PMCID: PMC9852030 DOI: 10.1016/j.antiviral.2022.105499] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Effective antivirals provide crucial benefits during the early phase of an influenza pandemic, when vaccines are still being developed and manufactured. Currently, two classes of viral protein-targeting drugs, neuraminidase inhibitors and polymerase inhibitors, are approved for influenza treatment and post-exposure prophylaxis. Resistance to both classes has been documented, highlighting the need to develop novel antiviral options that may include both viral and host-targeted inhibitors. Such efforts will form the basis of management of seasonal influenza infections and of strategic planning for future influenza pandemics. This review focuses on the two classes of approved antivirals, their drawbacks, and ongoing work to characterize novel agents or combination therapy approaches to address these shortcomings. The importance of these topics in the ongoing process of influenza pandemic planning is also discussed.
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Affiliation(s)
- Jeremy C Jones
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Hui-Ling Yen
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Peter Adams
- Biomedical Advanced Research and Development Authority, Administration for Strategic Preparedness and Response, U.S. Department of Health and Human Services, Washington, DC, USA
| | - Kimberly Armstrong
- Biomedical Advanced Research and Development Authority, Administration for Strategic Preparedness and Response, U.S. Department of Health and Human Services, Washington, DC, USA
| | - Elena A Govorkova
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA.
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13
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Influenza Treatment: Limitations of Antiviral Therapy and Advantages of Drug Combination Therapy. Microorganisms 2023; 11:microorganisms11010183. [PMID: 36677475 PMCID: PMC9865513 DOI: 10.3390/microorganisms11010183] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/23/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
Influenza infection is serious and debilitating for humans and animals. The influenza virus undergoes incessant mutation, segment recombination, and genome reassortment. As a result, new epidemics and pandemics are expected to emerge, making the elimination challenging of the disease. Antiviral therapy has been used for the treatment of influenza since the development of amantadine in the 1960s; however, its use is hampered by the emergence of novel strains and the development of drug resistance. Thus, combinational therapy with two or more antivirals or immunomodulators with different modes of action is the optimal strategy for the effective treatment of influenza infection. In this review, we describe current options for combination therapy, their performance, and constraints imposed by resistance, calling attention to the advantages of combination therapy against severe influenza infections. We also discuss the challenges of influenza therapy and the limitations of approved antiviral drugs.
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14
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Deneva V, Slavova S, Kumanova A, Vassilev N, Nedeltcheva-Antonova D, Antonov L. Favipiravir-Tautomeric and Complexation Properties in Solution. Pharmaceuticals (Basel) 2022; 16:ph16010045. [PMID: 36678542 PMCID: PMC9864296 DOI: 10.3390/ph16010045] [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: 11/07/2022] [Revised: 12/16/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022] Open
Abstract
The tautomeric properties of favipiravir were investigated experimentally for the first time by using molecular spectroscopy (UV-Vis absorption, fluorescence and NMR), as well as DFT quantum-chemical calculations. According to the obtained results, the enol tautomer is substantially more stable in most of the organic solvents. In the presence of water, a keto form appears to be favored due to the specific solute-solvent interactions. Upon the addition of alkaline-earth-metal ions, deprotonation and complexation occurred simultaneously, giving the formation of 2 : 1 ligand : metal complexes. According to the theoretical simulations, the metal ion is captured between the carbonyl groups as a result of the size-fit effect.
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Affiliation(s)
- Vera Deneva
- Institute of Electronics, Bulgarian Academy of Sciences, 1784 Sofia, Bulgaria
- Institute of Organic Chemistry with Centre of Phytochemistry, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria
- Correspondence: (V.D.); (L.A.)
| | - Sofia Slavova
- Institute of Electronics, Bulgarian Academy of Sciences, 1784 Sofia, Bulgaria
- Institute of General and Inorganic Chemistry, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria
| | - Alina Kumanova
- Institute of Electronics, Bulgarian Academy of Sciences, 1784 Sofia, Bulgaria
| | - Nikolay Vassilev
- Institute of Organic Chemistry with Centre of Phytochemistry, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria
| | - Daniela Nedeltcheva-Antonova
- Institute of Electronics, Bulgarian Academy of Sciences, 1784 Sofia, Bulgaria
- Institute of Organic Chemistry with Centre of Phytochemistry, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria
| | - Luidmil Antonov
- Institute of Electronics, Bulgarian Academy of Sciences, 1784 Sofia, Bulgaria
- Correspondence: (V.D.); (L.A.)
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Li L, Wu Y, Wang J, Yan H, Lu J, Wang Y, Zhang B, Zhang J, Yang J, Wang X, Zhang M, Li Y, Miao L, Zhang H. Potential Treatment of COVID-19 with Traditional Chinese Medicine: What Herbs Can Help Win the Battle with SARS-CoV-2? ENGINEERING (BEIJING, CHINA) 2022; 19:139-152. [PMID: 34729244 PMCID: PMC8552808 DOI: 10.1016/j.eng.2021.08.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/28/2021] [Accepted: 08/03/2021] [Indexed: 05/05/2023]
Abstract
Traditional Chinese medicine (TCM) has been successfully applied worldwide in the treatment of coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, the pharmacological mechanisms underlying this success remain unclear. Hence, the aim of this review is to combine pharmacological assays based on the theory of TCM in order to elucidate the potential signaling pathways, targets, active compounds, and formulas of herbs that are involved in the TCM treatment of COVID-19, which exhibits combatting viral infections, immune regulation, and amelioration of lung injury and fibrosis. Extensive reports on target screening are elucidated using virtual prediction via docking analysis or network pharmacology based on existing data. The results of these reports indicate that an intricate regulatory mechanism is involved in the pathogenesis of COVID-19. Therefore, more pharmacological research on the natural herbs used in TCM should be conducted in order to determine the association between TCM and COVID-19 and account for the observed therapeutic effects of TCM against COVID-19.
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Affiliation(s)
- Lin Li
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Yuzheng Wu
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- Laboratory of Pharmacology of TCM Formulae Co-Constructed by the Province-Ministry, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Jiabao Wang
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Huimin Yan
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Jia Lu
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Yu Wang
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Boli Zhang
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Junhua Zhang
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Jian Yang
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Xiaoying Wang
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Min Zhang
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Yue Li
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Lin Miao
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Han Zhang
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- Key Laboratory of Pharmacology of Traditional Chinese Medical Formulae, Ministry of Education, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
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Rahman M, Datta PK, Islam K, Haque M, Mahmud R, Mallik U, Hasan P, Haque M, Faruq I, Sharif M, Ratul RH, Azad KAK, Miah T, Rahman MM. Efficacy of colchicine in patients with moderate COVID-19: A double-blinded, randomized, placebo-controlled trial. PLoS One 2022; 17:e0277790. [PMID: 36383611 PMCID: PMC9668149 DOI: 10.1371/journal.pone.0277790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/21/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may cause severe life-threatening diseases called acute respiratory distress syndrome (ARDS) owing to cytokine storms. The mortality rate of COVID-19-related ARDS is as high as 40% to 50%. However, effective treatment for the extensive release of acute inflammatory mediators induced by hyperactive and inappropriate immune responses is very limited. Many anti-inflammatory drugs with variable efficacies have been investigated. Colchicine inhibits interleukin 1 beta (IL-1β) and its subsequent inflammatory cascade by primarily blocking pyrin and nucleotide-binding domain leucine-rich repeat and pyrin domain containing receptor 3 (NLRP3) activation. Therefore, this cheap, widely available, oral drug might provide an added benefit in combating the cytokine storm in COVID-19. Here, we sought to determine whether adding colchicine to other standards of care could be beneficial for moderate COVID-19 pneumonia in terms of the requirement for advanced respiratory support and mortality. METHODS AND FINDINGS This blinded placebo-controlled drug trial was conducted at the Dhaka Medical College Hospital, Dhaka, Bangladesh. A total of 300 patients with moderate COVID-19 based on a positive RT-PCR result were enrolled based on strict selection criteria from June 2020 to November 2020. Patients were randomly assigned to either treatment group in a 1:1 ratio. Patients were administered 1.2 mg of colchicine on day 1 followed by daily treatment with 0.6 mg of colchicine for 13 days or placebo along with the standard of care. The primary outcome was the time to clinical deterioration from randomization to two or more points on a seven-category ordinal scale within the 14 days post-randomization. Clinical outcomes were also recorded on day 28. The primary endpoint was met by 9 (6.2%) patients in the placebo group and 4 (2.7%) patients in the colchicine group (P = 0.171), which corresponds to a hazard ratio (95% CI) of 0.44 (0.13-1.43). Additional analysis of the outcomes on day 28 revealed significantly lower clinical deterioration (defined as a decrease by two or more points) in the colchicine group, with a hazard ratio [95%CI] of 0.29 [0.098-0.917], (P = 0.035). Despite a 56% reduction in the need for mechanical ventilation and death with colchicine treatment on day 14, the reduction was not statistically significant. On day 28, colchicine significantly reduced clinical deterioration measured as the need for mechanical ventilation and all-cause mortality. CONCLUSION Colchicine was not found to have a significant beneficial effect on reducing mortality and the need for mechanical ventilation. However, a delayed beneficial effect was observed. Therefore, further studies should be conducted to evaluate the late benefits of colchicine. CLINICAL TRIAL REGISTRATION Clinical trial registration no: ClinicalTrials.gov Identifier: NCT04527562 https://www.google.com/search?client=firefox-b-d&q=NCT04527562.
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Affiliation(s)
- Motlabur Rahman
- Department of Medicine, Dhaka Medical College, Dhaka, Bangladesh
| | - Ponkaj K. Datta
- Department of Medicine, Dhaka Medical College, Dhaka, Bangladesh
- * E-mail:
| | - Khairul Islam
- Department of Medicine, Dhaka Medical College, Dhaka, Bangladesh
| | - Mahfuzul Haque
- Department of Medicine, Dhaka Medical College, Dhaka, Bangladesh
| | - Reaz Mahmud
- Department of Neurology, Dhaka Medical College, Dhaka, Bangladesh
| | - Uzzwal Mallik
- Department of Medicine, Dhaka Medical College, Dhaka, Bangladesh
| | - Pratyay Hasan
- Department of Medicine, Dhaka Medical College, Dhaka, Bangladesh
| | - Manjurul Haque
- Department of Medicine, Dhaka Medical College, Dhaka, Bangladesh
| | - Imtiaz Faruq
- Department of Medicine, Dhaka Medical College, Dhaka, Bangladesh
| | - Mohiuddin Sharif
- Department of Medicine, Dhaka Medical College, Dhaka, Bangladesh
| | - Rifat H. Ratul
- Department of Medicine, Dhaka Medical College, Dhaka, Bangladesh
| | | | - Titu Miah
- Department of Medicine and Principal, Dhaka Medical College, Dhaka, Bangladesh
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Hayden FG, Lenk RP, Stonis L, Oldham-Creamer C, Kang LL, Epstein C. Favipiravir Treatment of Uncomplicated Influenza in Adults: Results of Two Phase 3, Randomized, Double-Blind, Placebo-Controlled Trials. J Infect Dis 2022; 226:1790-1799. [PMID: 35639525 PMCID: PMC9650493 DOI: 10.1093/infdis/jiac135] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/07/2022] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND We conducted double-blind, placebo-controlled trials assessing the efficacy and tolerability of favipiravir in acute influenza. METHODS Otherwise healthy adults with influenza-like symptoms and fever of ≤48 hours were randomized to favipiravir (1800 mg twice daily [BID] on day 1, 800 mg BID on days 2-5) or placebo tablets (1:1 in US316; 3:1 in US317). The primary efficacy endpoint was the time to illness alleviation when 6 influenza symptoms were self-rated as absent or mild and fever was absent in the intention-to-treat, influenza-infected participants. RESULTS In US316 (301 favipiravir, 322 placebo), favipiravir was associated with a 14.4-hour reduction (median, 84.2 vs 98.6 hours; P = .004) in time to illness alleviation vs placebo. In US317 (526 favipiravir, 169 placebo), favipiravir did not significantly reduce time to alleviation (median, 77.8 vs 83.9 hours). In both trials favipiravir was associated with reduced viral titers, RNA load area under the curve over days 1-5, and median times to cessation of virus detection (P < .001). Aside from asymptomatic hyperuricemia, no important differences in adverse events were found. CONCLUSIONS This favipiravir dosing regimen demonstrated significant antiviral efficacy but inconsistent illness alleviation in uncomplicated influenza. Studies of higher doses and antiviral combinations for treating serious influenza and other RNA viral infections are warranted. Clinical Trials Registration. NCT02026349; NCT02008344.
