1
|
Donnelly SC. COVID-19 and community self-prescribing: a dangerous folly. QJM 2021; 114:539. [PMID: 34740233 PMCID: PMC8689904 DOI: 10.1093/qjmed/hcab255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
2
|
Bokharee N, Khan YH, Khokhar A, Mallhi TH, Alotaibi NH, Rasheed M. Pharmacological interventions for COVID-19: a systematic review of observational studies and clinical trials. Expert Rev Anti Infect Ther 2021; 19:1219-1244. [PMID: 33719819 DOI: 10.1080/14787210.2021.1902805] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Currently, there is no approved therapeutic entity for coronavirus disease 2019 (COVID-19) and clinicians are primarily relying on drug repurposing. However, findings across studies are widely disparate, making it difficult to draw firm conclusions. Since clinicians need accurate evidence to treat COVID-19, this manuscript systematically analyzed the published and ongoing studies evaluating the pharmacological interventions for COVID-19.Areas Covered: A systematic search of observational studies and Clinical Trials on the treatment and prevention of COVID-19 was performed by using various databases from inception to 2 December 2020.Expert Opinion: A total of 460 studies met the inclusion criteria. Of these, 37 were research studies, 386 were ongoing trials, and 37 were completed trials. Anti-virals, steroids, anti-malarial, plasma exchange, and monoclonal antibodies were the most common treatment modalities used alone or in combination in these studies. However, tocilizumab, plasma exchange, and steroids have shown significant improvements in patient's clinical and radiological status. Tocilizumab reported minimum hospital stay of 2 days along with maximum recovery and patient's stability rate. Existing literature demonstrate promising results of tocilizumab, plasma exchange, and steroids among COVID-19 patients. Nevertheless, these studies are accompanied by several methodological disparities which should be considered while interpreting the results.
Collapse
Affiliation(s)
- Nida Bokharee
- Institute of Pharmacy, Lahore College for Women University, Lahore, Pakistan
| | - Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Kingdom of Saudi Arabia
| | - Aisha Khokhar
- Institute of Pharmacy, Lahore College for Women University, Lahore, Pakistan
| | - Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Kingdom of Saudi Arabia
| | - Nasser Hadal Alotaibi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Kingdom of Saudi Arabia
| | - Maria Rasheed
- Institute of Pharmacy, Lahore College for Women University, Lahore, Pakistan
| |
Collapse
|
3
|
Clinical Management of COVID-19: A Review of Pharmacological Treatment Options. Pharmaceuticals (Basel) 2021; 14:ph14060520. [PMID: 34071185 PMCID: PMC8229327 DOI: 10.3390/ph14060520] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 02/06/2023] Open
Abstract
Since the outbreak and subsequent declaration of COVID-19 as a global pandemic in March 2020, concerted efforts have been applied by the scientific community to curtail the spread of the disease and find a cure. While vaccines constitute a vital part of the public health strategy to reduce the burden of COVID-19, the management of this disease will continue to rely heavily on pharmacotherapy. This study aims to provide an updated review of pharmacological agents that have been developed and/or repurposed for the treatment of COVID-19. To this end, a comprehensive literature search was conducted using the PubMed, Google Scholar, and LitCovid databases. Relevant clinical studies on drugs used in the management of COVID-19 were identified and evaluated in terms of evidence of efficacy and safety. To date, the FDA has approved three therapies for the treatment of COVID-19 Emergency Use Authorization: convalescent plasma, remdesivir, and casirivimab/imdevimab (REGN-COV2). Drugs such as lopinavir/ritonavir, umifenovir, favipiravir, anakinra, chloroquine, hydroxychloroquine, tocilizumab, interferons, tissue plasminogen activator, intravenous immunoglobulins, and nafamosat have been used off-label with mixed therapeutic results. Adjunctive administration of corticosteroids is also very common. The clinical experience with these approved and repurposed drugs is limited, and data on efficacy for the new indication are not strong. Overall, the response of the global scientific community to the COVID-19 pandemic has been impressive, as evident from the volume of scientific literature elucidating the molecular biology and pathophysiology of SARS-CoV-2 and the approval of three new drugs for clinical management. Reviewed studies have shown mixed data on efficacy and safety of the currently utilized drugs. The lack of standard treatment for COVID-19 has made it difficult to interpret results from most of the published studies due to the risk of attribution error. The long-term effects of drugs can only be assessed after several years of clinical experience; therefore, the efficacy and safety of current COVID-19 therapeutics should continue to be rigorously monitored as part of post-marketing studies.
