1
|
Gilman SL. Following the Science in the Age of COVID-19. THE JOURNAL OF MEDICAL HUMANITIES 2024:10.1007/s10912-024-09888-4. [PMID: 39292387 DOI: 10.1007/s10912-024-09888-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 08/13/2024] [Indexed: 09/19/2024]
Abstract
This article discusses the complexity of the relationship between "law," "science," and "clinical practice" in the age of COVID-19.
Collapse
|
2
|
Sellers RS, Dormitzer PR. Toxicologic Pathology Forum*: mRNA Vaccine Safety-Separating Fact From Fiction. Toxicol Pathol 2024:1926233241278298. [PMID: 39254115 DOI: 10.1177/01926233241278298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
SARS-CoV-2 spread rapidly across the globe, contributing to the death of millions of individuals from 2019 to 2023, and has continued to be a major cause of morbidity and mortality after the pandemic. At the start of the pandemic, no vaccines or anti-viral treatments were available to reduce the burden of disease associated with this virus, as it was a novel SARS coronavirus. Because of the tremendous need, the development of vaccines to protect against COVID-19 was critically important. The flexibility and ease of manufacture of nucleic acid-based vaccines, specifically mRNA-based products, allowed the accelerated development of COVID-19 vaccines. Although mRNA-based vaccines and therapeutics had been in clinical trials for over a decade, there were no licensed mRNA vaccines on the market at the start of the pandemic. The rapid development of mRNA-based COVID-19 vaccines reduced serious complications and death from the virus but also engendered significant public concerns, which continue now, years after emergency-use authorization and subsequent licensure of these vaccines. This article summarizes and addresses some of the safety concerns that continue to be expressed about these vaccines and their underlying technology.
Collapse
Affiliation(s)
- Rani S Sellers
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | |
Collapse
|
3
|
Wimalawansa SJ. Unlocking insights: Navigating COVID-19 challenges and Emulating future pandemic Resilience strategies with strengthening natural immunity. Heliyon 2024; 10:e34691. [PMID: 39166024 PMCID: PMC11334859 DOI: 10.1016/j.heliyon.2024.e34691] [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: 03/06/2024] [Revised: 06/17/2024] [Accepted: 07/15/2024] [Indexed: 08/22/2024] Open
Abstract
The original COVID-19 vaccines, developed against SARS-CoV-2, initially mitigated hospitalizations. Bivalent vaccine boosters were used widely during 2022-23, but the outbreaks persisted. Despite this, hospitalizations, mortality, and outbreaks involving dominant mutants like Alpha and Delta increased during winters when the population's vitamin D levels were at their lowest. Notably, 75 % of human immune cell/system functions, including post-vaccination adaptive immunity, rely on adequate circulatory vitamin D levels. Consequently, hypovitaminosis compromises innate and adaptive immune responses, heightening susceptibility to infections and complications. COVID-19 vaccines primarily target SARS-CoV-2 Spike proteins, thus offering only a limited protection through antibodies. mRNA vaccines, such as those for COVID-19, fail to generate secretory/mucosal immunity-like IgG responses, rendering them ineffective in halting viral spread. Additionally, mutations in the SARS-CoV-2 binding domain reduce immune recognition by vaccine-derived antibodies, leading to immune evasion by mutant viruses like Omicron variants. Meanwhile, the repeated administration of bivalent boosters intended to enhance efficacy resulted in the immunoparesis of recipients. As a result, relying solely on vaccines for outbreak prevention, it became less effective. Dominant variants exhibit increased affinity to angiotensin-converting enzyme receptor-2, enhancing infectivity but reducing virulence. Meanwhile, spike protein-related viral mutations do not impact the potency of widely available, repurposed early therapies, like vitamin D and ivermectin. With the re-emergence of COVID-19 and impending coronaviral pandemics, regulators and health organizations should proactively consider approval and strategic use of cost-effective adjunct therapies mentioned above to counter the loss of vaccine efficacy against emerging variants and novel coronaviruses and eliminate vaccine- and anti-viral agents-related serious adverse effects. Timely implementation of these strategies could reduce morbidity, mortality, and healthcare costs and provide a rational approach to address future epidemics and pandemics. This perspective critically reviews relevant literature, providing insights, justifications, and viewpoints into how the scientific community and health authorities can leverage this knowledge cost-effectively.
Collapse
Affiliation(s)
- Sunil J. Wimalawansa
- Medicine, Endocrinology, and Nutrition, B14 G2, De Soyza Flats, Moratuwa, Sri Lanka
| |
Collapse
|
4
|
Jayasinghe S. Repurposing Drugs to Treat Novel Infections: A Proposal for a Decision-Making Framework for Clinicians. Clin Ther 2024; 46:e15-e18. [PMID: 38969585 DOI: 10.1016/j.clinthera.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 07/07/2024]
Abstract
PURPOSE Global fears regarding future epidemics of new and re-emerging infections will prompt clinicians to try out unconventional treatments based on limited evidence, including the repurposing of existing drugs. The dilemma involves balancing clinical intuition with the need to rely on low-quality information because of the scarcity of definitive evidence. An example was ivermectin; with its potential antiviral properties, it was promoted for its efficacy in treating coronavirus disease 2019 despite conflicting outcomes in clinical trials and varying expert opinions. This article describes the development of a decision-making framework to resolve such dilemmas. METHODS The case study from Sri Lanka illustrates multiple challenges faced by clinicians. As the horrific details of deaths in countries such as Italy spread on social media, there was panic and an unprecedented demand for clinicians and health services to provide effective treatment. This led to the popularity of drugs such as ivermectin and several herbal cures. However, there was no consensus among experts on the efficacy of ivermectin, which eventually led to the authorities to recommend limited approval for use under physician supervision. FINDINGS The situation lent itself to a framework with 4 elements: prerequisites, applying an appropriate decision-making tool (eg, multiple criteria decision-making methods), ethical considerations, and sensitive communication. IMPLICATIONS We propose this framework for clinicians when they face similar situations with demands to repurpose medicines with inconclusive evidence of efficacy to combat devastating infections from new or re-emerging infections.
Collapse
Affiliation(s)
- Saroj Jayasinghe
- Department of Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| |
Collapse
|
5
|
Mikamo H, Takahashi S, Yamagishi Y, Hirakawa A, Harada T, Nagashima H, Noguchi C, Masuko K, Maekawa H, Kashii T, Ohbayashi H, Hosokawa S, Maejima K, Yamato M, Manosuthi W, Paiboonpol S, Suganami H, Tanigawa R, Kawamura H. Efficacy and safety of ivermectin in patients with mild COVID-19 in Japan and Thailand. J Infect Chemother 2024; 30:536-543. [PMID: 38154616 DOI: 10.1016/j.jiac.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/30/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Ivermectin is an antiparasitic drug administered to hundreds of millions of people worldwide. Fundamental research suggests that ivermectin is effective against coronavirus disease 2019 (COVID-19); therefore, we investigated the efficacy and safety of ivermectin as a COVID-19 treatment option. METHODS This multi-regional (Japan and Thailand), multicenter, placebo-controlled, randomized, double-blind, parallel-group, Phase III study evaluated the efficacy and safety of ivermectin in patients with mild COVID-19 (IVERMILCO Study). The participants took a specified number of the investigational product (ivermectin or placebo) tablets of, adjusted to a dose of 0.3-0.4 mg/kg, orally on an empty stomach once daily for three days. The primary efficacy endpoint was the time at which clinical symptoms first showed an improving trend by 168 h after investigational product administration. RESULTS A total of 1030 eligible participants were assigned to receive the investigational product; 502 participants received ivermectin and 527 participants received a placebo. The primary efficacy endpoint was approximately 96 h (approximately four days) for both ivermectin and placebo groups, which did not show statistically significant difference (stratified log-rank test, p = 0.61). The incidence of adverse events and adverse drug reactions did not show statistically significant differences between the ivermectin and placebo groups (chi-square test, p = 0.97, p = 0.59). CONCLUSIONS The results show that ivermectin (0.3-0.4 mg/kg), as a treatment for patients with mild COVID-19, is ineffective; however, its safety has been confirmed for participants, including minor participants of 12 years or older (IVERMILCO Study ClinicalTrials.gov number, NCT05056883.).
Collapse
Affiliation(s)
- Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1, Yazakokarimata Nagakute-shi, Aichi, 480-1195, Japan.
| | - Satoshi Takahashi
- Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, 16-291, Minami1-jonishi, Chuo-ku, Sapporo-shi, Hokkaido, 060-8543, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Kochi Medical School, Kochi University, 185-1, Okocho-Kohasu, Nankoku-shi, Kochi, 783-8505, Japan
| | - Akihiro Hirakawa
- Department of Clinical Biostatistics, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Toshiyuki Harada
- Center for Respiratory Diseases, Department of Pulmonary Medicine, Japan Community Healthcare Organization Hokkaido Hospital, 1-8-3-18, Nakanoshima, Toyohira-ku, Sapporo, Hokkaido, 062-8618, Japan
| | | | - Chiaki Noguchi
- Sumida General Clinic, 3-4-8, Taihei, Sumida-ku, Tokyo, 130-0012, Japan
| | - Kentaro Masuko
- Shimamura Memorial Hospital, 2-4-1, Sekimachi-Kita, Nerima-ku, Tokyo, 177-0051, Japan
| | - Hiromitsu Maekawa
- Maekawa Medical Clinic, 1-1-8, Kitasaiwai, Nishi-ku, Yokohama-shi, Kanagawa, 220-0004, Japan
| | - Tatsuhiko Kashii
- Department of Oncology, Japan Organization of Occupational Health and Safety Toyama Rosai Hospital, 992, Rokuromaru, Uozu-shi, Toyama, 937-0042, Japan
| | - Hiroyuki Ohbayashi
- Department of Allergy and Respiratory Medicine, Tohno Chuo Clinic, 1-14-1, Matsugasecho, Mizunami-shi, Gifu, 509-6134, Japan
| | - Shinichiro Hosokawa
- Hosokawa Surgical Clinic, 1-75-2, Nishikomenocho, Nakamura-ku, Nagoya-shi, Aichi, 453-0812, Japan
| | - Katsuyuki Maejima
- Department of Internal Medicine, Diabetes Medicine, Maejima Clinic, 1-15-1, Midoricho, Showa-ku, Nagoya-shi, Aichi, 466-0013, Japan
| | - Masaya Yamato
- Department of General Internal Medicine, Infectious Disease, Rinku General Medical Center, 2-23, Rinku-Oraikita, Izumisano-shi, Osaka, 598-8577, Japan
| | - Weerawat Manosuthi
- Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, 38 Moo 4, Talat Khwan, Tiwanon Road, Mueang District, Nonthaburi 11000, Thailand
| | - Supachai Paiboonpol
- Department of Medicine, Ratchaburi Hospital, 85 Somboonkul Road, Na Mueang Subdistrict Muang District, Ratchaburi Provinc 70000, Thailand
| | - Hideki Suganami
- Global Data Science Center, Kowa Company, Ltd., 4-14, 3-Chome, Nihonbashi-Honcho Chuo-ku, Tokyo, 103-8433, Japan
| | - Ryohei Tanigawa
- Global Clinical Development Department, Kowa Company, Ltd., 4-14, 3-Chome, Nihonbashi-Honcho Chuo-ku, Tokyo, 103-8433, Japan
| | - Hitoshi Kawamura
- Medical Writing Department, Kowa Company, Ltd., 4-14, 3-Chome, Nihonbashi-Honcho Chuo-ku, Tokyo, 103-8433, Japan
| |
Collapse
|
6
|
Lu CL, Yang LQ, Jin XY, Friedemann T, Li YF, Liu XH, Chen XY, Zou XY, Zhang BR, Wang FX, Lin YL, Tang YM, Cao ML, Jiang YL, Gao YF, Liu K, Tao ZG, Robinson N, Schröder S, Liu JP, Lu HZ. Chinese herbal medicine Shufeng Jiedu capsule for mild to moderate COVID-19: a multicenter, randomized, double-blind, placebo-controlled phase II trial. Front Pharmacol 2024; 15:1383831. [PMID: 38863976 PMCID: PMC11165997 DOI: 10.3389/fphar.2024.1383831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/23/2024] [Indexed: 06/13/2024] Open
Abstract
Background: The COVID-19 pandemic has had a profound global impact, although the majority of recently infected cases have presented with mild to moderate symptoms. Previous clinical studies have demonstrated that Shufeng Jiedu (SFJD) capsule, a Chinese herbal patent medicine, effectively alleviates symptoms associated with the common cold, H1N1 influenza, and COVID-19. This study aimed to assess the efficacy and safety of SFJD capsules in managing symptoms of mild to moderate COVID-19 infection. Methods: A randomized, double-blind, placebo-controlled trial was conducted from May to December 2022 at two hospitals in China. Mild and moderate COVID-19-infected patients presenting respiratory symptoms within 3 days from onset were randomly assigned to either the SFJD or placebo groups in a 1:1 ratio. Individuals received SFJD capsules or a placebo three times daily for five consecutive days. Participants were followed up for more than 14 days after their RT-PCR nucleoid acid test for SARS-CoV-2 turned negative. The primary outcome measure was time to alleviate COVID-19 symptoms from baseline until the end of follow-up. Results: A total of 478 participants were screened; ultimately, 407 completed the trial after randomization (SFJD, n = 203; placebo, n = 204). No statistically significant difference in baseline parameters was observed between the two groups. The median time to alleviate all symptoms was 7 days in the SFJD group compared to 8 days in the placebo group (p = 0.037). Notably, the SFJD group significantly attenuated fever/chills (p = 0.04) and headache (p = 0.016) compared to the placebo group. Furthermore, the median time taken to reach normal body temperature within 24 h was reduced by 7 hours in the SFJD group compared to the placebo group (p = 0.033). No deaths or instances of serious or critical conditions occurred during this trial period; moreover, no serious adverse events were reported. Conclusion: The trial was conducted in a unique controlled hospital setting, and the 5-day treatment with SFJD capsules resulted in a 1-day reduction in overall symptoms, particularly headache and fever/chills, among COVID-19-infected participants with mild or moderate symptoms. Compared to placebo, SFJD capsules were found to be safe with fewer side effects. SFJD capsules could potentially serve as an effective treatment for alleviating mild to moderate symptoms of COVID-19. Clinical Trial Registration: https://www.isrctn.com/, identifier ISRCTN14236594.