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Affiliation(s)
- Frederick G Hayden
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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18
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Jeong JH, Chokkakula S, Min SC, Kim BK, Choi WS, Oh S, Yun YS, Kang DH, Lee OJ, Kim EG, Choi JH, Lee JY, Choi YK, Baek YH, Song MS. Combination therapy with nirmatrelvir and molnupiravir improves the survival of SARS-CoV-2 infected mice. Antiviral Res 2022; 208:105430. [PMID: 36209984 PMCID: PMC9535923 DOI: 10.1016/j.antiviral.2022.105430] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 01/21/2023]
Abstract
As the SARS-CoV-2 pandemic remains uncontrolled owing to the continuous emergence of variants of concern, there is an immediate need to implement the most effective antiviral treatment strategies, especially for risk groups. Here, we evaluated the therapeutic potency of nirmatrelvir, remdesivir and molnupiravir, and their combinations in SARS-CoV-2 infected K18-hACE2 transgenic mice. Systemic treatment of mice with each drug (20 mg/kg) resulted in slightly enhanced antiviral efficacy and yielded an increased life expectancy of only about 20-40% survival. However, combination therapy with nirmatrelvir (20 mg/kg) and molnupiravir (20 mg/kg) in lethally infected mice showed profound inhibition of SARS-CoV-2 replication in both the lung and brain and synergistically improved survival rates up to 80% compared to those with nirmatrelvir (36%, P < 0.001) and molnupiravir (43%, P < 0.001) administered alone. This combination therapy effectively reduced clinical severity score, virus-induced tissue damage, and viral distribution compared to those in animals treated with these monotherapies. Furthermore, all these assessments associated with this combination were also significantly higher than that of mice receiving remdesivir monotherapy (P < 0.001) and the nirmatrelvir (20 mg/kg) and remdesivir (20 mg/kg) combination (P < 0.001), underscored the clinical significance of this combination. By contrast, the nirmatrelvir and remdesivir combination showed less antiviral efficacy, with lower survival compared to nirmatrelvir monotherapy due to the insufficient plasma exposure of the remdesivir, demonstrating the inefficient therapeutic effect of this combination in the mouse model. The combination therapy with nirmatrelvir and molnupiravir contributes to alleviated morbidity and mortality, which can serve as a basis for the design of clinical studies of this combination in the treatment of COVID-19 patients.
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Affiliation(s)
- Ju Hwan Jeong
- Department of Microbiology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Chungbuk, 28644, South Korea
| | - Santosh Chokkakula
- Department of Microbiology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Chungbuk, 28644, South Korea
| | - Seong Cheol Min
- Department of Microbiology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Chungbuk, 28644, South Korea
| | - Beom Kyu Kim
- Department of Microbiology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Chungbuk, 28644, South Korea
| | - Won-Suk Choi
- Department of Microbiology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Chungbuk, 28644, South Korea
| | - Sol Oh
- Department of Microbiology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Chungbuk, 28644, South Korea
| | - Yu Soo Yun
- Department of Microbiology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Chungbuk, 28644, South Korea
| | - Da Hyeon Kang
- Department of Microbiology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Chungbuk, 28644, South Korea
| | - Ok-Jun Lee
- Department of Pathology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Eung-Gook Kim
- Department of Biochemistry, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Chungbuk, 28644, South Korea
| | - Jang-Hoon Choi
- Division of Acute Viral Disease, Center for Emerging Virus Research, National Institute of Infectious Diseases, Korea National Institute of Health, Cheongju, 28159, South Korea
| | - Joo-Yeon Lee
- Center for Emerging Virus Research, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju-si, South Korea
| | - Young Ki Choi
- Department of Microbiology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Chungbuk, 28644, South Korea; Center for Study of Emerging and Re-emerging Viruses, Korea Virus Research Institute, Institute for Basic Science (IBS), Daejeon, 34126, South Korea
| | - Yun Hee Baek
- Department of Microbiology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Chungbuk, 28644, South Korea
| | - Min-Suk Song
- Department of Microbiology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Chungbuk, 28644, South Korea.
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Trifonova I, Christova I, Madzharova I, Angelova S, Voleva S, Yordanova R, Tcherveniakova T, Krumova S, Korsun N. Clinical significance and role of coinfections with respiratory pathogens among individuals with confirmed severe acute respiratory syndrome coronavirus-2 infection. Front Public Health 2022; 10:959319. [PMID: 36117597 PMCID: PMC9479447 DOI: 10.3389/fpubh.2022.959319] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/04/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction This study aimed to determine the prevalence, viral profile, and clinical features of coinfections with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and other respiratory viruses. Methods Nasopharyngeal samples and clinical data of 221 hospitalized patients and 21 outpatients were collected and analyzed. Real-time reverse transcription-polymerase chain reaction was used to detect SARS-CoV-2, influenza virus, respiratory syncytial virus (RSV), human metapneumovirus (HMPV), parainfluenza virus (PIV) 1,2,3, rhinovirus (RV), adenovirus (AdV), bocaviruses (BoV), and seasonal coronaviruses (OC43, 229E, NL63, and HKU1). Viral load was determined by capillary electrophoresis. Results From November 2020 to mid-March 2022, 242 SARS-CoV-2 positive patients were tested for seasonal respiratory viruses, and 24 (9.9%) cases of coinfections were detected. The distribution of viruses involved in cases of coinfections were as follows: HMPV (n = 6; 25%), RSV (n = 4;16.7%), AdV (n = 4; 16.7%), BoV (n = 4; 16.7%), PIV3 (n = 2; 8.3%), influenza A (H3N2; n = 2; 8.3%), RV (n = 1; 4.62%), and RV+BoV (n = 1; 4.62%). The proportion of detected coinfections with SARS-CoV-2 was highest in children aged 0-5 years (59%), followed by those >65 years (33%). In specimens with detected coinfection, the viral load of influenza was higher than that of SARS-CoV-2, and the mean viral load of SARS-CoV-2 was higher than that of the other respiratory viruses. C-reactive protein (CRP) and lymphocytes count in co-infected patients >65 years of age were on average higher than in children <16 years of age (mean CRP of 161.8 ± 133.1 mg/L; 19.7 ± 3.09% vs. mean 6.9 ± 8.9 mg/L, 0.9 ± 3.1%; p < 0.01). Patients >65 years of age co-infected with SARS-CoV-2 and other respiratory viruses had longer hospital stays than those <16 years of age (mean 9 ± 3.96 days vs. 5.44 ± 1.89 days; p = 0.025). The combination of AdV and SARS-CoV-2 is fatal for patients aged >65 years. Conclusion In patients aged >65 years, coinfection with SARS CoV-2 and other respiratory viruses, together with concomitant diseases, causes worsening of the clinical picture and complications, and can be fatal. Screening of patients with SARS CoV-2 for other respiratory viruses is needed to select appropriate treatments and prevent a fatal outcome of the disease.
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Affiliation(s)
- Ivelina Trifonova
- National Laboratory “Influenza and ARD”, Department of Virology, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Iva Christova
- National Laboratory “Influenza and ARD”, Department of Virology, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Iveta Madzharova
- National Laboratory “Influenza and ARD”, Department of Virology, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Svetla Angelova
- Clinical Virology Laboratory, University Hospital “Prof. Dr. Stoyan Kirkovich”, Stara Zagora, Bulgaria
| | - Silvya Voleva
- Clinic for Neuro Infections, Airborne, Roof, and Transmissible Infections, Infectious Hospital “Prof. Ivan Kirov”, Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Ralitsa Yordanova
- Clinic for Neuro Infections, Airborne, Roof, and Transmissible Infections, Infectious Hospital “Prof. Ivan Kirov”, Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Tatiana Tcherveniakova
- Clinic for Neuro Infections, Airborne, Roof, and Transmissible Infections, Infectious Hospital “Prof. Ivan Kirov”, Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Stefka Krumova
- National Laboratory “Influenza and ARD”, Department of Virology, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Neli Korsun
- National Laboratory “Influenza and ARD”, Department of Virology, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria
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20
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Liao R, Chakladar S, Gamalo M. Win ratio approach for analyzing composite time-to-event endpoint with opposite treatment effects in its components. Pharm Stat 2022; 21:1342-1356. [PMID: 35766113 DOI: 10.1002/pst.2248] [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: 02/18/2021] [Revised: 04/09/2022] [Accepted: 05/08/2022] [Indexed: 11/07/2022]
Abstract
There is an increasing interest in the use of win ratio with composite time-to-event due to its flexibility in combining component endpoints. Exploring this flexibility further, one interesting question is in assessing the impact when there is a difference in treatment effect in the component endpoints. For example, the active treatment may prolong the time to occurrence of the negative event such as death or ventilation; meanwhile, the treatment effect may also shorten the time to achieving positive events, such as recovery or improvement. Notably, this portrays a situation where the treatment effect on time to recovery is in a different direction of benefit compared to the time to ventilation or death. Under such circumstances, if a single endpoint is used, the benefit gained for other individual outcomes is not counted and is diminished. As consequence, the study may need a larger sample size to detect a significant effect of treatment. Such a scenario can be handled by win ratio in a novel way by ranking component events, which is different from the usual composite endpoint approach such as time-to-first event. To evaluate how the different directions of treatment effect on component endpoints will impact the win ratio analysis, we use a Clayton copula-based bivariate survival simulation to investigate the correlation of component time-to-event. Through simulation, we found that compared to the marginal model using single endpoints, the win ratio analysis on composite endpoint performs better, especially when the correlation between two events is weak. Then, we applied the methodology to an infectious disease progression simulated study motivated by COVID-19. The application demonstrates that the win ratio approach offers advantages in empirical power compared to the traditional Cox proportional hazard approach when there is a difference in treatment effect in the marginal events.