Collapse
|
4
|
Raiteri A, Piscaglia F, Granito A, Tovoli F. Tocilizumab: From Rheumatic Diseases to COVID-19. Curr Pharm Des 2021; 27:1597-1607. [PMID: 33719967 DOI: 10.2174/1381612827666210311141512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 02/07/2023]
Abstract
Tocilizumab is a humanised interleukin-6 receptor-inhibiting monoclonal antibody that is currently approved for the treatment of rheumatoid arthritis and other immune-related conditions. Recently, tocilizumab has been investigated as a possible treatment for severe coronavirus-induced disease 2019 (COVID-19). Despite the lack of direct antiviral effects, tocilizumab could reduce the immune-induced organ damage caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV2) infection. Until recently, most reports on tocilizumab for COVID-19 included a limited number of patients, preventing an overall evaluation of its efficacy and safety for this specific condition. Therefore, we reviewed the literature regarding the physiopathological rationale of tocilizumab for COVID-19 and its outcomes. We searched the MEDLINE database with the string "(SARS-CoV-2 OR coronavirus OR COVID-19 OR MERS- cov OR SARS-cov) AND (IL-6 OR interleukin 6 OR tocilizumab)". While the scientific rationale supporting tocilizumab for COVID-19 is solid, the evidence regarding the outcomes remains controversial. Available data and results from ongoing trials will provide useful information in the event of new COVID-19 outbreaks or future pandemics from different coronaviruses.
Collapse
Affiliation(s)
- Alberto Raiteri
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Albertoni 15, Italy
| | - Fabio Piscaglia
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Albertoni 15, Italy
| | - Alessandro Granito
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Albertoni 15, Italy
| | - Francesco Tovoli
- Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Albertoni 15, Italy
| |
Collapse
|
5
|
Romani S, Gérard A, Fresse A, Viard D, Van‐Obberghen É, Micallef J, Rocher F, Drici M. Insights on the Evidence of Cardiotoxicity of Hydroxychloroquine Prior and During COVID-19 Epidemic. Clin Transl Sci 2021; 14:163-169. [PMID: 32964653 PMCID: PMC7877831 DOI: 10.1111/cts.12883] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/31/2020] [Indexed: 12/20/2022] Open
Abstract
The recent empirical use of hydroxychloroquine (HCQ) in coronavirus disease 2019 (COVID-19) revived the interest in its cardiac toxicity, increasingly sidelined over time. We aimed to assess and compare the profile of cardiac adverse drug reactions (CADRs) associated with HCQ before and during COVID-19. We performed a retrospective comparative observational study using the French Pharmacovigilance network database between 1985 and May 2020 to assess all postmarketing CADRs associated with HCQ notified before COVID-19 in its approved indications for lupus and rheumatoid arthritis (preCOV), and those concerning its empirical use in COVID-19 (COV). Eighty-five CADR in preCOV were compared with 141 CADRs in COV. The most common CADR of preCOV were cardiomyopathies (42.4%) and conduction disorders (28.2%), both statistically more frequent than in COV (P < 0.001). COV notifications significantly highlighted repolarization and ventricular rhythm disorders (78.0%, P < 0.001) as well as sinus bradycardias (14.9%, P = 0.01) as compared with preCOV. Estimated incidence of CADR was significantly higher among patients exposed to off-label use of HCQ in COVID-19 (2.9%) than before COVID-19 in its approved indications (0.01%, P < 0.001). The use of HCQ in COVID-19 sheds a new light on the spectrum of its cardiac toxicity. This fosters the value of a closer monitoring of all patients treated with HCQ, regardless of its indication, and the importance of an update of its summary of product characteristics.