Collapse
Affiliation(s)
- Chun-li Lu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Liu-qing Yang
- The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital to Southern University of Science and Technology, Shenzhen, China
| | - Xin-yan Jin
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Thomas Friedemann
- HanseMerkur Center for Traditional Chinese Medicine at the University Medical Center, Hamburg, Germany
| | - Yu-fei Li
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xue-han Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao-ying Chen
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xiang-yun Zou
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Bing-rui Zhang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Fu-xiang Wang
- The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital to Southern University of Science and Technology, Shenzhen, China
| | - Yuan-long Lin
- The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital to Southern University of Science and Technology, Shenzhen, China
| | - Yi-min Tang
- The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital to Southern University of Science and Technology, Shenzhen, China
| | - Meng-li Cao
- The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital to Southern University of Science and Technology, Shenzhen, China
| | | | | | - Kui Liu
- The People’s Hospital of Bozhou, Bozhou, China
| | - Zhen-gang Tao
- Zhongshan Hospital Affiliated of Fudan University, Shanghai, China
| | - Nicola Robinson
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Institute of Health and Social Care, London South Bank University, London, United Kingdom
| | - Sven Schröder
- HanseMerkur Center for Traditional Chinese Medicine at the University Medical Center, Hamburg, Germany
| | - Jian-ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Hong-zhou Lu
- The Third People’s Hospital of Shenzhen, The Second Affiliated Hospital to Southern University of Science and Technology, Shenzhen, China
| |
Collapse
|
7
|
Song Z, Shi S, Zhang Y. Ivermectin for treatment of COVID-19: A systematic review and meta-analysis. Heliyon 2024; 10:e27647. [PMID: 38510038 PMCID: PMC10950893 DOI: 10.1016/j.heliyon.2024.e27647] [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: 08/18/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 03/22/2024] Open
Abstract
The effect of ivermectin (IVM) in treating coronavirus disease 2019 (COVID-19) is still controversial, yet the drug has been widely used in the world. The aim of this review was to systematically evaluate the clinical outcomes of IVM in patients with COVID-19. From inception to June 22, 2023, the PubMed, EMBASE, Web of Science (WOS), and scopus databases were searched for relevant observational studies on the risk of RA in migraineurs. We searched PubMed/Medline, EMBASE, the Cochrane Library, Web of Science, medRxiv, and bioRxiv to collect all relevant publications from inception to June 22, 2023. Primary outcomes were all-cause mortality rate, mechanical ventilation (MV) requirement, PCR negative conversion, and adverse events (AEs). Revman 5.4 was used to assess the risk of bias (RoB) and quality of evidence. Thirty-three RCTs (n = 10,489) were included. No significant difference in all-cause mortality rates or PCR negative conversion between IVM and controls. There were significant differences in MV requirement (RR 0.67, 95% CI 0.47-0.96) and AEs (RR 0.87, 95% CI 0.80-0.95) between the two groups. Ivermectin could reduce the risk of MV requirement and AEs in patients with COVID-19, without increasing other risks. In the absence of a better alternative, clinicians could use it with caution.
Collapse
Affiliation(s)
- Zhilong Song
- School of Public Health, Xiamen University, Fujian, China
| | - Senyuan Shi
- School of Medicine, Southeast University, Jiangsu, China
| | - Yongli Zhang
- School of Medicine, Xiamen University, Fujian, China
| |
Collapse
|
8
|
Bakker C, Boughton S, Faggion CM, Fanelli D, Kaiser K, Schneider J. Reducing the residue of retractions in evidence synthesis: ways to minimise inappropriate citation and use of retracted data. BMJ Evid Based Med 2024; 29:121-126. [PMID: 37463764 PMCID: PMC10982619 DOI: 10.1136/bmjebm-2022-111921] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 07/20/2023]
Abstract
The incorporation of publications that have been retracted is a risk in reliable evidence synthesis. Retraction is an important mechanism for correcting the literature and protecting its integrity. Within the medical literature, the continued citation of retracted publications occurs for a variety of reasons. Recent evidence suggests that systematic reviews and meta-analyses often unwittingly cite retracted publications which, at least in some cases, may significantly impact quantitative effect estimates in meta-analyses. There is strong evidence that authors of systematic reviews and meta-analyses may be unaware of the retracted status of publications and treat them as if they are not retracted. These problems are difficult to address for several reasons: identifying retracted publications is important but logistically challenging; publications may be retracted while a review is in preparation or in press and problems with a publication may also be discovered after the evidence synthesis is published. We propose a set of concrete actions that stakeholders (eg, scientists, peer-reviewers, journal editors) might take in the near-term, and that research funders, citation management systems, and databases and search engines might take in the longer term to limit the impact of retracted primary studies on evidence syntheses.
Collapse
Affiliation(s)
- Caitlin Bakker
- Dr. John Archer Library, University of Regina, Regina, Saskatchewan, Canada
| | - Stephanie Boughton
- Research Integrity team, Editorial & Methods Department, Cochrane, London, UK
| | - Clovis Mariano Faggion
- Department of Periodontology and Operative Dentistry, Faculty of Dentistry, University Hospital Münster, Münster, Germany
| | - Daniele Fanelli
- London School of Economics and Political Science, Dept. of Methodology, London, UK
- Heriot-Watt University, School of Social Sciences, Edinburgh Business School, Edinburgh, UK
| | - Kathryn Kaiser
- The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jodi Schneider
- School of Information Sciences, University of Illinois Urbana-Champaign, Champaign, Illinois, USA
| |
Collapse
|
9
|
Wilkinson J, Heal C, Antoniou GA, Flemyng E, Alfirevic Z, Avenell A, Barbour G, Brown NJL, Carlisle J, Clarke M, Dicker P, Dumville JC, Grey A, Grohmann S, Gurrin L, Hayden JA, Heathers J, Hunter KE, Lasserson T, Lam E, Lensen S, Li T, Li W, Loder E, Lundh A, Meyerowitz-Katz G, Mol BW, O'Connell NE, Parker L, Redman BK, Seidler L, Sheldrick KA, Sydenham E, Torgerson D, van Wely M, Wang R, Bero L, Kirkham JJ. Protocol for the development of a tool (INSPECT-SR) to identify problematic randomised controlled trials in systematic reviews of health interventions. BMJ Open 2024; 14:e084164. [PMID: 38471680 PMCID: PMC10936473 DOI: 10.1136/bmjopen-2024-084164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/30/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Randomised controlled trials (RCTs) inform healthcare decisions. It is now apparent that some published RCTs contain false data and some appear to have been entirely fabricated. Systematic reviews are performed to identify and synthesise all RCTs that have been conducted on a given topic. While it is usual to assess methodological features of the RCTs in the process of undertaking a systematic review, it is not usual to consider whether the RCTs contain false data. Studies containing false data therefore go unnoticed and contribute to systematic review conclusions. The INveStigating ProblEmatic Clinical Trials in Systematic Reviews (INSPECT-SR) project will develop a tool to assess the trustworthiness of RCTs in systematic reviews of healthcare-related interventions. METHODS AND ANALYSIS The INSPECT-SR tool will be developed using expert consensus in combination with empirical evidence, over five stages: (1) a survey of experts to assemble a comprehensive list of checks for detecting problematic RCTs, (2) an evaluation of the feasibility and impact of applying the checks to systematic reviews, (3) a Delphi survey to determine which of the checks are supported by expert consensus, culminating in, (4) a consensus meeting to select checks to be included in a draft tool and to determine its format and (5) prospective testing of the draft tool in the production of new health systematic reviews, to allow refinement based on user feedback. We anticipate that the INSPECT-SR tool will help researchers to identify problematic studies and will help patients by protecting them from the influence of false data on their healthcare. ETHICS AND DISSEMINATION The University of Manchester ethics decision tool was used, and this returned the result that ethical approval was not required for this project (30 September 2022), which incorporates secondary research and surveys of professionals about subjects relating to their expertise. Informed consent will be obtained from all survey participants. All results will be published as open-access articles. The final tool will be made freely available.
Collapse
Affiliation(s)
- Jack Wilkinson
- Centre for Biostatistics, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Calvin Heal
- Centre for Biostatistics, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - George A Antoniou
- Manchester Vascular Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Centre, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
| | - Ella Flemyng
- Evidence Production and Methods Directorate, Cochrane, London, UK
| | - Zarko Alfirevic
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Ginny Barbour
- Medical Journal of Australia, Sydney, New South Wales, Australia
| | | | - John Carlisle
- Anaesthesia and Critical Care, Torbay Hospital, Torquay, UK
| | - Mike Clarke
- Northern Ireland Methodology Hub, Queen's University Belfast, Belfast, UK
| | - Patrick Dicker
- Department of Epidemiology and Public Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jo C Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Andrew Grey
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Steph Grohmann
- Evidence Production and Methods Directorate, Cochrane, London, UK
| | - Lyle Gurrin
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jill Alison Hayden
- Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Community Health & Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Kylie Elizabeth Hunter
- Evidence Integration, NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Toby Lasserson
- Evidence Production and Methods Directorate, Cochrane, London, UK
| | - Emily Lam
- Independent Lay Member, Cheshire, UK
| | - Sarah Lensen
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Tianjing Li
- Department of Ophthalmology, University of Colorado, Denver, Colorado, USA
| | - Wentao Li
- Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia
| | - Elizabeth Loder
- BMJ Publishing, London, UK
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andreas Lundh
- Centre of Evidence-Based Medicine Odense and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Kobenhavn, Denmark
| | - Gideon Meyerowitz-Katz
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Neil E O'Connell
- Department of Clinical Science, Brunel University, Uxbridge, UK
- Centre for Health and Wellbeing across the Lifecourse, Dept of Health Sciences, Brunel University, London, UK
| | - Lisa Parker
- School of Pharmacy, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Barbara K Redman
- Division of Medical Ethics, New York University Grossman School of Medicine, New York, New York, USA
| | - Lene Seidler
- Evidence Integration, NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Kyle A Sheldrick
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Emma Sydenham
- Cochrane Central Production Service, Cochrane, London, UK
| | - David Torgerson
- York Trials Unit, Dept of Health Sciences, University of York, York, UK
| | - Madelon van Wely
- Cochrane Gynaecology and Fertility Satellite and Cochrane Sexually Transmitted Infection Group, Cochrane, Duivendrecht, The Netherlands
- Reproduction and Development Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Rui Wang
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Lisa Bero
- Center for Bioethics and Humanities, University of Colorado-Anschutz Medical Campus, Denver, Colorado, USA
| | - Jamie J Kirkham
- Centre for Biostatistics, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| |
Collapse
|
10
|
Box HJ, Sharp J, Pennington SH, Kijak E, Tatham L, Caygill CH, Lopeman RC, Jeffreys LN, Herriott J, Neary M, Valentijn A, Pertinez H, Curley P, Arshad U, Rajoli RKR, Jochmans D, Vangeel L, Neyts J, Chatelain E, Escudié F, Scandale I, Rannard S, Stewart JP, Biagini GA, Owen A. Lack of antiviral activity of probenecid in vitro and in Syrian golden hamsters. J Antimicrob Chemother 2024; 79:172-178. [PMID: 37995258 PMCID: PMC10761260 DOI: 10.1093/jac/dkad362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVES Antiviral interventions are required to complement vaccination programmes and reduce the global burden of COVID-19. Prior to initiation of large-scale clinical trials, robust preclinical data to support candidate plausibility are required. This work sought to further investigate the putative antiviral activity of probenecid against SARS-CoV-2. METHODS Vero E6 cells were preincubated with probenecid, or control media for 2 h before infection (SARS-CoV-2/Human/Liverpool/REMRQ0001/2020). Probenecid or control media was reapplied, plates reincubated and cytopathic activity quantified by spectrophotometry after 48 h. In vitro human airway epithelial cell (HAEC) assays were performed for probenecid against SARS-CoV-2-VoC-B.1.1.7 (hCoV-19/Belgium/rega-12211513/2020; EPI_ISL_791333, 2020-12-21) using an optimized cell model for antiviral testing. Syrian golden hamsters were intranasally inoculated (SARS-CoV-2 Delta B.1.617.2) 24 h prior to treatment with probenecid or vehicle for four twice-daily doses. RESULTS No observable antiviral activity for probenecid was evident in Vero E6 or HAEC assays. No reduction in total or subgenomic RNA was observed in terminal lung samples (P > 0.05) from hamsters. Body weight of uninfected hamsters remained stable whereas both probenecid- and vehicle-treated infected hamsters lost body weight (P > 0.5). CONCLUSIONS These data do not support probenecid as a SARS-CoV-2 antiviral drug.