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Affiliation(s)
- Ran Liao
- Department of Biometrics, Eli Lilly and Company, Indiana, USA
| | | | - Margaret Gamalo
- Globel Patient Product (GPD) Inflammation and Immunology, Pfizer, Pennsylvania, USA
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21
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Rattanaumpawan P, Jirajariyavej S, Lerdlamyong K, Palavutitotai N, Saiyarin J. Real-World Effectiveness and Optimal Dosage of Favipiravir for Treatment of COVID-19: Results from a Multicenter Observational Study in Thailand. Antibiotics (Basel) 2022; 11:antibiotics11060805. [PMID: 35740211 PMCID: PMC9220013 DOI: 10.3390/antibiotics11060805] [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: 05/18/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 12/03/2022] Open
Abstract
Favipiravir is a broad-spectrum oral antiviral agent that shows in vitro activity against SARS-CoV-2. Presently, data on the real-world effectiveness and optimal dosage of favipiravir for treating COVID-19 are limited. We conducted a retrospective observational study of hospitalized adult patients with COVID-19 at five tertiary care hospitals in Thailand. We reviewed patient charts to obtain all necessary data. Among 247 COVID-19 patients, 63 (23.0%) received ≥1 dose of favipiravir. Of these 63 patients, 61.9% were male with a median age of 48 years (range 22–85 years), 27.0% required an O2 nasal cannula, 9.5% required non-invasive ventilation and/or high-flow O2 therapy, and 6.4% required invasive mechanical ventilation and/or ECMO. The median baseline NEWS2 score was 5 (0–16). The Day-7 clinical improvement rate [95%CI] was 66.7% [53.7–78.0%] in all patients, 92.5% [75.7–99.1%] in patients who did not require O2 supplementation, and 47.2% [0.4–64.5%] in patients who required O2 supplementation. No life-threatening adverse events were identified. The 28-day mortality rate was 4.8%. A multivariate analysis revealed three poor prognostic factors for Day-7 clinical improvement (odds ratio (95%CI); p-value): older age (0.94 (0.89–0.99); p = 0.04), a higher baseline NEWS2 score (0.64 (0.47–0.88); p = 0.006), and a lower favipiravir loading dose (≤45 mg/kg/day) (0.04 (0.005–0.4); p = 0.006). In conclusion, our study reports the promising effectiveness of favipiravir for treating COVID-19 patients. In addition to older age and a high baseline NEWS2 score, a low loading dose of favipiravir (≤45 mg/kg/day) was also identified as a poor prognostic factor for early clinical improvement. Further studies to explore the optimal dose and the optimal timing of drug initiation for favipiravir should be performed.
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Affiliation(s)
- Pinyo Rattanaumpawan
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
- Correspondence: ; Tel.: +66-2-419-7784; Fax: +66-2-419-7783
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22
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Abstract
Antiviral drugs are an important measure of control for influenza in the population, particularly for those that are severely ill or hospitalised. The neuraminidase inhibitor (NAI) class of drugs, including oseltamivir, have been the standard of care (SOC) for severe influenza illness for many years. The approval of drugs with novel mechanisms of action, such as baloxavir marboxil, is important and broadens potential treatment options for combination therapy. The use of antiviral treatments in combination for influenza is of interest; one potential benefit of this treatment strategy is that the combination of drugs with different mechanisms of action may lower the selection of resistance due to treatment. In addition, combination therapy may become an important treatment option to improve patient outcomes in those with severe illness due to influenza or those that are immunocompromised. Clinical trials increasingly evaluate drug combinations in a range of patient cohorts. Here, we summarise preclinical and clinical advances in combination therapy for the treatment of influenza with reference to immunocompromised animal models and clinical data in hospitalised patient cohorts where available. There is a wide array of drug categories in development that have also been tested in combination. Therefore, in this review, we have included polymerase inhibitors, monoclonal antibodies (mAbs), host-targeted therapies, and adjunctive therapies. Combination treatment regimens should be carefully evaluated to determine whether they provide an added benefit relative to effectiveness of monotherapy and in a variety of patient cohorts, particularly, if there is a greater chance of an adverse outcome. Safe and effective treatment of influenza is important not only for seasonal influenza infection, but also if a pandemic strain was to emerge.
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23
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Qin J, Lin J, Zhang X, Yuan S, Zhang C, Yin Y. Evaluation of the Clinical Effectiveness of Oseltamivir for Influenza Treatment in Children. Front Pharmacol 2022; 13:849545. [PMID: 35462914 PMCID: PMC9020783 DOI: 10.3389/fphar.2022.849545] [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: 01/06/2022] [Accepted: 03/17/2022] [Indexed: 11/25/2022] Open
Abstract
Objective: To estimate the clinical effectiveness of oseltamivir in children with different subtypes of influenza virus infection. Methods: A total of 998 children with acute respiratory infection were enrolled from January to March 2018, and were divided into influenza A, influenza B, influenza A + B, and non-influenza infection (IV-negative) groups. Influenza-like symptoms and duration of fever were evaluated and compared between oseltamivir-treated and non-treated groups. Results: There were no significant differences in the reduction in total febrile period and duration of fever from the onset of therapy between the oseltamivir treated and non-treated children infected with influenza A (p = 0.6885 for total febrile period and 0.7904 for the duration of fever from the onset of treatment), influenza B (p = 0.1462 and 0.1966), influenza A + B (p = 0.5568 and 0.9320), and IV-negative (p = 0.7631 and 0.4655). The duration of fever in children received oseltamivir therapy within 48 h was not significantly shorter than that beyond 48 h (p > 0.05). Additionally, percentages and severities of influenza-like symptoms, including headache, myalgia, fatigue, bellyache, vomiting, diarrhea, sore throat, cough, and coryza were not decreased and alleviated after treatment of oseltamivir. Conclusion: Oseltamivir treatment does not significantly shorten the duration of fever, nor does it significantly relieve influenza-like symptoms in children with infection of influenza.
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Affiliation(s)
- Jianru Qin
- NMPA Key Laboratory for Research and Evaluation of Innovative Drug, College of Life Sciences, Henan Normal University, Xinxiang, China
| | - Jilei Lin
- Department of Respiratory, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiangfei Zhang
- NMPA Key Laboratory for Research and Evaluation of Innovative Drug, College of Life Sciences, Henan Normal University, Xinxiang, China
| | - Shuhua Yuan
- Department of Respiratory, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chiyu Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yong Yin
- Department of Respiratory, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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24
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Efficacy and Safety of SARS-CoV-2 Neutralizing Antibody JS016 in Hospitalized Chinese Patients with COVID-19: A Phase 2/3, Multicenter, Randomized, Open-label, Controlled Trial. Antimicrob Agents Chemother 2022; 66:e0204521. [PMID: 35191746 PMCID: PMC8923168 DOI: 10.1128/aac.02045-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Recombinant human severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) monoclonal antibody JS016 showed neutralizing and therapeutic effects in preclinical studies. The clinical efficacy and safety of the therapy needed to be evaluated. In this phase 2/3, multicenter, randomized, open-label, controlled trial, hospitalized patients with moderate or severe coronavirus disease 2019 (COVID-19) were randomly assigned in a 1:1 ratio to receive standard care or standard care plus a single intravenous infusion of JS016. The primary outcome was a six-level ordinal scale of clinical status on day 28 since randomization. Secondary outcomes include adverse events, 28-day mortality, ventilator-free days within 28 days, length of hospital stay, and negative conversion rate of SARS-CoV-2 nucleic acid on day 14. A total of 199 patients were randomized, and 197 (99 in the JS016 group and 98 in the control group) were analyzed. Most patients, 95 (96%) in the JS016 group and 97 (99%) in the control group were in the best category on day 28 since randomization. The odds ratio of being in a better clinical status was 0.31 (95% confidence interval [CI], 0.03 to 3.19; P = 0.33). Few adverse events occurred in both groups (3% in the JS016 group and 1% in the control group, respectively; P = 0.34). SARS-CoV-2 neutralizing antibody JS016 did not show clinical efficacy among hospitalized Chinese patients with moderate to severe COVID-19 disease. Further studies are needed to assess the efficacy of the neutralizing antibody to prevent disease deterioration and its benefits among groups of patients specified by disease course and severity. (This study has been registered at ClinicalTrials.gov under identifier NCT04931238.)
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25
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Taniguchi K, Ando Y, Kobayashi M, Toba S, Nobori H, Sanaki T, Noshi T, Kawai M, Yoshida R, Sato A, Shishido T, Naito A, Matsuno K, Okamatsu M, Sakoda Y, Kida H. Characterization of the In Vitro and In Vivo Efficacy of Baloxavir Marboxil against H5 Highly Pathogenic Avian Influenza Virus Infection. Viruses 2022; 14:v14010111. [PMID: 35062315 PMCID: PMC8777714 DOI: 10.3390/v14010111] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 12/31/2021] [Indexed: 02/04/2023] Open
Abstract
Human infections caused by the H5 highly pathogenic avian influenza virus (HPAIV) sporadically threaten public health. The susceptibility of HPAIVs to baloxavir acid (BXA), a new class of inhibitors for the influenza virus cap-dependent endonuclease, has been confirmed in vitro, but it has not yet been fully characterized. Here, the efficacy of BXA against HPAIVs, including recent H5N8 variants, was assessed in vitro. The antiviral efficacy of baloxavir marboxil (BXM) in H5N1 virus-infected mice was also investigated. BXA exhibited similar in vitro activities against H5N1, H5N6, and H5N8 variants tested in comparison with seasonal and other zoonotic strains. Compared with oseltamivir phosphate (OSP), BXM monotherapy in mice infected with the H5N1 HPAIV clinical isolate, the A/Hong Kong/483/1997 strain, also caused a significant reduction in viral titers in the lungs, brains, and kidneys, thereby preventing acute lung inflammation and reducing mortality. Furthermore, compared with BXM or OSP monotherapy, combination treatments with BXM and OSP using a 48-h delayed treatment model showed a more potent effect on viral replication in the organs, accompanied by improved survival. In conclusion, BXM has a potent antiviral efficacy against H5 HPAIV infections.
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Affiliation(s)
- Keiichi Taniguchi
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
- Department of Disease Control, Faculty of Veterinary Medicine, Hokkaido University, Hokkaido 060-0818, Japan; (M.O.); (Y.S.)
| | - Yoshinori Ando
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
| | - Masanori Kobayashi
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
| | - Shinsuke Toba
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
- International Institute for Zoonosis Control, Hokkaido University, Hokkaido 001-0020, Japan; (K.M.); (H.K.)
| | - Haruaki Nobori
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
| | - Takao Sanaki
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
| | - Takeshi Noshi
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
| | - Makoto Kawai
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
| | - Ryu Yoshida
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
| | - Akihiko Sato
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
- International Institute for Zoonosis Control, Hokkaido University, Hokkaido 001-0020, Japan; (K.M.); (H.K.)
| | - Takao Shishido
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
- Correspondence: ; Tel.: +81-6-6331-7263
| | - Akira Naito
- Shionogi & Co., Ltd., Osaka 561-0825, Japan; (K.T.); (Y.A.); (M.K.); (S.T.); (H.N.); (T.S.); (T.N.); (M.K.); (R.Y.); (A.S.); (A.N.)
| | - Keita Matsuno
- International Institute for Zoonosis Control, Hokkaido University, Hokkaido 001-0020, Japan; (K.M.); (H.K.)
- Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Hokkaido 001-0020, Japan
| | - Masatoshi Okamatsu
- Department of Disease Control, Faculty of Veterinary Medicine, Hokkaido University, Hokkaido 060-0818, Japan; (M.O.); (Y.S.)
| | - Yoshihiro Sakoda
- Department of Disease Control, Faculty of Veterinary Medicine, Hokkaido University, Hokkaido 060-0818, Japan; (M.O.); (Y.S.)
- Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Hokkaido 001-0020, Japan
| | - Hiroshi Kida
- International Institute for Zoonosis Control, Hokkaido University, Hokkaido 001-0020, Japan; (K.M.); (H.K.)
- Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Hokkaido 001-0020, Japan
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Yang J, Liu S. Influenza Virus Entry inhibitors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1366:123-135. [DOI: 10.1007/978-981-16-8702-0_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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27
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Qiu L, Wu XW, Zhang SY, Yang M, Zhang SX, Fu JY, Li C, Zhang ZJ, Zheng PY, Lu ZH. Evaluation of efficacy and safety of Qiangzhu-qinggan formula as an adjunctive therapy in adult patients with severe influenza: study protocol for a randomized parallel placebo-controlled double-blind multicenter trial. Trials 2021; 22:955. [PMID: 34961550 PMCID: PMC8710932 DOI: 10.1186/s13063-021-05929-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 12/09/2021] [Indexed: 12/04/2022] Open
Abstract
Background Influenza can fall into three categories according to severity: mild influenza, severe influenza, and critical influenza. Severe influenza can result in critical illness and sometimes death particularly in patients with comorbidities, advanced age, or pregnancy. Neuraminidase inhibitors (NAIs) are the only antiviral drugs in widespread use for influenza. However, the effectiveness of NAIs against severe influenza is uncertain. New effective drugs or regimens are therefore urgently needed. Qiangzhu-qinggan (QZQG) formula has been found to be effective against influenza virus infection during long-term application in China, which lacks support of evidence-based clinical trial till now. This study is designed to assess the efficacy and safety of QZQG formula as an adjuvant therapy in adult patients with severe influenza. Methods This protocol is drawn up in accordance with the SPIRIT guidelines and CONSORT Extension for Chinese herbal medicine formulas. This is a randomized, placebo-controlled, double-blind, multicenter trial. Two hundred twenty-eight adults with severe influenza are randomly assigned in a 1:1 ratio to QZQG or placebo for 7 days. All participants need to receive 1 day of screening before randomization, 7 days of intervention, and 21 days of observation after randomization. The primary outcome is the proportion of clinical improvement, defined as the proportion of patients who met the criteria of 3 points or less in the seven-category ordinal scale or 2 points or less in National Early Warning Score 2 within 7 days after randomization. Discussion This is the first randomized, controlled, parallel, double-blind clinical trial to evaluate the efficacy and safety of traditional Chinese herbal formula granules as an adjuvant therapy in adult patients with severe influenza. This study aims to redefine the value of traditional Chinese herbal medicines in the treatment of virus-related respiratory infectious diseases and serves as an example of evidence-based clinical trials of other Chinese herbal medicines. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05929-8.
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Affiliation(s)
- Lei Qiu
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China
| | - Xian-Wei Wu
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China
| | - Shao-Yan Zhang
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China
| | - Ming Yang
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China
| | - Shun-Xian Zhang
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China
| | - Ji-You Fu
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China
| | - Cui Li
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China
| | - Zhi-Jie Zhang
- Department of Epidemiology, School of Public Health, Fudan University, 130 Dongan Road, No.8 building, Xuhui District, Shanghai, People's Republic of China
| | - Pei-Yong Zheng
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China.
| | - Zhen-Hui Lu
- Institute of Respiratory Diseases, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, No.7 building, Xuhui District, Shanghai, People's Republic of China.
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Abstract
Influenza infection causes severe illness in 3 to 5 million people annually, with up to an estimated 650,000 deaths per annum. As such, it represents an ongoing burden to health care systems and human health. Severe acute respiratory infection can occur, resulting in respiratory failure requiring intensive care support. Herein we discuss diagnostic approaches, including development of CLIA-waived point of care tests that allow rapid diagnosis and treatment of influenza. Bacterial and fungal coinfections in severe influenza pneumonia are associated with worse outcomes, and we summarize the approach and treatment options for diagnosis and treatment of bacterial and Aspergillus coinfection. We discuss the available drug options for the treatment of severe influenza, and treatments which are no longer supported by the evidence base. Finally, we describe the supportive management and ventilatory approach to patients with respiratory failure as a result of severe influenza in the intensive care unit.
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Affiliation(s)
- Liam S O'Driscoll
- Department of Intensive Care Medicine, St. James's University Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), Trinity Centre for Health Sciences, Dublin, Ireland
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, St. James's University Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), Trinity Centre for Health Sciences, Dublin, Ireland.,Respiratory Medicine, Hospital Clinic, IDIBAPS, Universidad de Barcelona, CIBERes, Barcelona, Spain
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29
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Santos GC, Martins LM, Bregadiolli BA, Moreno VF, Silva‐Filho LC, Silva BHST. Heterocyclic compounds as antiviral drugs: Synthesis, structure–activity relationship and traditional applications. J Heterocycl Chem 2021. [DOI: 10.1002/jhet.4349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | - Vitor Fernandes Moreno
- School of Sciences, Department of Chemistry São Paulo State University (UNESP) Bauru Brazil
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30
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Li C, Luo F, Liu C, Xiong N, Xu Z, Zhang W, Yang M, Wang Y, Liu D, Yu C, Zeng J, Zhang L, Li D, Liu Y, Feng M, Liu R, Mei J, Deng S, Zeng Z, He Y, Liu H, Shi Z, Duan M, Kang D, Liao J, Li W, Liu L. Effect of a genetically engineered interferon-alpha versus traditional interferon-alpha in the treatment of moderate-to-severe COVID-19: a randomised clinical trial. Ann Med 2021; 53:391-401. [PMID: 33620016 PMCID: PMC7906612 DOI: 10.1080/07853890.2021.1890329] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There are few effective therapies for coronavirus disease 2019 (COVID-19) upon the outbreak of the pandemic. To compare the effectiveness of a novel genetically engineered recombinant super-compound interferon (rSIFN-co) with traditional interferon-alpha added to baseline antiviral agents (lopinavir-ritonavir or umifenovir) for the treatment of moderate-to-severe COVID-19. METHOD In this multicenter randomized (1:1) trial, patients hospitalized with moderate-to-severe COVID-19 received either rSIFN-co nebulization or interferon-alpha nebulization added to baseline antiviral agents for no more than 28 days. The primary endpoint was the time to clinical improvement. Secondary endpoints included the overall rate of clinical improvement assessed on day 28, the time to radiological improvement and virus nucleic acid negative conversion. RESULTS A total of 94 patients were included in the safety set (46 patients assigned to rSIFN-co group, 48 to interferon-alpha group). The time to clinical improvement was 11.5 days versus 14.0 days (95% CI 1.10 to 2.81, p = .019); the overall rate of clinical improvement on day 28 was 93.5% versus 77.1% (difference, 16.4%; 95% CI 3% to 30%); the time to radiological improvement was 8.0 days versus 10.0 days (p = .002), the time to virus nucleic acid negative conversion was 7.0 days versus 10.0 days (p = .018) in the rSIFN-co and interferon alpha arms, respectively. Adverse events were balanced with no deaths among groups. CONCLUSIONS AND RELEVANCE rSIFN-co was associated with a shorter time of clinical improvement than traditional interferon-alpha in the treatment of moderate-to-severe COVID-19 when combined with baseline antiviral agents. rSIFN-co therapy alone or combined with other antiviral therapy is worth to be further studied.Key messagesThere are few effective therapies for coronavirus disease 2019 (COVID-19) upon the outbreak of the pandemic. Interferon alphas, by inducing both innate and adaptive immune responses, have shown clinical efficacy in treating severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus.In this multicenter, head-to-head, randomized, clinical trial which included 94 participants with moderate-to-severe COVID-19, the rSIFN-co plus antiviral agents (lopinavir-ritonavir or umifenovir) was associated with a shorter time of clinical improvement than interferon-alpha plus antiviral agents.
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Affiliation(s)
- Chuan Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Fengming Luo
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Chengwu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Nian Xiong
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Wuhan Red Cross Hospital, Wuhan, China
| | - Zhihua Xu
- Department of Critical Care Medicine, Mianyang Central Hospital, Mianyang, China
| | - Wei Zhang
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital, The Second Military Medical University, Shanghai, China.,Department of Infectious Diseases, Guanggu District, the Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Ming Yang
- Department of Respiratory Medicine, The Public Health Clinical Center of Chengdu, Chengdu, China
| | - Ye Wang
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Dan Liu
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Chao Yu
- Department of Infectious Diseases, Guanggu District, the Maternal and Child Health Hospital of Hubei Province, Wuhan, China.,Department of Respiratory and Critical Care Medicine, Naval Hospital of Eastern Theater of PLA, Zhoushan, China
| | - Jia Zeng
- Department of Infectious Diseases, Guanggu District, the Maternal and Child Health Hospital of Hubei Province, Wuhan, China.,Department of Aviation Disease, Naval medical center of PLA, the Second Military Medical University, Shanghai, China
| | - Li Zhang
- Department of Respiratory Disease, Wuhan Red Cross Hospital, Wuhan, China
| | - Duo Li
- Department of Respiratory Disease, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yanbin Liu
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Mei Feng
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Ruoyang Liu
- Department of Respiratory Disease, Sichuan Second Hospital of T. C. M, Chengdu, China
| | - Jiandong Mei
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Senyi Deng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhen Zeng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanhong He
- Department of Infectious Disease, The Public Health Clinical Center of Chengdu, Chengdu, China
| | - Haiyan Liu
- Department of Tuberculosis, The Public Health Clinical Center of Chengdu, Chengdu, China
| | - Zhengyu Shi
- Department of Tuberculosis, The Public Health Clinical Center of Chengdu, Chengdu, China
| | - Meng Duan
- Department of Liver Disease, The Public Health Clinical Center of Chengdu, Chengdu, China
| | - Deying Kang
- Department of Evidence based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiayu Liao
- Department of Bioengineering, Bourns College of Engineering, University of California, Riverside, CA, USA.,The West China-California Research Center for Predictive Intervention Medicine, West China hospital, Sichuan University, Chengdu, China
| | - Weimin Li
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
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31
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Zheng J, Chen F, Wu K, Wang J, Li F, Huang S, Lu J, Huang J, Liu H, Zhou R, Huang Z, Meng B, Yuan Z, Wu X. Clinical and virological impact of single and dual infections with influenza A (H1N1) and SARS-CoV-2 in adult inpatients. PLoS Negl Trop Dis 2021; 15:e0009997. [PMID: 34843492 PMCID: PMC8659415 DOI: 10.1371/journal.pntd.0009997] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/09/2021] [Accepted: 11/15/2021] [Indexed: 01/08/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mimics the influenza A (H1N1) virus in terms of clinical presentation, transmission mechanism, and seasonal coincidence. Comprehensive data for the clinical severity of adult patients co-infected by both H1N1 and SARS-CoV-2, and, particularly, the relationship with PCR cycle threshold (Ct) values are not yet available. All participants in this study were tested for H1N1 and SARS-CoV-2 simultaneously at admission. Demographic, clinical, treatment, and laboratory data were extracted from electronic medical records and compared among adults hospitalized for H1N1 infection, SARS-CoV-2 infection and co-infection with both viruses. Ct values for viral RNA detection were further compared within SARS-CoV-2 and co-infection groups. Score on seven-category ordinal scale of clinical status at day 7 and day 14 were assessed. Among patients with monoinfection, H1N1 infection had higher frequency of onset symptoms but lower incidence of adverse events during hospitalization than SAR-CoV-2 infection (P < 0.05). Co-infection had an increased odds of acute kidney injury, acute heart failure, secondary bacterial infections, multilobar infiltrates and admittance to ICU than monoinfection. Score on seven-category scale at day 7 and day 14 was higher in patients with coinfection than patients with SAR-CoV-2 monoinfection (P<0.05). Co-infected patients had lower initial Ct values (referring to higher viral load) (median 32) than patients with SAR-CoV-2 monoinfection (median 36). Among co-infected patients, low Ct values were significantly and positively correlated with acute kidney injury and ARDS (P = 0.03 and 0.02, respectively). Co-infection by SARS-CoV-2 and H1N1 caused more severe disease than monoinfection by either virus in adult inpatients. Early Ct value could provide clues for the later trajectory of the co-infection. Multiplex molecular diagnostics for both viruses and early assessment of SAR-CoV-2 Ct values are recommended to achieve optimal treatment for improved clinical outcome. The baseline enrolled 505 patients admitted to Guangzhou Eighth People’s Hospital (Guangzhou, Guangdong) with a diagnosis of COVID-19 or H1N1. All the patients were tested by both viruses at admission. Demographic, clinical, treatment, and laboratory data were extracted from electronic medical records and compared among adults (≥18 years) hospitalized for H1N1 infection (n = 220), SARS-CoV-2 infection (n = 249) and co-infection with both viruses (n = 36). The prevalence rate of H1N1 co-infection was 12.6% (36/285) among patients hospitalized with COVID-19. Co-infection affected a predominantly older age group and was associated with poorer clinical outcome. We also described the viral load trajectory in patients with diverse types of infection. Lower initial Ct values (higher viral loads in nasopharyngeal swabs) of co-infected patients was found to be associated with a higher number of adverse events and clinical symptoms. Considering the COVID-19 pandemic and a simultaneous epidemic of seasonal influenza, the data in China may critically inform future therapeutic or prophylactic strategies, especially for other developing countries.