Collapse
Affiliation(s)
- Serena Romani
- PharmacovigilanceDepartment of Clinical PharmacologyUniversité Côte d’Azur Medical CenterPasteur HospitalNiceFrance
| | - Alexandre Gérard
- PharmacovigilanceDepartment of Clinical PharmacologyUniversité Côte d’Azur Medical CenterPasteur HospitalNiceFrance
| | - Audrey Fresse
- PharmacovigilanceDepartment of Clinical PharmacologyUniversité Côte d’Azur Medical CenterPasteur HospitalNiceFrance
| | - Delphine Viard
- PharmacovigilanceDepartment of Clinical PharmacologyUniversité Côte d’Azur Medical CenterPasteur HospitalNiceFrance
| | - Élise Van‐Obberghen
- PharmacovigilanceDepartment of Clinical PharmacologyUniversité Côte d’Azur Medical CenterPasteur HospitalNiceFrance
| | - Joëlle Micallef
- PharmacovigilanceDepartment of Clinical Pharmacology and PharmacovigilanceAix Marseille UniversityAPHMINSERMInstitute for Neuroscience SystemsUMR 1106MarseilleFrance
| | - Fanny Rocher
- PharmacovigilanceDepartment of Clinical PharmacologyUniversité Côte d’Azur Medical CenterPasteur HospitalNiceFrance
| | - Milou‐Daniel Drici
- PharmacovigilanceDepartment of Clinical PharmacologyUniversité Côte d’Azur Medical CenterPasteur HospitalNiceFrance
| | | |
Collapse
|
6
|
Chloroquine/tocilizumab. REACTIONS WEEKLY 2020. [PMCID: PMC7750119 DOI: 10.1007/s40278-020-87544-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
Ferrari F, Visconti F, De Amici M, Guglielmi A, Colombo CN, Belliato M, Ronco C. Coronavirus disease 2019 in critically ill patients: can we re-program the immune system? A primer for Intensivists. Minerva Anestesiol 2020; 86:1214-1233. [PMID: 32755094 DOI: 10.23736/s0375-9393.20.14663-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In December 2019, Coronavirus disease 2019 (COVID-19) emerged in Wuhan and rapidly spread around the word. The immune response is essential to control and eliminate CoV infections, however, multiorgan damage might be due to direct SARS-CoV2 action against the infected organ cells, as well as an imbalanced host immune response. In effect, a "cytokines storm" and an impaired innate immunity were found in the COVID-19 critically ill patients. In this review, we summarized the virus immune response steps, underlying the relevance of introducing the measurement of plasma cytokine levels and of circulating lymphocyte subsets in clinical practice for the follow-up of critically ill COVID-19 patients and support new therapy.
Collapse
Affiliation(s)
- Fiorenza Ferrari
- Department of Anesthesia and Intensive Care Unit, IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy - .,Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy -
| | - Federico Visconti
- Department of Anesthesia and Intensive Care Unit, IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy
| | - Mara De Amici
- Immuno-Allergology Laboratory of the Clinical Chemistry Unit, IRCCS Polyclinic San Matteo Foundation, Pavia, Italy
| | - Angelo Guglielmi
- Department of Anesthesia and Intensive Care Unit, IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy
| | - Costanza N Colombo
- Department of Anesthesia and Intensive Care Unit, IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy
| | - Mirko Belliato
- Department of Anesthesia and Intensive Care Unit, IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy.,Unit of Nephrology, University of Padua, Padua, Italy.,Department Nephrology Dialysis and Transplant, AUSSL 8 Regione Veneto, San Bortolo Hospital, Vicenza, Italy
| |
Collapse
|
8
|
Ciotti M, Ciccozzi M, Terrinoni A, Jiang WC, Wang CB, Bernardini S. The COVID-19 pandemic. Crit Rev Clin Lab Sci 2020; 57:365-388. [DOI: 10.1080/10408363.2020.1783198] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Marco Ciotti
- Virology Unit, Tor Vergata University Covid-Hospital, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Italy
| | | | - Wen-Can Jiang
- Department of Laboratory Medicine, Chinese PLA General Hospital, Beijing, China
| | - Cheng-Bin Wang
- Department of Laboratory Medicine, Chinese PLA General Hospital, Beijing, China
| | - Sergio Bernardini
- Department of Experimental Medicine, University of Tor Vergata, Rome, Italy
- Emerging Technologies Division, International Federation of Clinical Chemistry and Laboratory Medicine (IFCC), Milano, Italy
| |
Collapse
|