Collapse
Affiliation(s)
- Helen J Box
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L7 3NY, UK
- Centre of Excellence in Long-acting Therapeutics (CELT), University of Liverpool, Liverpool L7 3NY, UK
| | - Joanne Sharp
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L7 3NY, UK
- Centre of Excellence in Long-acting Therapeutics (CELT), University of Liverpool, Liverpool L7 3NY, UK
| | - Shaun H Pennington
- Centre for Drugs and Diagnostics, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Edyta Kijak
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L7 3NY, UK
- Centre of Excellence in Long-acting Therapeutics (CELT), University of Liverpool, Liverpool L7 3NY, UK
| | - Lee Tatham
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L7 3NY, UK
- Centre of Excellence in Long-acting Therapeutics (CELT), University of Liverpool, Liverpool L7 3NY, UK
| | - Claire H Caygill
- Centre for Drugs and Diagnostics, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Rose C Lopeman
- Centre for Drugs and Diagnostics, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Laura N Jeffreys
- Centre for Drugs and Diagnostics, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Joanne Herriott
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L7 3NY, UK
- Centre of Excellence in Long-acting Therapeutics (CELT), University of Liverpool, Liverpool L7 3NY, UK
| | - Megan Neary
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L7 3NY, UK
- Centre of Excellence in Long-acting Therapeutics (CELT), University of Liverpool, Liverpool L7 3NY, UK
| | - Anthony Valentijn
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L7 3NY, UK
- Centre of Excellence in Long-acting Therapeutics (CELT), University of Liverpool, Liverpool L7 3NY, UK
| | - Henry Pertinez
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L7 3NY, UK
- Centre of Excellence in Long-acting Therapeutics (CELT), University of Liverpool, Liverpool L7 3NY, UK
| | - Paul Curley
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L7 3NY, UK
- Centre of Excellence in Long-acting Therapeutics (CELT), University of Liverpool, Liverpool L7 3NY, UK
| | - Usman Arshad
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L7 3NY, UK
- Centre of Excellence in Long-acting Therapeutics (CELT), University of Liverpool, Liverpool L7 3NY, UK
| | - Rajith K R Rajoli
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L7 3NY, UK
- Centre of Excellence in Long-acting Therapeutics (CELT), University of Liverpool, Liverpool L7 3NY, UK
| | - Dirk Jochmans
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology and Chemotherapy, 3000, Leuven, Belgium and the Global Virus Network (GVN), Baltimore, MD, USA
| | - Laura Vangeel
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology and Chemotherapy, 3000, Leuven, Belgium and the Global Virus Network (GVN), Baltimore, MD, USA
| | - Johan Neyts
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory of Virology and Chemotherapy, 3000, Leuven, Belgium and the Global Virus Network (GVN), Baltimore, MD, USA
| | - Eric Chatelain
- Drugs for Neglected Diseases initiative (DNDi), Research and Development, 1202, Geneva, Switzerland
| | - Fanny Escudié
- Drugs for Neglected Diseases initiative (DNDi), Research and Development, 1202, Geneva, Switzerland
| | - Ivan Scandale
- Drugs for Neglected Diseases initiative (DNDi), Research and Development, 1202, Geneva, Switzerland
| | - Steve Rannard
- Centre of Excellence in Long-acting Therapeutics (CELT), University of Liverpool, Liverpool L7 3NY, UK
- Department of Chemistry, University of Liverpool,Liverpool L7 3NY, UK
| | - James P Stewart
- Department of Infection Biology & Microbiomes, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Giancarlo A Biagini
- Centre for Drugs and Diagnostics, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Andrew Owen
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L7 3NY, UK
- Centre of Excellence in Long-acting Therapeutics (CELT), University of Liverpool, Liverpool L7 3NY, UK
| |
Collapse
|
11
|
Gasmi A, Noor S, Menzel A, Khanyk N, Semenova Y, Lysiuk R, Beley N, Bolibrukh L, Gasmi Benahmed A, Storchylo O, Bjørklund G. Potential Drugs in COVID-19 Management. Curr Med Chem 2024; 31:3245-3264. [PMID: 37461346 DOI: 10.2174/0929867331666230717154101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/27/2023] [Accepted: 06/05/2023] [Indexed: 11/18/2023]
Abstract
The SARS-CoV-2 virus first emerged in China in December 2019 and quickly spread worldwide. Despite the absence of a vaccination or authorized drug specifically developed to combat this infection, certain medications recommended for other diseases have shown potential effectiveness in treating COVID-19, although without definitive confirmation. This review aims to evaluate the existing literature on the efficacy of these medications against COVID-19. The review encompasses various potential treatments, including antiviral medications, anti-malaria and anti-rheumatic drugs, vaccines, corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), antipyretic and analgesic medicines, antiparasitic drugs, and statins. The analysis also addresses the potential benefits and drawbacks of these medications, as well as their effects on hypertension and diabetes. Although these therapies hold promise against COVID-19, further research, including suitable product production or clinical testing, is needed to establish their therapeutic efficacy.
Collapse
Affiliation(s)
- Amin Gasmi
- Société Francophone de Nutrithérapie et de Nutrigénétique Appliquée, Villeurbanne, France
| | - Sadaf Noor
- Institute of Molecular Biology and Biotechnology, Bahauddin Zakariya University, Multan, Pakistan
| | | | - Nataliia Khanyk
- Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
- CONEM Ukraine Life Science Research Group, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Yuliya Semenova
- Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Roman Lysiuk
- Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
- CONEM Ukraine Life Science Research Group, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Nataliya Beley
- I. Ya. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | | | | | - Olha Storchylo
- Medical Chemistry Department, Odessa National Medical University, Odesa, Ukraine
| | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine (CONEM), Mo i Rana, Norway
| |
Collapse
|
12
|
Marques LLM, Beneti SC, Pinzon C, Cardoso FAR. Ivermectin as a possible treatment for COVID-19: a review of the 2022 protocols. BRAZ J BIOL 2024; 84:e258325. [DOI: 10.1590/1519-6984.258325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/16/2022] [Indexed: 11/22/2022] Open
Abstract
Abstract Ivermectin is a safe and effective drug in humans and has been approved for use in numerous parasitic infections for over 50 years. In addition, many studies have already shown its antiviral activity. Ivermectin is generally well tolerated, with no indication of central nervous system-associated toxicity at doses up to 10 times the highest FDA-approved dose of 200 µg/kg. The in vitro results of ivermectin for reducing SARS-CoV-2 viral load are promising and show that Ivermectin kills SARS-CoV-2 within 48 hours. A hypothesized mechanism of action for this drug is a likely inhibition of IMPα/β1-mediated nuclear import of viral proteins as demonstrated for other RNA viruses. However, controlled and randomized studies are needed to prove its effectiveness in COVID-19 in humans. In a single in vivo study with published results, patients confirmed to be infected with SARS-CoV-2 received at least one dose of ivermectin at any time during hospitalization. The use of ivermectin was associated with lower mortality during treatment with COVID-19, especially in patients who required increased inspired oxygen or ventilatory support. Additionally, 81 studies with the clinical use of ivermectin in humans are being carried out worldwide according to ClinicalTrials.gov. However, none of these data has been published so far. However, private and public entities in Brazil have been adopting this drug in their protocols as prophylaxis and in the initial phase of the disease. In addition, ivermectin has been used in mass treatment to prevent onchocerciasis and lymphatic filariasis in sub-Saharan Africa for many years. Surprisingly, this region has the lowest proportional mortality rate among the continents, despite the increasing numbers of infected people released by the World Health Organization.
Collapse
Affiliation(s)
| | - S. C. Beneti
- Universidade Tecnológica Federal do Paraná, Brasil
| | - C. Pinzon
- Universidade Tecnológica Federal do Paraná, Brasil
| | | |
Collapse
|
13
|
Hu X, Ju Y, Zhang YK. Ivermectin as a potential therapeutic strategy for glioma. J Neurosci Res 2024; 102:e25254. [PMID: 37814994 DOI: 10.1002/jnr.25254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/11/2023]
Abstract
Ivermectin (IVM), a semi-synthetic macrolide parasiticide, has demonstrated considerable effectiveness in combating internal and external parasites, particularly nematodes and arthropods. Its remarkable ability to control parasites has earned it significant recognition, culminating in Satoshi Omura and William C. Campbell's receipt of the 2015 Nobel Prize in Physiology or Medicine for their contributions to the development of IVM. In recent years, investigations have revealed that IVM possesses antitumor properties. It can suppress the growth of various cancer cells, including glioma, through a multitude of mechanisms such as selective targeting of tumor-specific proteins, inducing programmed cell death, and modulation of tumor-related signaling pathways. Hence, IVM holds tremendous potential as a novel anticancer drug. This review seeks to provide an overview of the underlying mechanisms that enable IVM's capacity to suppress glioma. Furthermore, it aims to elucidate the challenges and prospects associated with utilizing IVM as a new anticancer agent.
Collapse
Affiliation(s)
- Xing Hu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yan Ju
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yue-Kang Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| |
Collapse
|
14
|
Sabry N, Fouad Y, AbdAllah M, Cordie A, Esmat G. Dose-Dependent Ivermectin Effect on COVID-19 Polymerase Chain Reaction Status. Am J Ther 2024; 31:e72-e81. [PMID: 35383577 DOI: 10.1097/mjt.0000000000001490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Nirmeen Sabry
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Yasser Fouad
- Department of Gastroenterology and Endemic Medicine, Minia University, Minia, Egypt
| | - Mohamed AbdAllah
- Medical Research Division, National Research Center, Giza, Egypt and
| | - Ahmed Cordie
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Gamal Esmat
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
15
|
Cheraghi S, Babataheri S, Soraya H. The Detrimental Effect of Pre-Treatment with Ivermectin on Myocardial Ischemia. Pharmacology 2023; 109:1-9. [PMID: 37879298 DOI: 10.1159/000534206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/18/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Ivermectin (IVM) is a broad-spectrum anti-parasitic agent with potential antibacterial, antiviral, and anti-cancer effects. There are limited studies on the effects of IVM on cardiovascular diseases, so the present study sought to determine the effects of pre-treatment with IVM on myocardial ischemia in both ex vivo and in vivo. METHODS In the ex vivo part, two groups of control and treated rats with IVM (0.2 mg/kg) were examined for cardiac function and arrhythmias by isolated heart perfusion. In the in vivo part, four groups, namely, control, IVM, Iso (MI), and Iso + IVM 0.2 mg/kg were used. Subcutaneous injection of isoproterenol (100 mg/kg/day) for 2 consecutive days was used for the induction of myocardial infarction (MI) in male Wistar rats. Then electrocardiogram, hemodynamic factors, cardiac hypertrophy, and malondialdehyde (MDA) levels were investigated. RESULTS The ex vivo results showed that administration of IVM induces cardiac arrhythmia and decreases the left ventricular maximal rate of pressure increase (contractility) and maximal rate of pressure decline (relaxation). The isoproterenol-induced MI model used as an in vivo model showed that cardiac hypertrophy were increased with no improvement in the hemodynamic and electrocardiogram pattern in the IVM-treated group in comparison to MI (Iso) group. However, the MDA level was lower in the IVM-treated group. CONCLUSION IVM pre-treatment demonstrates detrimental effects in cardiac ischemia through exacerbation of cardiac arrhythmia, myocardial dysfunction, and increased cardiac hypertrophy. Therefore, the use of IVM in ischemic heart patients should be done with great caution.