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Affiliation(s)
- Jiazhen Zheng
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, Guangdong, China
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Fengjuan Chen
- Department of Medical Administration, Guangzhou Eighth People’s Hospital, Guangzhou, Guangdong, China
| | - Keyi Wu
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, Guangdong, China
| | - Jiancheng Wang
- Department of Intensive Care Unit, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Furong Li
- School of Medicine, Southern University of Science and Technology, Shenzhen, China
| | - Shan Huang
- P3 biosafety laboratory, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, Guangdong, China
| | - Jianyun Lu
- Department of Infectious Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Jinghan Huang
- Department of Biostatistics, School of Public Health, Boston University, Boston, United States of America
| | - Huamin Liu
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, Guangdong, China
| | - Rui Zhou
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, Guangdong, China
| | - Zhiwei Huang
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, Guangdong, China
| | - Bingyao Meng
- Department of Toxicology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, Guangdong, China
| | - Zelin Yuan
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, Guangdong, China
| | - Xianbo Wu
- Department of Epidemiology, School of Public Health (Guangdong Provincial Key Laboratory of Tropical Disease Research), Southern Medical University, Guangzhou, Guangdong, China
- * E-mail:
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32
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Ison MG, Hayden FG, Hay AJ, Gubareva LV, Govorkova EA, Takashita E, McKimm-Breschkin JL. Influenza polymerase inhibitor resistance: Assessment of the current state of the art - A report of the isirv Antiviral group. Antiviral Res 2021; 194:105158. [PMID: 34363859 PMCID: PMC9012257 DOI: 10.1016/j.antiviral.2021.105158] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 12/31/2022]
Abstract
It is more than 20 years since the neuraminidase inhibitors, oseltamivir and zanamivir were approved for the treatment and prevention of influenza. Guidelines for global surveillance and methods for evaluating resistance were established initially by the Neuraminidase Inhibitor Susceptibility Network (NISN), which merged 10 years ago with the International Society for influenza and other Respiratory Virus Diseases (isirv) to become the isirv-Antiviral Group (isirv-AVG). With the ongoing development of new influenza polymerase inhibitors and recent approval of baloxavir marboxil, the isirv-AVG held a closed meeting in August 2019 to discuss the impact of resistance to these inhibitors. Following this meeting and review of the current literature, this article is intended to summarize current knowledge regarding the clinical impact of resistance to polymerase inhibitors and approaches for surveillance and methods for laboratory evaluation of resistance, both in vitro and in animal models. We highlight limitations and gaps in current knowledge and suggest some strategies for addressing these gaps, including the need for additional clinical studies of influenza antiviral drug combinations. Lessons learned from influenza resistance monitoring may also be helpful for establishing future drug susceptibility surveillance and testing for SARS-CoV-2.
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Affiliation(s)
- Michael G Ison
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Frederick G Hayden
- Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Alan J Hay
- The Francis Crick Institute, London, UK.
| | - Larisa V Gubareva
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Elena A Govorkova
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, USA.
| | - Emi Takashita
- National Institute of Infectious Diseases, Tokyo, Japan.
| | - Jennifer L McKimm-Breschkin
- Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Victoria, Australia.
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Wayne MT, Weng W, O’Malley M, Bozyk P, Doshi MM, Flanders SA, McSparron JI, Sharma P, Swaminathan L, Prescott HC. Variation in COVID-19 disease severity at hospital admission over time and across hospitals: A multi-institution cohort of Michigan hospitals. Medicine (Baltimore) 2021; 100:e27265. [PMID: 34664879 PMCID: PMC8448065 DOI: 10.1097/md.0000000000027265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/14/2021] [Accepted: 08/31/2021] [Indexed: 12/19/2022] Open
Abstract
ABSTRACT During the spring 2020 COVID-19 surge, hospitals in Southeast Michigan were overwhelmed, and hospital beds were limited. However, it is unknown whether threshold for hospital admission varied across hospitals or over time.Using a statewide registry, we performed a retrospective cohort study. We identified adult patients hospitalized with COVID-19 in Southeast Michigan (3/1/2020-6/1/2020). We classified disease severity on admission using the World Health Organization (WHO) ordinal scale. Our primary measure of interest was the proportion of patients admitted on room air. We also determined the proportion without acute organ dysfunction on admission or any point during hospitalization. We quantified variation across hospitals and over time by half-month epochs.Among 1315 hospitalizations across 22 hospitals, 57.3% (754/1,315) were admitted on room air, and 26.1% (343/1,315) remained on room air for the duration of hospitalization. Across hospitals, the proportion of COVID-19 hospitalizations admitted on room air varied from 32.3% to 80.0%. Across half-month epochs, the proportion ranged from 49.4% to 69.4% and nadired in early April 2020. Among patients admitted on room air, 75.1% (566/754) had no acute organ dysfunction on admission, and 35.3% (266/754) never developed acute organ dysfunction at any point during hospitalization; there was marked variation in both proportions across hospitals. In-hospital mortality was 13.7% for patients admitted on room air vs 26.3% for patients requiring nasal cannula oxygen.Among patients hospitalized with COVID-19 during the spring 2020 surge in Southeast Michigan, more than half were on room air and a third had no acute organ dysfunction upon admission, but experienced high rates of disease progression and in-hospital mortality.
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Affiliation(s)
- Max T. Wayne
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Wenjing Weng
- Michigan Surgical Quality Collaborative, University of Michigan, Ann Arbor, MI
| | - Megan O’Malley
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Paul Bozyk
- Section of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Beaumont Health, Royal Oak, MI
| | - Mona M. Doshi
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Scott A. Flanders
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Jakob I. McSparron
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Pratima Sharma
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | | | - Hallie C. Prescott
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- VA Center for Clinical Management Research, Ann Arbor, MI
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Zhao B, Yang TF, Zheng R. Theory and reality of antivirals against SARS-CoV-2. World J Clin Cases 2021; 9:6663-6673. [PMID: 34447813 PMCID: PMC8362513 DOI: 10.12998/wjcc.v9.i23.6663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/16/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] Open
Abstract
At present, over 180 million people have been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) worldwide and there have been more than 3.8 million deaths due to the virus. However, specific effective antiviral treatment for this infectious disease is absent. At the beginning of the epidemic, relevant cellular and animal experiments of antiviral treatment for SARS-CoV-2 were conducted based on the prior studies of SARS-CoV and Middle East respiratory syndrome coronavirus. Some antivirals were preliminarily validated to be potentially effective in the clinical settings. But as the epidemic continued and more studies were carried out, the efficacy of these antiviral drugs became controversial. This paper reviews the pharmacology and application of interferon, lopinavir/ritonavir, ribavirin, chloroquine, arbidol, favipiravir, remdesivir, and thymosin α1 in coronavirus disease 2019. The actual effect of these drugs remains controversial. Meanwhile, the efficacy and safety of these drugs for patients with coronavirus disease 2019 still need to be explored.
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Affiliation(s)
- Bo Zhao
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Teng-Fei Yang
- Department of Health Management and Family Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Rui Zheng
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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de St. Maurice A, Martin‐Blais R, Halasa N. Preparing for the 2020-2021 influenza season. Pediatr Transplant 2021; 25:e14025. [PMID: 33904211 PMCID: PMC8237025 DOI: 10.1111/petr.14025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/23/2020] [Indexed: 12/13/2022]
Abstract
The COVID-19 pandemic has altered health seeking behaviors and has increased attention to non-pharmaceutical interventions that reduce the risk of transmission of respiratory viruses including SARS-CoV-2 and influenza. While the potential impact of the COVID-19 pandemic on influenza is not fully known, in the Southern hemisphere influenza infection rates appear to be very low. Influenza vaccine efficacy for 2019-2020 season was comparable to prior season and influenza vaccine recommendations for pediatric immunizations remain similar to prior years. Influenza treatments continue to include neuraminidase inhibitors as well as baloxavir for treatment and in some instances prophylaxis.
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Affiliation(s)
- Annabelle de St. Maurice
- Division of Pediatric Infectious DiseasesDepartment of PediatricsUCLA David Geffen School of MedicineLos AngelesCAUSA
| | - Rachel Martin‐Blais
- Division of Pediatric Infectious DiseasesDepartment of PediatricsUCLA David Geffen School of MedicineLos AngelesCAUSA
| | - Natasha Halasa
- Division of Pediatric Infectious DiseasesDepartment of PediatricsVanderbilt University Medical CenterLos AngelesCAUSA
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36
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Oruç MA, Öz H, Öztürk O. Investigation of the disease process and drug combinations in patients with suspected/confirmed COVID-19 using favipiravir. Int J Clin Pract 2021; 75:e14167. [PMID: 33743543 PMCID: PMC8250050 DOI: 10.1111/ijcp.14167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS It is aimed to investigate the disease processes and drug combinations in patients who received favipiravir treatment. METHODS This cross-sectional, analytical and retrospective study included all patients aged ≥18 years (n = 502) who were hospitalised in Samsun, Turkey, for COVID-19 and were given favipiravir from the date between 25 March 2020 and 3 June 2020. RESULTS In total, 58.6% (n = 294) of the patients were male and 24.5% (n = 123) were between the ages of 71 and 80 years. During the first case process, the mortality rate was 19.9%, whereas the rate of those who were discharged as is/followed up at home for 14 days was 37.3%. During the second case process, the mortality rate was 6.2%, and the rate of those who was discharged as is/followed up at home for 14 days was 65.6%. The mean length of hospital stay was 10.61 ± 8.17 days for the first and 7.97 ± 4.16 days for the second hospitalisation; this difference was significant. Mortality risk of those who used Tocilizumab or vitamin C beside Favipiravir was higher than those who did not. The length of hospital stay was higher in patients using tocilizumab than in those who did not (P < .001). CONCLUSION Administration of favipiravir later in the course of the disease makes it difficult to achieve the true efficacy expected from the drug and also makes it difficult for other combination drugs to contribute to survival. Favipiravir may also be effective in case of recurrence.
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Affiliation(s)
- Muhammet Ali Oruç
- Department of Family MedicineFaculty of MedicineAhi Evran UniversityKirsehirTurkey
| | - Hatice Öz
- Public HealthSamsun Provincial Health DirectorateSamsunTurkey
| | - Onur Öztürk
- Department of Family MedicineSBU Samsun Education and Research HospitalSamsunTurkey
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Al-Azzam S, Mhaidat NM, Banat HA, Alfaour M, Ahmad DS, Muller A, Al-Nuseirat A, Lattyak EA, Conway BR, Aldeyab MA. An Assessment of the Impact of Coronavirus Disease (COVID-19) Pandemic on National Antimicrobial Consumption in Jordan. Antibiotics (Basel) 2021; 10:690. [PMID: 34207567 PMCID: PMC8229725 DOI: 10.3390/antibiotics10060690] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/02/2021] [Accepted: 06/05/2021] [Indexed: 12/27/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has overlapping clinical characteristics with bacterial respiratory tract infection, leading to the prescription of potentially unnecessary antibiotics. This study aimed at measuring changes and patterns of national antimicrobial use for one year preceding and one year during the COVID-19 pandemic. Annual national antimicrobial consumption for 2019 and 2020 was obtained from the Jordan Food and Drug Administration (JFDA) following the WHO surveillance methods. The WHO Access, Watch, and Reserve (AWaRe) classification was used. Total antibiotic consumption in 2020 (26.8 DDD per 1000 inhabitants per day) decreased by 5.5% compared to 2019 (28.4 DDD per 1000 inhabitants per day). There was an increase in the use of several antibiotics during 2020 compared with 2019 (third generation cephalosporins (19%), carbapenems (52%), macrolides (57%), and lincosamides (106%)). In 2020, there was a marked reduction in amoxicillin use (-53%), while the use of azithromycin increased by 74%. National antimicrobial consumption of the Access group decreased by 18% from 2019 to 2020 (59.1% vs. 48.1% of total consumption). The use of the Watch group increased in 2020 by 26%. The study highlighted an increase in the use of certain antibiotics during the pandemic period that are known to be associated with increasing resistance. Efforts to enhance national antimicrobial stewardship are needed to ensure rational use of antimicrobials.
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Affiliation(s)
- Sayer Al-Azzam
- Clinical Pharmacy Department, Jordan University of Science and Technology, Irbid 22110, Jordan; (S.A.-A.); (N.M.M.)
| | - Nizar Mahmoud Mhaidat
- Clinical Pharmacy Department, Jordan University of Science and Technology, Irbid 22110, Jordan; (S.A.-A.); (N.M.M.)
| | - Hayaa A. Banat
- Jordan Food and Drug Administration (JFDA), Amman 11181, Jordan; (H.A.B.); (M.A.); (D.S.A.)
| | - Mohammad Alfaour
- Jordan Food and Drug Administration (JFDA), Amman 11181, Jordan; (H.A.B.); (M.A.); (D.S.A.)
| | - Dana Samih Ahmad
- Jordan Food and Drug Administration (JFDA), Amman 11181, Jordan; (H.A.B.); (M.A.); (D.S.A.)
| | - Arno Muller
- Antimicrobial Resistance Division, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland;
| | - Adi Al-Nuseirat
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo 11371, Egypt;
| | | | - Barbara R. Conway
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK;
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Mamoon A. Aldeyab
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK;
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Mazumder P, Kalamdhad A, Chaminda GT, Kumar M. Coalescence of co-infection and antimicrobial resistance with SARS-CoV-2 infection: The blues of post-COVID-19 world. CASE STUDIES IN CHEMICAL AND ENVIRONMENTAL ENGINEERING 2021; 3:100093. [PMID: 38620798 PMCID: PMC7897456 DOI: 10.1016/j.cscee.2021.100093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 05/07/2023]
Abstract
In viral respiratory infections, bacterial co-pathogens are widely known to co-infect, and they significantly increase the morbidity and mortality rate. During the influenza season, the advent of 2019-nCoV (novel coronavirus) has led to the widespread use of oral and intravenous antibiotics and inhibitors of neuraminidase enzyme. Owing to causes such as extended intubation, the ubiquitous use of intrusive catheters, and compromised host immunity, coronavirus disease (COVID-19) patients are at heightened risk of secondary bacterial and fungal infections, leading to the difficulty in their treatment. Apart from the pandemic, the primary risk is a likely surge in multidrug resistance. In this work, we evaluated the coalescence of present co-infection alongside the COVID-19 and post-pandemic antimicrobial resistance due to high ongoing drug use for the treatment of COVID-19. We found that while there is currently limited evidence of bacterial infections in COVID-19, available proof supports the restricted use of antibiotics from an antibiotic stewardship viewpoint, primarily upon entry. Paramount attempts should be made to collect sputum and blood culture samples as well as pneumococcal urinary antigen monitoring in order to endorse stringent antibiotic usage. For antimicrobial stewardship, inflammatory markers like procalcitonin have been added, but such biomarkers are typically upraised in COVID-19. Antimicrobials cannot be completely removed in wastewater treatment plants (WWTPs) and once they enter the water environment, possesses a great risk of inducing resistance to drugs in microbes. Hence, their prescription and administrations should be regulated and alternate solutions such as vaccines, preventive measures and personal hygiene should be given top priority. It is imperative to establish an antimicrobial strategy discrete to COVID-19, as this pandemic has caused an outbreak of numerous other associated diseases and has the potential to drive microbial resistance. Coordinated plans are essential for this at the citizen, health-care and policy levels.
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Affiliation(s)
- Payal Mazumder
- Centre for the Environment, Indian Institute of Technology Guwahati, Assam, 781039, India
| | - Ajay Kalamdhad
- Department of Civil Engineering, Indian Institute of Technology Guwahati, Assam, 781039, India
| | - Gg Tushara Chaminda
- Departmnet of Civil and Environmental Engineering, University of Ruhuna, Galle, Sri Lanka
| | - Manish Kumar
- Discipline of Earth Science, Indian Institute of Technology Gandhinagar, Gujarat, 3823009, India
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Aziz A, Asif M, Ashraf G, Yang Q, Wang S. COVID-19 Impacts, Diagnosis and Possible Therapeutic Techniques: A Comprehensive Review. Curr Pharm Des 2021; 27:1170-1184. [PMID: 33280586 DOI: 10.2174/1874467213666201204154239] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/19/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The spread of COVID-19 has become a growing cause of mortalities over the globe since its major outbreak in December 2019. The scientific and medical communities are rallying to study different strains and probable mutations to develop more rapid and reliable molecular diagnostic tests and possible therapeutic approaches for SARS-CoV-2. INTRODUCTION In the first section, following the introductory part, we shed light on structural and pathogenic features of SARS-CoV-2 and risk factors related to age, gender, neonatal and comorbidities. The next section summarizes the current diagnostic tests for COVID-19, such as nucleic acid and computed tomography (CT) techniques, with further emphasis on emerging diagnostic approaches for COVID-19. METHODS Further, we also review the ongoing therapeutic practices which can block virus-host interaction, cease viral proliferation or inhibit hyperbolic host immune response with subsections on drug therapy, cell therapy, immunotherapy and herbal medicines that are being used for the possible treatment of patients. RESULTS AND CONCLUSION Among the different promising drugs, remdesivir, by inhibiting the RNA-dependent RNA-Polymerase activity, gives much better results, including declined viral load and quick lung tissue recovery. The long-lasting repercussions of COVID-19 have also been discussed at the end. In this review, we have also critically discussed the progress in several vaccines that are under development.
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Affiliation(s)
- Ayesha Aziz
- School of Biomedical Engineering, Huazhong University of Science and Technology (HUST), Wuhan, 430074, China
| | - Muhammad Asif
- School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Ghazala Ashraf
- Britton Chance Center for Biomedical Photonics at Wuhan National Laboratory for Optoelectronics-Hubei Bioinformatics & Molecular Imaging Key Laboratory, Collaborative Innovation Center for Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Qiaoli Yang
- School of Biomedical Engineering, Huazhong University of Science and Technology (HUST), Wuhan, 430074, China
| | - Shenqi Wang
- School of Biomedical Engineering, Huazhong University of Science and Technology (HUST), Wuhan, 430074, China
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40
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Shyr ZA, Cheng YS, Lo DC, Zheng W. Drug combination therapy for emerging viral diseases. Drug Discov Today 2021; 26:2367-2376. [PMID: 34023496 PMCID: PMC8139175 DOI: 10.1016/j.drudis.2021.05.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/14/2021] [Accepted: 05/16/2021] [Indexed: 12/17/2022]
Abstract
Effective therapeutics to combat emerging viral infections are an unmet need. Historically, treatments for chronic viral infections with single drugs have not been successful, as exemplified by human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections. Combination therapy for these diseases has led to improved clinical outcomes with dramatic reductions in viral load, morbidity, and mortality. Drug combinations can enhance therapeutic efficacy through additive, and ideally synergistic, effects for emerging and re-emerging viruses, such as influenza, severe acute respiratory syndrome-coronavirus (SARS-CoV), Middle East respiratory syndrome (MERS)-CoV, Ebola, Zika, and SARS-coronavirus 2 (CoV-2). Although novel drug development through traditional pipelines remains a priority, in the interim, effective synergistic drug candidates could be rapidly identified by drug-repurposing screens, facilitating accelerated paths to clinical testing and potential emergency use authorizations.
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Affiliation(s)
- Zeenat A Shyr
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA.
| | - Yu-Shan Cheng
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Donald C Lo
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Wei Zheng
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA.
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41
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Takashita E. Influenza Polymerase Inhibitors: Mechanisms of Action and Resistance. Cold Spring Harb Perspect Med 2021; 11:cshperspect.a038687. [PMID: 32122918 PMCID: PMC8091960 DOI: 10.1101/cshperspect.a038687] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The influenza virus RNA-dependent RNA polymerase is highly conserved among influenza A, B, C, and D viruses. It comprises three subunits: polymerase basic protein 1 (PB1), polymerase basic protein 2 (PB2), and polymerase acidic protein (PA) in influenza A and B viruses or polymerase 3 protein (P3) in influenza C and D viruses. Because this polymerase is essential for influenza virus replication, it has been considered as a target for antiviral agents. Recently, several polymerase inhibitors that target each subunit have been developed. This review discusses the mechanism of action, antiviral activity, and emergence of resistance to three inhibitors approved for the treatment of influenza or in late-phase clinical trials: the PB1 inhibitor favipiravir, the PB2 inhibitor pimodivir, and the PA inhibitor baloxavir marboxil.