Collapse
Affiliation(s)
- Sara Cheraghi
- Department of Pharmacology and Toxicology, School of Pharmacy, Urmia University of Medical Sciences, Urmia, Iran
| | - Shabnam Babataheri
- Department of Pharmacology and Toxicology, School of Pharmacy, Urmia University of Medical Sciences, Urmia, Iran
| | - Hamid Soraya
- Department of Pharmacology and Toxicology, School of Pharmacy, Urmia University of Medical Sciences, Urmia, Iran
| |
Collapse
|
16
|
Lou P, Fang A, Zhao W, Yao K, Yang Y, Hu J. Potential Target Discovery and Drug Repurposing for Coronaviruses: Study Involving a Knowledge Graph-Based Approach. J Med Internet Res 2023; 25:e45225. [PMID: 37862061 PMCID: PMC10592722 DOI: 10.2196/45225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 08/30/2023] [Accepted: 09/22/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND The global pandemics of severe acute respiratory syndrome, Middle East respiratory syndrome, and COVID-19 have caused unprecedented crises for public health. Coronaviruses are constantly evolving, and it is unknown which new coronavirus will emerge and when the next coronavirus will sweep across the world. Knowledge graphs are expected to help discover the pathogenicity and transmission mechanism of viruses. OBJECTIVE The aim of this study was to discover potential targets and candidate drugs to repurpose for coronaviruses through a knowledge graph-based approach. METHODS We propose a computational and evidence-based knowledge discovery approach to identify potential targets and candidate drugs for coronaviruses from biomedical literature and well-known knowledge bases. To organize the semantic triples extracted automatically from biomedical literature, a semantic conversion model was designed. The literature knowledge was associated and integrated with existing drug and gene knowledge through semantic mapping, and the coronavirus knowledge graph (CovKG) was constructed. We adopted both the knowledge graph embedding model and the semantic reasoning mechanism to discover unrecorded mechanisms of drug action as well as potential targets and drug candidates. Furthermore, we have provided evidence-based support with a scoring and backtracking mechanism. RESULTS The constructed CovKG contains 17,369,620 triples, of which 641,195 were extracted from biomedical literature, covering 13,065 concept unique identifiers, 209 semantic types, and 97 semantic relations of the Unified Medical Language System. Through multi-source knowledge integration, 475 drugs and 262 targets were mapped to existing knowledge, and 41 new drug mechanisms of action were found by semantic reasoning, which were not recorded in the existing knowledge base. Among the knowledge graph embedding models, TransR outperformed others (mean reciprocal rank=0.2510, Hits@10=0.3505). A total of 33 potential targets and 18 drug candidates were identified for coronaviruses. Among them, 7 novel drugs (ie, quinine, nelfinavir, ivermectin, asunaprevir, tylophorine, Artemisia annua extract, and resveratrol) and 3 highly ranked targets (ie, angiotensin converting enzyme 2, transmembrane serine protease 2, and M protein) were further discussed. CONCLUSIONS We showed the effectiveness of a knowledge graph-based approach in potential target discovery and drug repurposing for coronaviruses. Our approach can be extended to other viruses or diseases for biomedical knowledge discovery and relevant applications.
Collapse
Affiliation(s)
- Pei Lou
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - An Fang
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wanqing Zhao
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Kuanda Yao
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yusheng Yang
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiahui Hu
- Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| |
Collapse
|
17
|
Hayanga JWA, Kakuturu J, Dhamija A, Asad F, McCarthy P, Sappington P, Badhwar V. Cannulate, extubate, ambulate approach for extracorporeal membrane oxygenation for COVID-19. J Thorac Cardiovasc Surg 2023; 166:1132-1142.e33. [PMID: 35396123 PMCID: PMC8915439 DOI: 10.1016/j.jtcvs.2022.02.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/07/2022] [Accepted: 02/23/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVE We compared outcomes in patients with severe COVID-19 versus non-COVID-19-related acute respiratory distress syndrome (ARDS) managed using a dynamic, goal-driven approach to venovenous extracorporeal membrane oxygenation (ECMO). METHODS We performed a retrospective, single-center analysis of our institutional ECMO registry using data from 2017 to 2021. We used Kaplan-Meier plots, Cox proportional hazard models, and propensity score analyses to evaluate the association of COVID-19 status (COVID-19-related ARDS vs non-COVID-19 ARDS) and survival to decannulation, discharge, tracheostomy, and extubation. We also conducted subgroup analyses to compare outcomes with the use of extracorporeal cytoreductive techniques (CytoSorb [CytoSorbents Corp] and plasmapheresis). RESULTS The sample comprised 128 patients, 50 with COVID-19 and 78 with non-COVID-19 ARDS. Advancing age was associated with decreased probability of survival to decannulation (P = .04). Compared with the non-COVID-19 ARDS group, patients with COVID-19 had a greater probability of survival to extubation (P < .01) and comparable survival to discharge (P = .14). CONCLUSIONS Patients with COVID-19 managed with ECMO had comparable outcomes as patients with non-COVID ARDS. A strategy of early extubation and ambulation might be a safe and effective strategy to improve outcomes and survival, even for patients with severe COVID-19.
Collapse
Affiliation(s)
- J W Awori Hayanga
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa.
| | - Jahnavi Kakuturu
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Ankit Dhamija
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Fatima Asad
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Paul McCarthy
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Penny Sappington
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| |
Collapse
|
18
|
Bakker CJ, Theis-Mahon N, Brown SJ, Zeegers MP. The relationship between methodological quality and the use of retracted publications in evidence syntheses. Syst Rev 2023; 12:168. [PMID: 37730590 PMCID: PMC10512544 DOI: 10.1186/s13643-023-02316-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 08/09/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Evidence syntheses cite retracted publications. However, citation is not necessarily endorsement, as authors may be criticizing or refuting its findings. We investigated the sentiment of these citations-whether they were critical or supportive-and associations with the methodological quality of the evidence synthesis, reason for the retraction, and time between publication and retraction. METHODS Using a sample of 286 evidence syntheses containing 324 citations to retracted publications in the field of pharmacy, we used AMSTAR-2 to assess methodological quality. We used scite.ai and a human screener to determine citation sentiment. We conducted a Pearson's chi-square test to assess associations between citation sentiment, methodological quality, and reason for retraction, and one-way ANOVAs to investigate association between time, methodological quality, and citation sentiment. RESULTS Almost 70% of the evidence syntheses in our sample were of critically low quality. We found that these critically low-quality evidence syntheses were more associated with positive statements while high-quality evidence syntheses were more associated with negative citation of retracted publications. In our sample of 324 citations, 20.4% of citations to retracted publications noted that the publication had been retracted. CONCLUSION The association between high-quality evidence syntheses and recognition of a publication's retracted status may indicate that best practices are sufficient. However, the volume of critically low-quality evidence syntheses ultimately perpetuates the citation of retracted publications with no indication of their retracted status. Strengthening journal requirements around the quality of evidence syntheses may lessen the inappropriate citation of retracted publications.
Collapse
Affiliation(s)
- Caitlin J Bakker
- Dr. John Archer Library and Archives, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada.
- Department of Epidemiology, School for Nutrition and Translational Research in Metabolisms, Care and Health Research Institute, Maastricht University Medical Center +, PO Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Nicole Theis-Mahon
- Health Sciences Libraries, University of Minnesota Twin Cities, Phillips-Wangensteen Building, 516 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Sarah Jane Brown
- Health Sciences Libraries, University of Minnesota Twin Cities, Phillips-Wangensteen Building, 516 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Maurice P Zeegers
- Department of Epidemiology, School for Nutrition and Translational Research in Metabolisms, Care and Health Research Institute, Maastricht University Medical Center +, PO Box 616, 6200, MD, Maastricht, The Netherlands
| |
Collapse
|
19
|
Ragó Z, Tóth B, Szalenko-Tőkés Á, Bella Z, Dembrovszky F, Farkas N, Kiss S, Hegyi P, Matuz M, Tóth N, Hegedüs I, Máthé D, Csupor D. Results of a systematic review and meta-analysis of early studies on ivermectin in SARS-CoV-2 infection. GeroScience 2023; 45:2179-2193. [PMID: 36879183 PMCID: PMC9988599 DOI: 10.1007/s11357-023-00756-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/16/2023] [Indexed: 03/08/2023] Open
Abstract
Ivermectin, an antiparasitic drug, has been repurposed for COVID-19 treatment during the SARS-CoV-2 pandemic. Although its antiviral efficacy was confirmed early in vitro and in preclinical studies, its clinical efficacy remained ambiguous. Our purpose was to assess the efficacy of ivermectin in terms of time to viral clearance based on the meta-analysis of available clinical trials at the closing date of the data search period, one year after the start of the pandemic. This meta-analysis was reported by following the PRISMA guidelines and by using the PICO format for formulating the question. The study protocol was registered on PROSPERO. Embase, MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), bioRvix, and medRvix were searched for human studies of patients receiving ivermectin therapy with control groups. No language or publication status restrictions were applied. The search ended on 1/31/2021 exactly one year after WHO declared the public health emergency on novel coronavirus. The meta-analysis of three trials involving 382 patients revealed that the mean time to viral clearance was 5.74 days shorter in case of ivermectin treatment compared to the control groups [WMD = -5.74, 95% CI (-11.1, -0.39), p = 0.036]. Ivermectin has significantly reduced the time to viral clearance in mild to moderate COVID-19 diseases compared to control groups. However, more eligible studies are needed for analysis to increase the quality of evidence of ivermectin use in COVID-19.
Collapse
Affiliation(s)
- Zsuzsanna Ragó
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Barbara Tóth
- Institute of Pharmacognosy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Ágnes Szalenko-Tőkés
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
- NOÉ Health Care Centre, Szeged, Hungary
| | - Zsolt Bella
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
- NOÉ Health Care Centre, Szeged, Hungary
| | - Fanni Dembrovszky
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Nelli Farkas
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
- Institute of Bioanalysis, Medical School, University of Pécs, Pécs, Hungary
| | - Szabolcs Kiss
- Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Mária Matuz
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Noémi Tóth
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Imre Hegedüs
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Domokos Máthé
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary.
- In Vivo Imaging ACF, Hungarian Centre of Excellence for Molecular Medicine (HCEMM), Szeged, Hungary.
| | - Dezső Csupor
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| |
Collapse
|
20
|
Zhou G, Verweij S, Bijlsma MJ, de Vos S, Oude Rengerink K, Pasmooij AMG, van Baarle D, Niesters HGM, Mol P, Vonk JM, Hak E. Repurposed drug studies on the primary prevention of SARS-CoV-2 infection during the pandemic: systematic review and meta-analysis. BMJ Open Respir Res 2023; 10:e001674. [PMID: 37640510 PMCID: PMC10462970 DOI: 10.1136/bmjresp-2023-001674] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE Current evidence on the effectiveness of SARS-CoV-2 prophylaxis is inconclusive. We aimed to systematically evaluate published studies on repurposed drugs for the prevention of laboratory-confirmed SARS-CoV-2 infection and/or COVID-19 among healthy adults. DESIGN Systematic review. ELIGIBILITY Quantitative experimental and observational intervention studies that evaluated the effectiveness of repurposed drugs for the primary prevention of SARS-CoV-2 infection and/or COVID-19 disease. DATA SOURCE PubMed and Embase (1 January 2020-28 September 2022). RISK OF BIAS Cochrane Risk of Bias 2.0 and Risk of Bias in Non-Randomised Studies of Interventions tools were applied to assess the quality of studies. DATA ANALYSIS Meta-analyses for each eligible drug were performed if ≥2 similar study designs were available. RESULTS In all, 65 (25 trials, 40 observational) and 29 publications were eligible for review and meta-analyses, respectively. Most studies pertained to hydroxychloroquine (32), ACE inhibitor (ACEi) or angiotensin receptor blocker (ARB) (11), statin (8), and ivermectin (8). In trials, hydroxychloroquine prophylaxis reduced laboratory-confirmed SARS-CoV-2 infection (risk ratio: 0.82 (95% CI 0.74 to 0.90), I2=48%), a result largely driven by one clinical trial (weight: 60.5%). Such beneficial effects were not observed in observational studies, nor for prognostic clinical outcomes. Ivermectin did not significantly reduce the risk of SARS-CoV-2 infection (RR: 0.35 (95% CI 0.10 to 1.26), I2=96%) and findings for clinical outcomes were inconsistent. Neither ACEi or ARB were beneficial in reducing SARS-CoV-2 infection. Most of the evidence from clinical trials was of moderate quality and of lower quality in observational studies. CONCLUSIONS Results from our analysis are insufficient to support an evidence-based repurposed drug policy for SARS-CoV-2 prophylaxis because of inconsistency. In the view of scarce supportive evidence on repurposing drugs for COVID-19, alternative strategies such as immunisation of vulnerable people are warranted to prevent the future waves of infection. PROSPERO REGISTRATION NUMBER CRD42021292797.