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Affiliation(s)
- Emi Takashita
- Influenza Virus Research Center, National Institute of Infectious Diseases, Musashimurayama, Tokyo 208-0011, Japan
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42
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Wolf M, Alladina J, Navarrete-Welton A, Shoults B, Brait K, Ziehr D, Malhotra A, Hardin CC, Hibbert KA. Obesity and Critical Illness in COVID-19: Respiratory Pathophysiology. Obesity (Silver Spring) 2021; 29:870-878. [PMID: 33533193 PMCID: PMC8014725 DOI: 10.1002/oby.23142] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/24/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Recent cohort studies have identified obesity as a risk factor for poor outcomes in coronavirus disease 2019 (COVID-19). To further explore the relationship between obesity and critical illness in COVID-19, the association of BMI with baseline demographic and intensive care unit (ICU) parameters, laboratory values, and outcomes in a critically ill patient cohort was examined. METHODS In this retrospective study, the first 277 consecutive patients admitted to Massachusetts General Hospital ICUs with laboratory-confirmed COVID-19 were examined. BMI class, initial ICU laboratory values, physiologic characteristics including gas exchange and ventilatory mechanics, and ICU interventions as clinically available were measured. Mortality, length of ICU admission, and duration of mechanical ventilation were also measured. RESULTS There was no difference found in respiratory system compliance or oxygenation between patients with and without obesity. Patients without obesity had higher initial ferritin and D-dimer levels than patients with obesity. Standard acute respiratory distress syndrome management, including prone ventilation, was equally distributed between BMI groups. There was no difference found in outcomes between BMI groups, including 30- and 60-day mortality and duration of mechanical ventilation. CONCLUSIONS In this cohort of critically ill patients with COVID-19, obesity was not associated with meaningful differences in respiratory physiology, inflammatory profile, or clinical outcomes.
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Affiliation(s)
- Molly Wolf
- Division of Pulmonary and Critical Care MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Jehan Alladina
- Division of Pulmonary and Critical Care MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Allison Navarrete-Welton
- Division of Pulmonary and Critical Care MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Benjamin Shoults
- Division of Pulmonary and Critical Care MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Kelsey Brait
- Division of Pulmonary and Critical Care MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - David Ziehr
- Division of Pulmonary and Critical Care MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Atul Malhotra
- Division of Pulmonary and Critical Care MedicineUniversity of California San DiegoSan DiegoCaliforniaUSA
| | - C. Corey Hardin
- Division of Pulmonary and Critical Care MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Kathryn A. Hibbert
- Division of Pulmonary and Critical Care MedicineMassachusetts General HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
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43
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Abstract
Influenza infection poses significant risk for solid organ transplant recipients who often experience more severe infection with increased rates of complications, including those relating to the allograft. Although symptoms of influenza experienced by transplant recipients are similar to that of the general population, fever is not a ubiquitous symptom and lymphopenia is common. Annual inactivated influenza vaccine is recommended for all transplant recipients. Newer strategies such as using a higher dose vaccine or multiple doses in the same season appear to provide greater immunogenicity. Neuraminidase inhibitors are the mainstay of treatment and chemoprophylaxis although resistance may occur in the transplant setting. Influenza therapeutics are advancing, including the recent licensure of baloxavir; however, many remain to be evaluated in transplant recipients and are not yet in routine clinical use. Further population-based studies spanning multiple influenza seasons are needed to enhance our understanding of influenza epidemiology in solid organ transplant recipients. Specific assessment of newer influenza therapeutics in transplant recipients and refinement of prevention strategies are vital to reducing morbidity and mortality.
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Affiliation(s)
- Tina M Marinelli
- Division of Infectious Diseases, Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada
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44
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Bakhiet M, Taurin S. SARS-CoV-2: Targeted managements and vaccine development. Cytokine Growth Factor Rev 2021; 58:16-29. [PMID: 33293238 PMCID: PMC7706592 DOI: 10.1016/j.cytogfr.2020.11.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 02/06/2023]
Abstract
Infection with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) results in diverse outcomes. The symptoms appear to be more severe in males older than 65 and people with underlying health conditions; approximately one in five individuals could be at risk worldwide. The virus's sequence was rapidly established days after the first cases were reported and identified an RNA virus from the Coronaviridae family closely related to a Betacoronavirus virus found in bats in China. SARS-CoV-2 is the seventh coronavirus known to infect humans, and with the severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS), the only ones to cause severe diseases. Lessons from these two previous outbreaks guided the identification of critical therapeutic targets such as the spike viral proteins promoting the virus's cellular entry through the angiotensin-converting enzyme 2 (ACE2) receptor expressed on the surface of multiple types of eukaryotic cells. Although several therapeutic agents are currently evaluated, none seems to provide a clear path for a cure. Also, various types of vaccines are developed in record time to address the urgency of efficient SARS-CoV-2 prevention. Currently, 58 vaccines are evaluated in clinical trials, including 11 in phase III, and 3 of them reported efficacy above 90 %. The results so far from the clinical trials suggest the availability of multiple effective vaccines within months.
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45
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Chakladar S, Liao R, Landau W, Gamalo M, Wang Y. Discrete Time Multistate Model With Regime Switching for Modeling COVID-19 Disease Progression and Clinical Outcomes. Stat Biopharm Res 2021. [DOI: 10.1080/19466315.2021.1880966] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Ran Liao
- Eli Lilly & Co., Indianapolis, IN
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46
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Basiri A, Pazhouhnia Z, Beheshtizadeh N, Hoseinpour M, Saghazadeh A, Rezaei N. Regenerative Medicine in COVID-19 Treatment: Real Opportunities and Range of Promises. Stem Cell Rev Rep 2021; 17:163-175. [PMID: 32564256 PMCID: PMC7305935 DOI: 10.1007/s12015-020-09994-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Novel coronavirus disease (COVID-19) has attracted much attention around the world due to its rapid transmission among humans and relatively high mortality rate. Studies are increasing to find the best therapeutic approach for the disease and its management. Regenerative medicine offers various cell-tissue therapeutics and related products, such as stem cell therapy, natural killer (NK) cell therapy, Chimeric antigen receptor (CAR) T cell therapy, exosomes, and tissue products. Interestingly, mesenchymal stem cells (MSCs) can reduce inflammatory symptoms and protect against cytokine storm, which critically contributes to the COVID-19 progression. Notably, having the potentials to exert cytotoxic effects on infected cells and induce interferon production probably make NK cells a candidate for COVID-19 cell therapy. Besides, exosomes are one of the crucial products of cells that can exert therapeutic effects through the induction of immune responses and neutralizing antibody titers. The paper aims to briefly consider current options for COVID-19 therapy to show that there is no specific cure for COVID-19, and then assess the real opportunities and range of promises regenerative medicine can provide for specific treatment of COVID-19. Graphical Abstract Therapeutic Potential of Regenerative Medicine against COVID19.
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Affiliation(s)
- Arefeh Basiri
- Department of Biomaterials and Tissue Engineering, School of Advanced Technology in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Zahra Pazhouhnia
- Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Nima Beheshtizadeh
- Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdieh Hoseinpour
- Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Amene Saghazadeh
- Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. .,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
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47
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Gao D, Xu M, Wang G, Lv J, Ma X, Guo Y, Zhang D, Yang H, Jiang W, Deng F, Xia G, Lu Z, Lv L, Gong S. The efficiency and safety of high-dose vitamin C in patients with COVID-19: a retrospective cohort study. Aging (Albany NY) 2021; 13:7020-7034. [PMID: 33638944 PMCID: PMC7993712 DOI: 10.18632/aging.202557] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/04/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The inflammatory reaction is the main cause of acute respiratory distress syndrome and multiple organ failure in patients with Coronavirus disease 2019, especially those with severe and critical illness. Several studies suggested that high-dose vitamin C reduced inflammatory reaction associated with sepsis and acute respiratory distress syndrome. This study aimed to determine the efficacy and safety of high-dose vitamin C in Coronavirus disease 2019. METHODS We included 76 patients with Coronavirus disease 2019, classified into the high-dose vitamin C group (loading dose of 6g intravenous infusion per 12 hr on the first day, and 6g once for the following 4 days, n=46) and the standard therapy group (standard therapy alone, n=30). RESULTS The risk of 28-day mortality was reduced for the high-dose vitamin C versus the standard therapy group (HR=0.14, 95% CI, 0.03-0.72). Oxygen support status was improved more with high-dose vitamin C than standard therapy (63.9% vs 36.1%). No safety events were associated with high-dose vitamin C therapy. CONCLUSION High-dose vitamin C may reduce the mortality and improve oxygen support status in patients with Coronavirus disease 2019 without adverse events.
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Affiliation(s)
- Dengfeng Gao
- Department of Cardiology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Min Xu
- Department of Cardiology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Gang Wang
- Department of Critical Care, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Jianrui Lv
- Department of Anesthesiology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Xiaorong Ma
- Department of Hematology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Yonghong Guo
- Department of Infectious Diseases, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Dexin Zhang
- Department of Respiratory and Critical Care, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Huiyun Yang
- Department of Nursing, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Wei Jiang
- Department of Cardiology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Fuxue Deng
- Department of Cardiology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Guozhi Xia
- Department of Cardiology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Ziwei Lu
- Department of Cardiology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Lv Lv
- Department of Cardiology, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
| | - Shouping Gong
- Department of Neurosurgery, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi, P.R. China
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48
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Mansour E, Palma AC, Ulaf RG, Ribeiro LC, Bernardes AF, Nunes TA, Agrela MV, Bombassaro B, Monfort-Pires M, Camargo RL, Araujo EP, Brunetti NS, Farias AS, Falcão ALE, Santos TM, Trabasso P, Dertkigil RP, Dertkigil SS, Moretti ML, Velloso LA. Safety and Outcomes Associated with the Pharmacological Inhibition of the Kinin-Kallikrein System in Severe COVID-19. Viruses 2021; 13:v13020309. [PMID: 33669276 PMCID: PMC7920028 DOI: 10.3390/v13020309] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Coronavirus disease 19 (COVID-19) can develop into a severe respiratory syndrome that results in up to 40% mortality. Acute lung inflammatory edema is a major pathological finding in autopsies explaining O2 diffusion failure and hypoxemia. Only dexamethasone has been shown to reduce mortality in severe cases, further supporting a role for inflammation in disease severity. SARS-CoV-2 enters cells employing angiotensin-converting enzyme 2 (ACE2) as a receptor, which is highly expressed in lung alveolar cells. ACE2 is one of the components of the cellular machinery that inactivates the potent inflammatory agent bradykinin, and SARS-CoV-2 infection could interfere with the catalytic activity of ACE2, leading to the accumulation of bradykinin. Methods: In this case control study, we tested two pharmacological inhibitors of the kinin–kallikrein system that are currently approved for the treatment of hereditary angioedema, icatibant, and inhibitor of C1 esterase/kallikrein, in a group of 30 patients with severe COVID-19. Results: Neither icatibant nor inhibitor of C1 esterase/kallikrein resulted in changes in time to clinical improvement. However, both compounds were safe and promoted the significant improvement of lung computed tomography scores and increased blood eosinophils, which are indicators of disease recovery. Conclusions: In this small cohort, we found evidence for safety and a beneficial role of pharmacological inhibition of the kinin–kallikrein system in two markers that indicate improved disease recovery.
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Affiliation(s)
- Eli Mansour
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, 13083-887 Campinas, São Paulo, Brazil; (E.M.); (A.C.P.); (R.G.U.); (L.C.R.); (A.F.B.); (T.A.N.); (M.V.A.); (T.M.S.); (P.T.); (M.L.M.)
| | - Andre C. Palma
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, 13083-887 Campinas, São Paulo, Brazil; (E.M.); (A.C.P.); (R.G.U.); (L.C.R.); (A.F.B.); (T.A.N.); (M.V.A.); (T.M.S.); (P.T.); (M.L.M.)
| | - Raisa G. Ulaf
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, 13083-887 Campinas, São Paulo, Brazil; (E.M.); (A.C.P.); (R.G.U.); (L.C.R.); (A.F.B.); (T.A.N.); (M.V.A.); (T.M.S.); (P.T.); (M.L.M.)
| | - Luciana C. Ribeiro
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, 13083-887 Campinas, São Paulo, Brazil; (E.M.); (A.C.P.); (R.G.U.); (L.C.R.); (A.F.B.); (T.A.N.); (M.V.A.); (T.M.S.); (P.T.); (M.L.M.)
| | - Ana Flavia Bernardes
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, 13083-887 Campinas, São Paulo, Brazil; (E.M.); (A.C.P.); (R.G.U.); (L.C.R.); (A.F.B.); (T.A.N.); (M.V.A.); (T.M.S.); (P.T.); (M.L.M.)
| | - Thyago A. Nunes
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, 13083-887 Campinas, São Paulo, Brazil; (E.M.); (A.C.P.); (R.G.U.); (L.C.R.); (A.F.B.); (T.A.N.); (M.V.A.); (T.M.S.); (P.T.); (M.L.M.)
| | - Marcus V. Agrela
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, 13083-887 Campinas, São Paulo, Brazil; (E.M.); (A.C.P.); (R.G.U.); (L.C.R.); (A.F.B.); (T.A.N.); (M.V.A.); (T.M.S.); (P.T.); (M.L.M.)
| | - Bruna Bombassaro
- Obesity and Comorbidities Research Center, University of Campinas, 13083-864 Campinas, São Paulo, Brazil; (B.B.); (M.M.-P.); (R.L.C.); (E.P.A.)
| | - Milena Monfort-Pires
- Obesity and Comorbidities Research Center, University of Campinas, 13083-864 Campinas, São Paulo, Brazil; (B.B.); (M.M.-P.); (R.L.C.); (E.P.A.)
| | - Rafael L. Camargo
- Obesity and Comorbidities Research Center, University of Campinas, 13083-864 Campinas, São Paulo, Brazil; (B.B.); (M.M.-P.); (R.L.C.); (E.P.A.)
| | - Eliana P. Araujo
- Obesity and Comorbidities Research Center, University of Campinas, 13083-864 Campinas, São Paulo, Brazil; (B.B.); (M.M.-P.); (R.L.C.); (E.P.A.)
- School of Nursing, University of Campinas, 13083-887 Campinas, São Paulo, Brazil
| | - Natalia S. Brunetti
- Autoimmune Research Lab, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas, 13083-862 Campinas, São Paulo, Brazil; (N.S.B.); (A.S.F.)
| | - Alessandro S. Farias
- Autoimmune Research Lab, Department of Genetics, Microbiology and Immunology, Institute of Biology, University of Campinas, 13083-862 Campinas, São Paulo, Brazil; (N.S.B.); (A.S.F.)
| | - Antônio Luís E. Falcão
- Department of Surgery, School of Medical Sciences, University of Campinas, 13083-887 Campinas, São Paulo, Brazil;
| | - Thiago Martins Santos
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, 13083-887 Campinas, São Paulo, Brazil; (E.M.); (A.C.P.); (R.G.U.); (L.C.R.); (A.F.B.); (T.A.N.); (M.V.A.); (T.M.S.); (P.T.); (M.L.M.)
| | - Plinio Trabasso
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, 13083-887 Campinas, São Paulo, Brazil; (E.M.); (A.C.P.); (R.G.U.); (L.C.R.); (A.F.B.); (T.A.N.); (M.V.A.); (T.M.S.); (P.T.); (M.L.M.)
| | - Rachel P. Dertkigil
- Department of Radiology, School of Medical Sciences, University of Campinas, 13083-887 Campinas, São Paulo, Brazil; (R.P.D.); (S.S.D.)
| | - Sergio S. Dertkigil
- Department of Radiology, School of Medical Sciences, University of Campinas, 13083-887 Campinas, São Paulo, Brazil; (R.P.D.); (S.S.D.)
| | - Maria Luiza Moretti
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, 13083-887 Campinas, São Paulo, Brazil; (E.M.); (A.C.P.); (R.G.U.); (L.C.R.); (A.F.B.); (T.A.N.); (M.V.A.); (T.M.S.); (P.T.); (M.L.M.)
| | - Licio A. Velloso
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, 13083-887 Campinas, São Paulo, Brazil; (E.M.); (A.C.P.); (R.G.U.); (L.C.R.); (A.F.B.); (T.A.N.); (M.V.A.); (T.M.S.); (P.T.); (M.L.M.)
- Obesity and Comorbidities Research Center, University of Campinas, 13083-864 Campinas, São Paulo, Brazil; (B.B.); (M.M.-P.); (R.L.C.); (E.P.A.)
- Correspondence:
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49
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Mitsumura T, Okamoto T, Shirai T, Iijima Y, Sakakibara R, Honda T, Ishizuka M, Aiboshi J, Tateishi T, Tamaoka M, Shigemitsu H, Arai H, Otomo Y, Tohda S, Anzai T, Takahashi K, Yasuda S, Miyazaki Y. Predictors associated with clinical improvement of SARS-CoV-2 pneumonia. J Infect Chemother 2021; 27:857-863. [PMID: 33676842 PMCID: PMC7885694 DOI: 10.1016/j.jiac.2021.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/27/2021] [Accepted: 02/10/2021] [Indexed: 01/08/2023]
Abstract
Background There are few agents that have been proven effective for COVID-19. Predicting clinical improvement as well as mortality or severity is very important. Objectives This study aimed to investigate the factors associated with the clinical improvement of COVID-19. Methods Overall, 74 patients receiving treatment for COVID-19 at Tokyo Medical and Dental University Hospital from April 6th to May 15th, 2020 were included in this study. Clinical improvement was evaluated, which defined as the decline of two levels on a six-point ordinal scale of clinical status or discharge alive from the hospital within 28 days after admission. The clinical courses were particularly investigated and the factors related to time to clinical improvement were analyzed with the log-rank test and the Cox proportional hazard model. Results Forty-nine patients required oxygen support during hospitalization, 22 patients required invasive mechanical ventilation, and 5 patients required extracorporeal membrane oxygenation. A total of 83% of cases reached clinical improvement. Longer period of time from onset to admission (≥10 days) (HR, 1.057; 95% CI, 1.002–1.114), no hypertension (HR, 2.077; 95% CI, 1.006–4.287), and low D-dimer levels (<1 μg/ml) (HR, 2.372; 95% CI, 1.229–4.576) were confirmed to be significant predictive factors for time to clinical improvement. Furthermore, a lower SARS-CoV-2 RNA copy number was also a predictive factor for clinical improvement. Conclusions Several predictors for the clinical improvement of COVID-19 pneumonia were identified. These results may be important for the management of COVID-19 pneumonia.
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Affiliation(s)
- Takahiro Mitsumura
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Tsukasa Okamoto
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Tsuyoshi Shirai
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yuki Iijima
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Rie Sakakibara
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Takayuki Honda
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Masahiro Ishizuka
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Junichi Aiboshi
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Tomoya Tateishi
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Meiyo Tamaoka
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Hidenobu Shigemitsu
- Department of Intensive Care Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Shuji Tohda
- Department of Laboratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Tatsuhiko Anzai
- M&D Data Science Center, Tokyo Medical and Dental University, 2-3-10, Kandasurugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Kunihiko Takahashi
- M&D Data Science Center, Tokyo Medical and Dental University, 2-3-10, Kandasurugadai, Chiyoda-ku, Tokyo, 101-0062, Japan
| | - Shinsuke Yasuda
- Department of Rheumatology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
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50
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Mansour E, Bueno FF, de Lima-Júnior JC, Palma A, Monfort-Pires M, Bombassaro B, Araujo EP, Bernardes AF, Ulaf RG, Nunes TA, Ribeiro LC, Falcão ALE, Santos TM, Trabasso P, Dertkigil RP, Dertkigil SS, Maia RP, Benaglia T, Moretti ML, Velloso LA. Evaluation of the efficacy and safety of icatibant and C1 esterase/kallikrein inhibitor in severe COVID-19: study protocol for a three-armed randomized controlled trial. Trials 2021; 22:71. [PMID: 33472675 PMCID: PMC7816150 DOI: 10.1186/s13063-021-05027-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 01/06/2021] [Indexed: 12/24/2022] Open
Abstract
Background SARS-CoV-2, the virus that causes COVID-19, enters the cells through a mechanism dependent on its binding to angiotensin-converting enzyme 2 (ACE2), a protein highly expressed in the lungs. The putative viral-induced inhibition of ACE2 could result in the defective degradation of bradykinin, a potent inflammatory substance. We hypothesize that increased bradykinin in the lungs is an important mechanism driving the development of pneumonia and respiratory failure in COVID-19. Methods This is a phase II, single-center, three-armed parallel-group, open-label, active control superiority randomized clinical trial. One hundred eighty eligible patients will be randomly assigned in a 1:1:1 ratio to receive either the inhibitor of C1e/kallikrein 20 U/kg intravenously on day 1 and day 4 plus standard care; or icatibant 30 mg subcutaneously, three doses/day for 4 days plus standard care; or standard care alone, as recommended in the clinical trials published to date, which includes supplemental oxygen, non-invasive and invasive ventilation, antibiotic agents, anti-inflammatory agents, prophylactic antithrombotic therapy, vasopressor support, and renal replacement therapy. Discussion Accumulation of bradykinin in the lungs is a common side effect of ACE inhibitors leading to cough. In animal models, the inactivation of ACE2 leads to severe acute pneumonitis in response to lipopolysaccharide (LPS), and the inhibition of bradykinin almost completely restores the lung structure. We believe that inhibition of bradykinin in severe COVID-19 patients could reduce the lung inflammatory response, impacting positively on the severity of disease and mortality rates. Trial registration Brazilian Clinical Trials Registry Universal Trial Number (UTN) U1111-1250-1843. Registered on May/5/2020.
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Affiliation(s)
- Eli Mansour
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Flávia F Bueno
- Obesity and Comorbidities Research Center, University of Campinas, Campinas, São Paulo, Brazil
| | - José C de Lima-Júnior
- Obesity and Comorbidities Research Center, University of Campinas, Campinas, São Paulo, Brazil
| | - Andre Palma
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Milena Monfort-Pires
- Obesity and Comorbidities Research Center, University of Campinas, Campinas, São Paulo, Brazil
| | - Bruna Bombassaro
- Obesity and Comorbidities Research Center, University of Campinas, Campinas, São Paulo, Brazil
| | - Eliana P Araujo
- Obesity and Comorbidities Research Center, University of Campinas, Campinas, São Paulo, Brazil.,School of Nursing, University of Campinas, Campinas, São Paulo, Brazil
| | - Ana Flavia Bernardes
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Raisa G Ulaf
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Thyago A Nunes
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Luciana C Ribeiro
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Antônio Luís E Falcão
- Department of Surgery, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Thiago Martins Santos
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Plinio Trabasso
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Rachel P Dertkigil
- Department of Radiology, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Sergio S Dertkigil
- Department of Radiology, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Rafael P Maia
- Department of Statistics, Institute of Mathematics, Statistics, and Scientific Computation, University of Campinas, Campinas, São Paulo, Brazil
| | - Tatiana Benaglia
- Department of Statistics, Institute of Mathematics, Statistics, and Scientific Computation, University of Campinas, Campinas, São Paulo, Brazil
| | - Maria Luiza Moretti
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Licio A Velloso
- Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil. .,Obesity and Comorbidities Research Center, University of Campinas, Campinas, São Paulo, Brazil.
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