Collapse
Affiliation(s)
- Guiling Zhou
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Stefan Verweij
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
- Dutch Medicines Evaluation Board, Utrecht, The Netherlands
| | - Maarten J Bijlsma
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Stijn de Vos
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | | | | | - Debbie van Baarle
- Virology and Immunology Research Group, Department of Medical Microbiology and Infection Prevention, University Medical Centre, Groningen, The Netherlands
| | - Hubert G M Niesters
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, Groningen, The Netherlands
| | - Peter Mol
- Dutch Medicines Evaluation Board, Utrecht, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre, Groningen, The Netherlands
| | - Judith M Vonk
- Groningen Research Institute for Asthma and COPD, University Medical Centre, Groningen, The Netherlands
- Department of Epidemiology, University Medical Centre, Groningen, The Netherlands
| | - Eelko Hak
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
21
|
Badi Y, Hammad M, Tawfik AG, Eshag MME, Elhady MM, Ragab KM, Nourelden AZ, Gamal MH, Fathallah AH. Inhaled corticosteroids' effect on COVID-19 patients: A systematic review and meta-analysis of randomized controlled trials. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2023; 59:154-166. [PMID: 37781348 PMCID: PMC10540159 DOI: 10.29390/001c.84260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 07/17/2023] [Indexed: 10/03/2023]
Abstract
Background More than six million people died due to COVID-19, and 10-15% of infected individuals suffer from post-covid syndrome. Corticosteroids are widely used in the management of severe COVID-19 and post-acute COVID-19 symptoms. This study synthesizes current evidence of the effectiveness of inhaled corticosteroids (ICS) on mortality, hospital length-of-stay (LOS), and improvement of smell scores in patients with COVID-19. Methods We searched Embase, Web of Science, PubMed, Cochrane Library, and Scopus until Aug 2022. The Cochrane risk of bias tool was used to assess the quality of studies. We evaluated the effectiveness of ICS in COVID-19 patients through measures of mortality, LOS, alleviation of post-acute COVID-19 symptoms, time to sustained self-reported cure, and sense of smell (visual analog scale (VAS)). Results Ten studies were included in the meta-analysis. Our study showed a significant decrease in the LOS in ICS patients over placebo (MD = -1.52, 95% CI [-2.77 to -0.28], p-value = 0.02). Patients treated with intranasal corticosteroids (INC) showed a significant improvement in VAS smell scores from week three to week four (MD =1.52, 95% CI [0.27 to 2.78], p-value = 0.02), and alleviation of COVID-related symptoms after 14 days (RR = 1.17, 95% CI [1.09 to 1.26], p-value < 0.0001). No significant differences were detected in mortality (RR= 0.69, 95% CI [0.36 to 1.35], p-value = 0.28) and time to sustained self-reported cure (MD = -1.28, 95% CI [-6.77 to 4.20], p-value = 0.65). Conclusion We concluded that the use of ICS decreased patient LOS and improved COVID-19-related symptoms. INC may have a role in improving the smell score. Therefore, using INC and ICS for two weeks or more may prove beneficial. Current data do not demonstrate an effect on mortality or time to sustained self-reported cure. However, the evidence is inconclusive, and more studies are needed for more precise data.
Collapse
Affiliation(s)
- Yasra Badi
- All Saints University School of Medicine
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Halma MTJ, Plothe C, Marik P, Lawrie TA. Strategies for the Management of Spike Protein-Related Pathology. Microorganisms 2023; 11:1308. [PMID: 37317282 PMCID: PMC10222799 DOI: 10.3390/microorganisms11051308] [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: 03/16/2023] [Revised: 05/04/2023] [Accepted: 05/10/2023] [Indexed: 06/16/2023] Open
Abstract
In the wake of the COVID-19 crisis, a need has arisen to prevent and treat two related conditions, COVID-19 vaccine injury and long COVID-19, both of which can trace at least part of their aetiology to the spike protein, which can cause harm through several mechanisms. One significant mechanism of harm is vascular, and it is mediated by the spike protein, a common element of the COVID-19 illness, and it is related to receiving a COVID-19 vaccine. Given the significant number of people experiencing these two related conditions, it is imperative to develop treatment protocols, as well as to consider the diversity of people experiencing long COVID-19 and vaccine injury. This review summarizes the known treatment options for long COVID-19 and vaccine injury, their mechanisms, and their evidentiary basis.
Collapse
Affiliation(s)
| | - Christof Plothe
- Center for Biophysical Osteopathy, Am Wegweiser 27, 55232 Alzey, Germany
| | - Paul Marik
- Front Line COVID-19 Critical Care Alliance (FLCCC), 2001 L St. NW Suite 500, Washington, DC 20036, USA;
| | | |
Collapse
|
23
|
Chambergo-Michilot D, Runzer-Colmenares FM, Segura-Saldaña PA. Discontinuation of Antihypertensive Drug Use Compared to Continuation in COVID-19 Patients: A Systematic Review with Meta-analysis and Trial Sequential Analysis. High Blood Press Cardiovasc Prev 2023; 30:265-279. [PMID: 37171528 PMCID: PMC10177739 DOI: 10.1007/s40292-023-00579-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/04/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION COVID-19 related mortality is about 2%, and it increases with comorbidities, like hypertension. Regarding management, there is debatable evidence about the benefits of continuation vs. discontinuation of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ACEI/ARB). AIM We performed a systematic review to assess the effects and safety of in-hospital discontinuation compared to continuation of ACEI/ARB in COVID-19 patients. METHODS We systematically searched on PubMed, Scopus, and EMBASE from inception to June 19, 2021. We included observational studies and trials that compared the effects and safety of continuing ACEI/ARB compared to discontinuing it in COVID-19 patients. Effects sizes for dichotomous variables were expressed as risk ratios (RR) and 95% confidence intervals. For continuous variables, effects were expressed as mean difference (MD). We used random effect models with the inverse variance method. We assessed certainty of evidence using the GRADE approach. RESULTS We included three open-label randomized controlled trials and five cohort studies. We found that the continuation group had lower risk of death compared with the discontinuation group only in the cohort group (RR: 0.46, 95% CI: 0.24-0.90), but not in the RCT group (RR: 1.22, 95% CI: 0.75-2.00). The ICU admission rate was significantly lower in the continuation group (RR: 0.46, 95% CI: 0.31-0.68) in the cohort group, but not in RCT group (RR: 1.03, 95% CI: 0.67-1.59). We did not find significant differences between groups regarding hospitalization length, hypotension, AKI needing renal replacement therapy, mechanical ventilation, new or worsening heart failure, myocarditis, renal replacement therapy, arrhythmias, thromboembolic events and SOFA AUC. The GRADE approach revealed that the certainty ranged from moderate to high level. CONCLUSIONS There is no significant difference in mortality and other outcomes between continuation and discontinuation groups.
Collapse
Affiliation(s)
- Diego Chambergo-Michilot
- Universidad Científica del Sur, Lima, Peru.
- CHANGE Research Working Group, Carrera de Medicina Humana, Universidad Científica del Sur, Lima, Peru.
| | | | - Pedro A Segura-Saldaña
- Department of Cardiology Research, Torres de Salud National Research Center, Lima, Peru
- Ingeniería Biomédica, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Cardiología, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| |
Collapse
|
24
|
Llenas-García J, Del Pozo A, Talaya A, Roig-Sánchez N, Poveda Ruiz N, Devesa García C, Borrajo Brunete E, González Cuello I, Lucas Dato A, Navarro M, Wikman-Jorgensen P. Ivermectin Effect on In-Hospital Mortality and Need for Respiratory Support in COVID-19 Pneumonia: Propensity Score-Matched Retrospective Study. Viruses 2023; 15:v15051138. [PMID: 37243224 DOI: 10.3390/v15051138] [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: 04/25/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION There is negligible evidence on the efficacy of ivermectin for treating COVID-19 pneumonia. This study aimed to assess the efficacy of ivermectin for pre-emptively treating Strongyloides stercoralis hyperinfection syndrome in order to reduce mortality and the need for respiratory support in patients hospitalized for COVID-19. METHODS This single-center, observational, retrospective study included patients admitted with COVID-19 pneumonia at Hospital Vega Baja from 23 February 2020 to 14 March 2021. Because strongyloidiasis is endemic to our area, medical criteria support empiric administration of a single, 200 μg/kg dose of ivermectin to prevent Strongyloides hyperinfection syndrome. The outcome was a composite of all-cause in-hospital mortality and the need for respiratory support. RESULTS Of 1167 patients in the cohort, 96 received ivermectin. After propensity score matching, we included 192 patients. The composite outcome of in-hospital mortality or need for respiratory support occurred in 41.7% of the control group (40/96) and 34.4% (33/96) of the ivermectin group. Ivermectin was not associated with the outcome of interest (adjusted odds ratio [aOR] 0.77, 95% confidence interval [CI] 0.35, 1.69; p = 0.52). The factors independently associated with this endpoint were oxygen saturation (aOR 0.78, 95% CI 0.68, 0.89, p < 0.001) and C-reactive protein at admission (aOR: 1.09, 95% CI 1.03, 1.16, p < 0.001). CONCLUSIONS In hospitalized patients with COVID-19 pneumonia, ivermectin at a single dose for pre-emptively treating Strongyloides stercoralis is not effective in reducing mortality or the need for respiratory support measures.
Collapse
Affiliation(s)
- Jara Llenas-García
- Internal Medicine Service, Hospital Vega Baja, 03314 Orihuela, Spain
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), 46020 Valencia, Spain
- Clinical Medicine Department, Miguel Hernández University, 03202 Elche, Spain
| | - Alfonso Del Pozo
- Internal Medicine Service, Hospital Vega Baja, 03314 Orihuela, Spain
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), 46020 Valencia, Spain
| | - Alberto Talaya
- Internal Medicine Service, Hospital Vega Baja, 03314 Orihuela, Spain
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), 46020 Valencia, Spain
| | - Nuria Roig-Sánchez
- Internal Medicine Service, Hospital Vega Baja, 03314 Orihuela, Spain
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), 46020 Valencia, Spain
| | | | | | | | - Inmaculada González Cuello
- Internal Medicine Service, Hospital Vega Baja, 03314 Orihuela, Spain
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), 46020 Valencia, Spain
| | - Ana Lucas Dato
- Internal Medicine Service, Hospital Vega Baja, 03314 Orihuela, Spain
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), 46020 Valencia, Spain
| | - Miriam Navarro
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), 46020 Valencia, Spain
- Epidemiology Unit, Public Health Centre, 03202 Elche, Spain
| | - Philip Wikman-Jorgensen
- Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), 46020 Valencia, Spain
- Internal Medicine Service, Elda General University Hospital, 03600 Elda, Spain
| |
Collapse
|
25
|
Requejo Domínguez JA, Mino-León D, Wirtz VJ. Quality of clinical evidence and political justifications of ivermectin mass distribution of COVID-19 kits in eight Latin American countries. BMJ Glob Health 2023; 8:bmjgh-2022-010962. [PMID: 37225261 DOI: 10.1136/bmjgh-2022-010962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 04/13/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Several countries in Latin America conducted mass distribution of COVID-19 kits intended to treat mild COVID-19, thereby preventing excess hospitalisations. Many of the kits contained ivermectin, an antiparasitic medicine that was not approved at the time for the treatment of COVID-19. The study objective was to compare the timing of the publication of scientific evidence about the efficacy of ivermectin for COVID-19 with the timeline of distribution of COVID-19 kits in eight Latin American countries and to analyse whether evidence was used to justify ivermectin distribution. METHODS We conducted a systematic review of randomised controlled trials (RCTs) published on the efficacy of ivermectin or ivermectin as adjuvant therapy on mortality from, or as prevention for, COVID-19. Each RCT was assessed using the Cochrane Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Information on the timing and justification of government decisions was collected through a systematic search of leading newspapers and government press releases. RESULTS After removing the duplicates and abstracts without full text, 33 RCTs met our inclusion criteria. According to GRADE, the majority had a substantial risk of bias. Many government officials made claims that ivermectin was effective and safe in the prevention or treatment of COVID-19, despite the lack of published evidence. CONCLUSION All eight governments distributed COVID-19 kits to their populations despite the absence of high-quality evidence on the efficacy of ivermectin for prevention, hospitalisation and mortality in COVID-19 patients. Lessons learnt from this situation could be used to strengthen government institutions' capacities to implement evidence-informed public health policies.
Collapse
Affiliation(s)
| | - Dolores Mino-León
- Hospital de Especialidades CMN SXXI Instituto Mexicano del Seguro Social Ciudad de México, Mexico City, Mexico
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
26
|
Weibel S, Popp M, Reis S, Skoetz N, Garner P, Sydenham E. Identifying and managing problematic trials: A research integrity assessment tool for randomized controlled trials in evidence synthesis. Res Synth Methods 2023; 14:357-369. [PMID: 36054583 PMCID: PMC10551123 DOI: 10.1002/jrsm.1599] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/28/2022] [Accepted: 08/11/2022] [Indexed: 12/29/2022]
Abstract
Evidence synthesis findings depend on the assumption that the included studies follow good clinical practice and results are not fabricated or false. Studies which are problematic due to scientific misconduct, poor research practice, or honest error may distort evidence synthesis findings. Authors of evidence synthesis need transparent mechanisms to identify and manage problematic studies to avoid misleading findings. As evidence synthesis authors of the Cochrane COVID-19 review on ivermectin, we identified many problematic studies in terms of research integrity and regulatory compliance. Through iterative discussion, we developed a research integrity assessment (RIA) tool for randomized controlled trials for the update of this Cochrane review. In this paper, we explain the rationale and application of the RIA tool in this case study. RIA assesses six study criteria: study retraction, prospective trial registration, adequate ethics approval, author group, plausibility of methods (e.g., randomization), and plausibility of study results. RIA was used in the Cochrane review as part of the eligibility check during screening of potentially eligible studies. Problematic studies were excluded and studies with open questions were held in awaiting classification until clarified. RIA decisions were made independently by two authors and reported transparently. Using the RIA tool resulted in the exclusion of >40% of studies in the first update of the review. RIA is a complementary tool prior to assessing "Risk of Bias" aiming to establish the integrity and authenticity of studies. RIA provides a platform for urgent development of a standard approach to identifying and managing problematic studies.
Collapse
Affiliation(s)
- Stephanie Weibel
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Maria Popp
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Stefanie Reis
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, 97080 Wuerzburg, Germany
| | - Nicole Skoetz
- Evidence-based Oncology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Paul Garner
- Centre for Evidence Synthesis in Global Health, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Emma Sydenham
- Cochrane Injuries Group, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| |
Collapse
|
27
|
Korb VG, Schultz IC, Beckenkamp LR, Wink MR. A Systematic Review of the Role of Purinergic Signalling Pathway in the Treatment of COVID-19. Int J Mol Sci 2023; 24:ijms24097865. [PMID: 37175571 PMCID: PMC10178215 DOI: 10.3390/ijms24097865] [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: 01/09/2023] [Revised: 03/27/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global health concern. Three years since its origin, despite the approval of vaccines and specific treatments against this new coronavirus, there are still high rates of infection, hospitalization, and mortality in some countries. COVID-19 is characterised by a high inflammatory state and coagulation disturbances that may be linked to purinergic signalling molecules such as adenosine triphosphate (ATP), adenosine diphosphate (ADP), adenosine (ADO), and purinergic receptors (P1 and P2). These nucleotides/nucleosides play important roles in cellular processes, such as immunomodulation, blood clot formation, and vasodilation, which are affected during SARS-CoV-2 infection. Therefore, drugs targeting this purinergic pathway, currently used for other pathologies, are being evaluated in preclinical and clinical trials for COVID-19. In this review, we focus on the potential of these drugs to control the release, degradation, and reuptake of these extracellular nucleotides and nucleosides to treat COVID-19. Drugs targeting the P1 receptors could have therapeutic efficacy due to their capacity to modulate the cytokine storm and the immune response. Those acting in P2X7, which is linked to NLRP3 inflammasome activation, are also valuable candidates as they can reduce the release of pro-inflammatory cytokines. However, according to the available preclinical and clinical data, the most promising medications to be used for COVID-19 treatment are those that modulate platelets behaviour and blood coagulation factors, mainly through the P2Y12 receptor.
Collapse
Affiliation(s)
- Vitoria Guero Korb
- Laboratório de Biologia Celular, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, RS, Brazil
| | - Iago Carvalho Schultz
- Laboratório de Biologia Celular, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, RS, Brazil
| | - Liziane Raquel Beckenkamp
- Laboratório de Biologia Celular, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, RS, Brazil
| | - Márcia Rosângela Wink
- Laboratório de Biologia Celular, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, RS, Brazil
- Departamento de Ciências Básicas da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, Sala 304 Centro, Porto Alegre 90050-170, RS, Brazil
| |
Collapse
|
28
|
Astărăstoae V, Rogozea LM. Against Authority: The Bioethics of Ivermectin Use for COVID-19 Infection. Am J Ther 2023:00045391-990000000-00143. [PMID: 37068020 DOI: 10.1097/mjt.0000000000001629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND The COVID-19 pandemic has brought new ethical challenges to both health care professionals and the general public. Among the ethical problems amplified during this period were the making of medical decisions to quickly introduce some drugs into therapeutic practice with unproven or insufficiently proven effects (such as ivermectin), the validity of drug testing, and the allocation of limited resources. FIELDS OF UNCERTAINTY The COVID-19 pandemic brought to the attention of the entire scientific world a new problem, which exceeded the guidelines and rules known until then. Out of the desire to quickly solve this medical problem, a series of measures were taken, however not sufficiently validated in scientific terms; the recommendations regarding the use of drugs known for their properties to treat a greater number of conditions, such as ivermectin, was tried. DATA SOURCES A narrative review of the specialized literature was carried out using keywords such as COVID-19, ivermectin, ethics, and off-label medication from Scopus and Google Scholar but also of official documents developed at the international level (World Health Organization). ETHICS AND THERAPEUTIC ADVANCES The off-label use of ivermectin alone or in combination with other medications during COVID pandemic raised problems related to the demonstration of its effectiveness, but also to ethics, starting from the expectations that both the medical staff and the population had of it. Ivermectin therapy was also evaluated by analyzing the behavior of ivermectin based on ethical principles (nonmaleficence, beneficence, and respect for one's autonomy) or on justice. Even in times of pandemic, exceptionalism must not triumph, and finding an effective treatment must be done through studies that respect ethical standard. CONCLUSIONS The failures or rather lack of success in decision making during the pandemic showed that alongside scientific knowledge and the development of health policies, it is necessary to constantly evaluate the measures and decisions from an ethical point of view, and the prevention of slippages and abuses is not only necessary but even mandatory.
Collapse
Affiliation(s)
- Vasile Astărăstoae
- Faculty of Medicine, Grigore T Popa University of Medicine & Pharmacy, Iasi, Romania; and
| | - Liliana M Rogozea
- Basic, Preventive and Clinical Sciences Department, Transilvania University, Brasov, Romania
| |
Collapse
|
29
|
Hill A, Mirchandani M. The dangers of non-randomized, observational studies: experience from the COVID-19 epidemic. J Antimicrob Chemother 2023; 78:323-327. [PMID: 36575642 DOI: 10.1093/jac/dkac437] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In regulatory evaluations, high-quality randomized controlled trials (RCTs) are considered the gold standard for assessing the efficacy of medical interventions. However, during the COVID-19 pandemic, the urgent need for treatment options led to regulatory approvals being made based on evidence from non-randomized, observational studies. In this study we contrast results from observational studies and RCTs of six drugs to treat COVID-19 infection. Across a range of studies evaluating hydroxychloroquine, remdesivir, ivermectin, aspirin, molnupiravir and tenofovir for COVID-19, there was statistically significant evidence of benefit from non-randomized observational studies, which was then not seen in RCTs. We propose that all observational studies need to be labelled as 'non-randomized' in the title. This should indicate that they are not as reliable for evaluating the efficacy of a drug and should not be used independently for regulatory approval decisions.
Collapse
Affiliation(s)
- Andrew Hill
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool L7 3NY, UK
| | | |
Collapse
|
30
|
Lazarus JV, Wyka K, White TM, Picchio CA, Gostin LO, Larson HJ, Rabin K, Ratzan SC, Kamarulzaman A, El-Mohandes A. A survey of COVID-19 vaccine acceptance across 23 countries in 2022. Nat Med 2023; 29:366-375. [PMID: 36624316 DOI: 10.1038/s41591-022-02185-4] [Citation(s) in RCA: 124] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continued to mutate and spread in 2022 despite the introduction of safe, effective vaccines and medications. Vaccine hesitancy remains substantial, fueled in part by misinformation. Our third study of Coronavirus Disease 2019 (COVID-19) vaccine hesitancy among 23,000 respondents in 23 countries (Brazil, Canada, China, Ecuador, France, Germany, Ghana, India, Italy, Kenya, Mexico, Nigeria, Peru, Poland, Russia, Singapore, South Africa, South Korea, Spain, Sweden, Turkey, the United Kingdom and the United States), surveyed from 29 June to 10 July 2022, found willingness to accept vaccination at 79.1%, up 5.2% from June 2021. Hesitancy increased in eight countries, however, ranging from 1.0% (United Kingdom) to 21.1% (South Africa). Almost one in eight (12.1%) vaccinated respondents are hesitant about booster doses. Overall support for vaccinating children under 18 years of age increased slightly but declined among parents who were personally hesitant. Almost two in five (38.6%) respondents reported paying less attention to new COVID-19 information than previously, and support for vaccination mandates decreased. Almost a quarter (24%) of those who became ill reported taking medications to combat COVID-19 symptoms. Vaccination remains a cornerstone of the COVID-19 pandemic response, but broad public support remains elusive. These data can be used by health system decisionmakers, practitioners, advocates and researchers to address COVID-19 vaccine hesitancy more effectively.
Collapse
Affiliation(s)
- Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain. .,Graduate School of Public Health & Health Policy, City University of New York (CUNY), New York, NY, USA.
| | - Katarzyna Wyka
- Graduate School of Public Health & Health Policy, City University of New York (CUNY), New York, NY, USA
| | - Trenton M White
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Camila A Picchio
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Lawrence O Gostin
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA
| | - Heidi J Larson
- Graduate School of Public Health & Health Policy, City University of New York (CUNY), New York, NY, USA.,London School of Hygiene and Tropical Medicine (LSHTM), London, UK.,Institute for Health Metrics & Evaluation (IHME), University of Washington, Seattle, WA, USA
| | - Kenneth Rabin
- Graduate School of Public Health & Health Policy, City University of New York (CUNY), New York, NY, USA
| | - Scott C Ratzan
- Graduate School of Public Health & Health Policy, City University of New York (CUNY), New York, NY, USA
| | | | - Ayman El-Mohandes
- Graduate School of Public Health & Health Policy, City University of New York (CUNY), New York, NY, USA
| |
Collapse
|
31
|
Vaezi A, Salmasi M, Soltaninejad F, Salahi M, Javanmard SH, Amra B. Favipiravir in the Treatment of Outpatient COVID-19: A Multicenter, Randomized, Triple-Blind, Placebo-Controlled Clinical Trial. Adv Respir Med 2023; 91:18-25. [PMID: 36825938 PMCID: PMC9951951 DOI: 10.3390/arm91010004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/11/2023] [Accepted: 01/20/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND Finding effective outpatient treatments to prevent COVID-19 progression and hospitalization is necessary and is helpful in managing limited hospital resources. Repurposing previously existing treatments is highly desirable. In this study, we evaluate the efficacy of Favipiravir in the prevention of hospitalization in symptomatic COVID-19 patients who were not eligible for hospitalization. METHODS This study was a triple-blind randomized controlled trial conducted between 5 December 2020 and 31 March 2021 in three outpatient centers in Isfahan, Iran. Patients in the intervention group received Favipiravir 1600 mg daily for five days, and the control group received a placebo. Our primary outcome was the proportion of hospitalized participants from day 0 to day 28. The outcome was assessed on days 3, 7, 14, 21, and 28 through phone calls. RESULTS Seventy-seven patients were randomly allocated to Favipiravir and placebo groups. There was no significant difference between groups considering baseline characteristics. During the study period, 10.5% of patients in the Favipiravir group and 5.1% of patients in the placebo group were hospitalized, but there was no significant difference between them (p-value = 0.3). No adverse event was reported in the treatment group. CONCLUSIONS Our study shows that Favipiravir did not reduce the hospitalization rate of mild to moderate COVID-19 patients in outpatient settings.
Collapse
Affiliation(s)
- Atefeh Vaezi
- Cancer Prevention Research Center, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
| | - Mehrzad Salmasi
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
| | - Forogh Soltaninejad
- Bamdad Respiratory and Sleep Research Center, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
| | - Mehrdad Salahi
- Department of Infectious Disease, School of Medicine, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
- Correspondence:
| | - Shaghayegh Haghjooy Javanmard
- Department of Physiology, Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
| | - Babak Amra
- Bamdad Respiratory and Sleep Research Center, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
| |
Collapse
|
32
|
Parchwani D, Sonagra AD, Dholariya S, Motiani A, Singh R. COVID-19-related liver injury: Focus on genetic and drug-induced perspectives. World J Virol 2023; 12:53-67. [PMID: 36743658 PMCID: PMC9896591 DOI: 10.5501/wjv.v12.i1.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/15/2022] [Accepted: 12/01/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Empirical use of potentially hepatotoxic drugs in the management of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is considered as one of the major etiopathogenetic factors for liver injury. Recent evidence has shown that an underlying genetic factor may also occur. Hence, it is important to understand the host genetics and iatrogenic-based mechanisms for liver dysfunction to make timely remedial measures.
AIM To investigate drug-induced and genetic perspectives for the development of coronavirus disease 2019 (COVID-19)-related liver injury.
METHODS Reference Citation Analysis, PubMed, Google Scholar and China National Knowledge Infrastructure were searched by employing the relevant MeSH keywords and pertaining data of the duration, site and type of study, sample size with any subgroups and drug-induced liver injury outcome. Genetic aspects were extracted from the most current pertinent publications.
RESULTS In all studies, the hepatic specific aminotransferase and other biochemical indices were more than their prescribed upper normal limit in COVID-19 patients and were found to be significantly related with the gravity of disease, hospital stay, number of COVID-19 treatment drugs and worse clinical outcomes. In addition, membrane bound O-acyltransferase domain containing 7 rs641738, rs11385942 G>GA at chromosome 3 gene cluster and rs657152 C>A at ABO blood locus was significantly associated with severity of livery injury in admitted SARS-CoV-2 patients.
CONCLUSION Hepatic dysfunction in SARS-CoV-2 infection could be the result of individual drugs or due to drug-drug interactions and may be in a subset of patients with a genetic propensity. Thus, serial estimation of hepatic indices in hospitalized SARS-CoV-2 patients should be done to make timely corrective actions for iatrogenic causes to avoid clinical deterioration. Additional molecular and translational research is warranted in this regard.
Collapse
Affiliation(s)
- Deepak Parchwani
- Department of Biochemistry, All India Institute of Medical Sciences, Rajkot 360001, India
| | - Amit D Sonagra
- Department of Biochemistry, All India Institute of Medical Sciences, Rajkot 360001, India
| | - Sagar Dholariya
- Department of Biochemistry, All India Institute of Medical Sciences, Rajkot 360001, India
| | - Anita Motiani
- Department of Biochemistry, All India Institute of Medical Sciences, Rajkot 360001, India
| | - Ragini Singh
- Department of Biochemistry, All India Institute of Medical Sciences, Rajkot 360001, India
| |
Collapse
|
33
|
Hayanga JWA, Chatterjee S, Kim BS, Merritt-Genore H, Karianna Milewski RC, Haft JW, Arora RC. Venovenous extracorporeal membrane oxygenation in patients with COVID-19 respiratory failure. J Thorac Cardiovasc Surg 2023; 165:212-217. [PMID: 34756623 PMCID: PMC8505026 DOI: 10.1016/j.jtcvs.2021.09.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/15/2021] [Accepted: 09/28/2021] [Indexed: 12/16/2022]
Affiliation(s)
- J W Awori Hayanga
- Department of Cardiothoracic and Vascular Surgery, West Virginia University Medicine, Morgantown, WVa.
| | - Subhasis Chatterjee
- Divisions of General and Cardiothoracic Surgery, Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Bo Soo Kim
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Md
| | | | | | - Jonathan W Haft
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Mich
| | - Rakesh C Arora
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
34
|
Ivermectin: Not yet an approved COVID-19 treatment. Nursing 2023; 53:10-11. [PMID: 36573860 DOI: 10.1097/01.nurse.0000902960.61159.d5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
35
|
Silva NBLD, Rocha RPDS, Andrade ACDS, Terças-Trettel ACP, Muraro AP. Prevalence of Ivermectin use to prevent COVID-19 during the pandemic in Mato Grosso: cross-sectional home-based study. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023; 26:e230026. [PMID: 37162068 PMCID: PMC10168631 DOI: 10.1590/1980-549720230026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/31/2023] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVE To analyze the use of ivermectin as COVID-19 prevention method by the population of Mato Grosso in 2020. METHODS This is a home-based survey, carried out between September and October 2020, in 10 pole cities of the socioeconomic regions of State. The use of ivermectin was evaluated through the question: "Did you take ivermectin to prevent COVID-19?". Sociodemographic variables (sex, age group, education, family income), current work situation, being benefitted by government financial programs, as well as symptoms, seroprevalence of antibodies against SARS-CoV-2, and previous diagnosis of COVID-19 were evaluated. Prevalence and their associations were estimated using the chi-square test. RESULTS 4.206 individuals were evaluated for prevalence of ivermectin use; 58.3% of the individuals responded positively, this rate being higher in the municipalities of the western region of the state (66.6%). There was no significant difference between sexes, but the prevalence was higher among people aged 50-59 years (69.7%), who were white (66.5%), with complete higher education or more (68.8%) and higher family income (≥3 minimum wages-64.2%). The use of this drug was even higher among participants who considered their knowledge of the disease good or very good (65.0%), who reported having symptoms of COVID-19 (75.3%), and who had been previously diagnosed with the disease (91.2%). CONCLUSION There was a high prevalence of use of ivermectin as a method to prevent covid-19 by the population of Mato Grosso, indicating the need for strategies to inform the population about the risks of off-label use of drugs and to combat the advertising of drugs that are ineffective against COVID-19.
Collapse
Affiliation(s)
| | | | | | - Ana Cláudia Pereira Terças-Trettel
- Universidade do Estado de Mato Grosso - Tangará da Serra (MT), Brazil
- Universidade Federal de Mato Grosso, Graduate Program in Collective Health - Cuiabá (MT), Brazil
| | - Ana Paula Muraro
- Universidade Federal de Mato Grosso, Institute for Collective Health - Cuiabá (MT), Brazil
| |
Collapse
|
36
|
Chugh A, Sehgal I, Khurana N, Verma K, Rolta R, Vats P, Salaria D, Fadare OA, Awofisayo O, Verma A, Phartyal R, Verma M. Comparative docking studies of drugs and phytocompounds for emerging variants of SARS-CoV-2. 3 Biotech 2023; 13:36. [PMID: 36619821 PMCID: PMC9815891 DOI: 10.1007/s13205-022-03450-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023] Open
Abstract
In the last three years, COVID-19 has impacted the world with back-to-back waves leading to devastating consequences. SARS-CoV-2, the causative agent of COVID-19, was first detected in 2019 and since then has spread to 228 countries. Even though the primary focus of research groups was diverted to fight against COVID-19, yet no dedicated drug has been developed to combat the emergent life-threatening medical conditions. In this study, 35 phytocompounds and 43 drugs were investigated for comparative docking analysis. Molecular docking and virtual screening were performed against SARS-CoV-2 spike glycoprotein of 13 variants using AutoDock Vina tool 1.5.6 and Discovery Studio, respectively, to identify the most efficient drugs. Selection of the most suitable compounds with the best binding affinity was done after screening for toxicity, ADME (absorption, distribution, metabolism and excretion) properties and drug-likeliness. The potential candidates were discovered to be Liquiritin (binding affinities ranging between -7.0 and -8.1 kcal/mol for the 13 variants) and Apigenin (binding affinities ranging between -6.8 and -7.3 kcal/mol for the 13 variants) based on their toxicity and consistent binding affinity with the Spike protein of all variants. The stability of the protein-ligand complex was determined using Molecular dynamics (MD) simulation of Apigenin with the Delta plus variant of SARS-CoV-2. Furthermore, Liquiritin and Apigenin were also found to be less toxic than the presently used drugs and showed promising results based on in silico studies, though, confirmation using in vitro studies is required. This in-depth comparative investigation suggests potential drug candidates to fight against SARS-CoV-2 variants. Supplementary Information The online version contains supplementary material available at 10.1007/s13205-022-03450-6.
Collapse
Affiliation(s)
- Ananya Chugh
- Sri Venkateswara College, University of Delhi, New Delhi, 110021 India
| | - Ishita Sehgal
- Sri Venkateswara College, University of Delhi, New Delhi, 110021 India
| | - Nimisha Khurana
- Sri Venkateswara College, University of Delhi, New Delhi, 110021 India
| | - Kangna Verma
- Sri Venkateswara College, University of Delhi, New Delhi, 110021 India
| | - Rajan Rolta
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Pranjal Vats
- School of Biological Sciences, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Deeksha Salaria
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Olatomide A. Fadare
- Organic Chemistry Research Lab, Department of Chemistry, Obafemi Awolowo University, Ile-Ife, Osun 220282 Nigeria
| | - Oladoja Awofisayo
- Department of Pharmaceutical and Medical Chemistry, University of Uyo, Uyo, 520003 Nigeria
| | - Anita Verma
- Sri Venkateswara College, University of Delhi, New Delhi, 110021 India
| | - Rajendra Phartyal
- Sri Venkateswara College, University of Delhi, New Delhi, 110021 India
| | - Mansi Verma
- Department of Zoology, Hansraj College, University of Delhi, Delhi, 110007 India
| |
Collapse
|
37
|
Chary MA, Barbuto AF, Izadmehr S, Tarsillo M, Fleischer E, Burns MM. COVID-19 Therapeutics: Use, Mechanism of Action, and Toxicity (Xenobiotics). J Med Toxicol 2023; 19:26-36. [PMID: 36525217 PMCID: PMC9756926 DOI: 10.1007/s13181-022-00918-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 11/12/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022] Open
Abstract
SARS-CoV-2 emerged in 2019 and led to the COVID-19 pandemic. Efforts to develop therapeutics against SARS-Cov-2 led to both new treatments and attempts to repurpose existing medications. Here, we provide a narrative review of the xenobiotics and alternative remedies used or proposed to treat COVID-19. Most repositioned xenobiotics have had neither the feared toxicity nor the anticipated efficacy. Repurposed viral replication inhibitors are not efficacious and frequently associated with nausea, vomiting, and diarrhea. Antiviral medications designed specifically against SARS-CoV-2 may prevent progression to severe disease in at-risk individuals and appear to have a wide therapeutic index. Colloidal silver, zinc, and ivermectin have no demonstrated efficacy. Ivermectin has a wide therapeutic index but is not efficacious and acquiring it from veterinary sources poses additional danger. Chloroquine has a narrow therapeutic index and no efficacy. A companion review covers vaccines, monoclonal antibodies, and immunotherapies. Together, these two reviews form an update to our 2020 review.
Collapse
Affiliation(s)
- Michael A Chary
- Division of Medical Toxicology, Department of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA.
- Regional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island, Boston, MA, USA.
- Division of Medical Toxicology, Department of Emergency Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Alexander F Barbuto
- Division of Medical Toxicology, Department of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
- Regional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island, Boston, MA, USA
- Department of Emergency Medicine, Carl R. Darnall Army Medical Center, Fort Hood, TX, USA
| | - Sudeh Izadmehr
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marc Tarsillo
- Division of Medical Toxicology, Department of Emergency Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Eduardo Fleischer
- Division of Medical Toxicology, Department of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Michele M Burns
- Division of Medical Toxicology, Department of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
- Regional Center for Poison Control and Prevention Serving Massachusetts and Rhode Island, Boston, MA, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|
38
|
Ho M, Tadrous M, Iacono A, Suda K, Gomes T. Outpatient purchasing patterns of hydroxychloroquine and ivermectin in the USA and Canada during the COVID-19 pandemic: an interrupted time series analysis from 2016 to 2021. J Antimicrob Chemother 2022; 78:242-251. [PMID: 36374569 PMCID: PMC10132323 DOI: 10.1093/jac/dkac382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hydroxychloroquine and ivermectin received widespread attention after initial studies suggested that they were effective against COVID-19. However, several of these studies were later discredited. OBJECTIVES We explored the impact of scientific articles, public announcements and social media posts on hydroxychloroquine and ivermectin purchases in the USA and Canada during the COVID-19 pandemic. METHODS We conducted a retrospective, population-based time series analysis of retail hydroxychloroquine and ivermectin purchases in the USA and Canada from February 2016 through to December 2021, using IQVIA's Multinational Integrated Data Analysis database. We fitted the purchasing rates with interventional autoregressive integrated moving average models. We used Google Trends to identify the most influential interventions to include in the models. RESULTS There were significant pulse increases in hydroxychloroquine purchases in March 2020 in both the USA (P < 0.0001) and Canada (P < 0.0001). For ivermectin, there were no significant changes in April 2020 in either the USA (P = 0.41) or Canada (P = 0.16); however, significant pulse increases occurred from December 2020 to January 2021 in both the USA (P = 0.0006) and Canada (P < 0.0001), as well as significant ramp increases from April to August 2021 in both the USA (P < 0.0001) and Canada (P = 0.02). The increases in ivermectin purchases were larger in the USA than in Canada. CONCLUSIONS Increases in hydroxychloroquine and ivermectin purchasing rates aligned with controversial scientific articles and social media posts. This highlights the importance of scientific integrity and disseminating accurate epidemiologic information during pandemics.
Collapse
Affiliation(s)
- Martin Ho
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Anita Iacono
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Katie Suda
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Tara Gomes
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
39
|
Lei S, Chen X, Wu J, Duan X, Men K. Small molecules in the treatment of COVID-19. Signal Transduct Target Ther 2022; 7:387. [PMID: 36464706 PMCID: PMC9719906 DOI: 10.1038/s41392-022-01249-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/02/2022] [Accepted: 11/08/2022] [Indexed: 12/11/2022] Open
Abstract
The outbreak of COVID-19 has become a global crisis, and brought severe disruptions to societies and economies. Until now, effective therapeutics against COVID-19 are in high demand. Along with our improved understanding of the structure, function, and pathogenic process of SARS-CoV-2, many small molecules with potential anti-COVID-19 effects have been developed. So far, several antiviral strategies were explored. Besides directly inhibition of viral proteins such as RdRp and Mpro, interference of host enzymes including ACE2 and proteases, and blocking relevant immunoregulatory pathways represented by JAK/STAT, BTK, NF-κB, and NLRP3 pathways, are regarded feasible in drug development. The development of small molecules to treat COVID-19 has been achieved by several strategies, including computer-aided lead compound design and screening, natural product discovery, drug repurposing, and combination therapy. Several small molecules representative by remdesivir and paxlovid have been proved or authorized emergency use in many countries. And many candidates have entered clinical-trial stage. Nevertheless, due to the epidemiological features and variability issues of SARS-CoV-2, it is necessary to continue exploring novel strategies against COVID-19. This review discusses the current findings in the development of small molecules for COVID-19 treatment. Moreover, their detailed mechanism of action, chemical structures, and preclinical and clinical efficacies are discussed.
Collapse
Affiliation(s)
- Sibei Lei
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Xiaohua Chen
- Department of Pharmacy, Personalized Drug Therapy Key Laboratory of Sichuan Province Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Jieping Wu
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Xingmei Duan
- Department of Pharmacy, Personalized Drug Therapy Key Laboratory of Sichuan Province Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610072, China.
| | - Ke Men
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
| |
Collapse
|
40
|
Alkhemeiri A, Al Zaabi S, Lakshmanan J, El-Khatib Z, Awofeso N. COVID-19 Case Management Outcomes Amongst Diabetes and Hypertensive Patients in the United Arab Emirates: A Prospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15967. [PMID: 36498037 PMCID: PMC9738357 DOI: 10.3390/ijerph192315967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
The global pandemic of the novel Coronavirus infection 2019 (COVID-19) challenged the care of comorbid patients. The risk imposed by COVID-19 on diabetes patients is multisystemic, exponential, and involves glucose dysregulation. The increased burden for diabetes patients infected with COVID-19 is substantial in countries with a high prevalence of diabetics, such as the United Arab Emirates (UAE). This study aims to explore the prevalence of diabetes, clinical characteristic, and outcomes of patients admitted for COVID-19 treatment with or without a concurrent preadmission diagnosis of diabetes. A prospective study was performed on 1199 adults admitted with confirmed COVID-19 from December 2020 to April 2021 to a single hospital in the UAE. The study compared the demographics, clinical characteristics, and outcomes in COVID-19-infected patients with diabetes to patients without diabetes. The study endpoints include the development of new-onset diabetes, admission to ICU, trends in the blood glucose levels, and death. A total of 1199 patients (390 with diabetes) were included in the study. A diabetes prevalence was detected among 9.8% of the study population. Among the diabetes group, 10.8% were morbidly obese, 65.4% had associated hypertension, and 18.9% had coronary artery disease. Diabetes patients showed higher rates of ICU admission (11.1% vs. 7.1%), NIV requirement (9.6% vs. 6.4%), and intubation (5.45% vs. 2%) compared to the non-diabetes group. Advanced age was a predictor of a worsening COVID-19 course, while diabetes (p < 0.050) and hypertension (p < 0.025) were significant predictors of death from COVID-19. Nearly three-fourths (284 (73.4%)) of the diabetic patients developed worsened hyperglycemia as compared to one-fifth (171 (20.9%)) of the nondiabetic patients. New-onset diabetes was detected in 9.8% of COVID-19 patients. COVID-19 severity is higher in the presence of diabetes and is associated with worsening hyperglycemia and poor clinical outcomes. Preexisting hypertension is a predictor of COVID-19 severity and death.
Collapse
Affiliation(s)
- Aysha Alkhemeiri
- Department of Medicine, Tawam Hospital, Abu Dhabi P.O. Box 15258, United Arab Emirates
| | - Shaikha Al Zaabi
- Internal Medicine Department, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai P.O. Box 505055, United Arab Emirates
| | - Jeyaseelan Lakshmanan
- Biostatistics Department, Mohammed Bin Rashed University of Medicine and Health Sciences, Dubai P.O. Box 505055, United Arab Emirates
| | - Ziad El-Khatib
- Department of Global Public Health, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Niyi Awofeso
- School of Health and Environmental Studies, Hamdan Bin Muhammed Smart University, Dubai P.O. Box 71400, United Arab Emirates
| |
Collapse
|
41
|
Walunj SB, Wang C, Wagstaff KM, Patankar S, Jans DA. Conservation of Importin α Function in Apicomplexans: Ivermectin and GW5074 Target Plasmodium falciparum Importin α and Inhibit Parasite Growth in Culture. Int J Mol Sci 2022; 23:ijms232213899. [PMID: 36430384 PMCID: PMC9695642 DOI: 10.3390/ijms232213899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
Signal-dependent transport into and out of the nucleus mediated by members of the importin (IMP) superfamily of nuclear transporters is critical to the eukaryotic function and a point of therapeutic intervention with the potential to limit disease progression and pathogenic outcomes. Although the apicomplexan parasites Plasmodium falciparum and Toxoplasma gondii both retain unique IMPα genes that are essential, a detailed analysis of their properties has not been performed. As a first step to validate apicomplexan IMPα as a target, we set out to compare the properties of P. falciparum and T. gondii IMPα (PfIMPα and TgIMPα, respectively) to those of mammalian IMPα, as exemplified by Mus musculus IMPα (MmIMPα). Close similarities were evident, with all three showing high-affinity binding to modular nuclear localisation signals (NLSs) from apicomplexans as well as Simian virus SV40 large tumour antigen (T-ag). PfIMPα and TgIMPα were also capable of binding to mammalian IMPβ1 (MmIMPβ1) with high affinity; strikingly, NLS binding by PfIMPα and TgIMPα could be inhibited by the mammalian IMPα targeting small molecules ivermectin and GW5074 through direct binding to PfIMPα and TgIMPα to perturb the α-helical structure. Importantly, GW5074 could be shown for the first time to resemble ivermectin in being able to limit growth of P. falciparum. The results confirm apicomplexan IMPα as a viable target for the development of therapeutics, with agents targeting it worthy of further consideration as an antimalarial.
Collapse
Affiliation(s)
- Sujata B. Walunj
- Molecular Parasitology Lab., Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Powai, Mumbai 400076, India
- Nuclear Signalling Lab., Department of Biochemistry and Molecular Biology, Monash Biomedicine Discovery Institute, Monash University, Monash, VIC 3800, Australia
| | - Chunxiao Wang
- Nuclear Signalling Lab., Department of Biochemistry and Molecular Biology, Monash Biomedicine Discovery Institute, Monash University, Monash, VIC 3800, Australia
| | - Kylie M. Wagstaff
- Nuclear Signalling Lab., Department of Biochemistry and Molecular Biology, Monash Biomedicine Discovery Institute, Monash University, Monash, VIC 3800, Australia
| | - Swati Patankar
- Molecular Parasitology Lab., Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Powai, Mumbai 400076, India
| | - David A. Jans
- Nuclear Signalling Lab., Department of Biochemistry and Molecular Biology, Monash Biomedicine Discovery Institute, Monash University, Monash, VIC 3800, Australia
- Correspondence:
| |
Collapse
|
42
|
Ivermectin for COVID-19: The 2022 Update. Am J Ther 2022; 29:e647-e648. [PMID: 36608065 DOI: 10.1097/mjt.0000000000001577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
43
|
Boussageon R, Blanchard C, Charuel E, Menini T, Pereira B, Naudet F, Kassai B, Gueyffier F, Cucherat M, Vaillant-Roussel H. Project rebuild the evidence base (REB): A method to interpret randomised clinical trials and their meta-analysis to present solid benefit-risk assessments to patients. Therapie 2022:S0040-5957(22)00177-9. [PMID: 36371260 DOI: 10.1016/j.therap.2022.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 09/16/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022]
Abstract
Evidence-based medicine is the cornerstone of shared-decision making in healthcare today. The public deserves clear, transparent and trust-worthy information on drug efficacy. Yet today, many drugs are prescribed and used without solid evidence of efficacy. Clinical trials and randomised clinical trials (RCTs) are the best method to evaluate drug efficacy and side effects. In a shared medical decision-making approach, general practitioners need drug assessment based on patient-important outcomes. The aim of project rebuild the evidence base (REB) is to bridge the gap between the data needed in clinical practice and the data available from clinical research. The drugs will be assessed on clinical patient important outcomes and for a population. Using the Cochrane tools, we propose to analyse for each population and outcome: 1) a meta-analysis based on RCTs with a low risk of bias overall; 2) an evaluation of results of confirmatory RCTs; 3) a statistical analysis of heterrogeneity between RCTs and 4) an analysis of publication bias. Depending on the results of these analyses, the evidence will be categorized in 4 different levels: firm evidence, evidence (to be confirmed), signal or absence of evidence. Project REB proposes a method for reading and interpreting RCTs and their meta-analysis to produce quality data for general practitioners to focus on risk-benefit assessment in the interest of patients. If this data does not exist, it could enable clinical research to better its aim.
Collapse
|
44
|
Boretti A. Steroids Induced Black Fungus Infection in India During the May 2021 COVID-19 Outbreak. Indian J Otolaryngol Head Neck Surg 2022; 74:3216-3219. [PMID: 34804906 PMCID: PMC8592068 DOI: 10.1007/s12070-021-02988-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/08/2021] [Indexed: 11/11/2022] Open
Abstract
India was at the center of the attention of global media for the outbreak of COVID-19 infection in May 2021, because of the large total number of daily new cases and fatalities not expressed as a fraction of the total population. In addition to the alleged more infective and fatal variant delta, the emergence of particularly lethal fungal infections in between those that have been infected was also reported. Here we comment as while the specific numbers for India, for both new cases and fatalities, were everything but dramatic, with other countries such as the United Kingdom has experienced much worse outcomes, the incidence of black fungus minimally affected the COVID-19 fatalities. First better care, and the use of intravenous antifungals, and then the use of better therapies in the early stages of infection to prevent more serious outcomes, reduced the burden of this fungal infection.
Collapse
Affiliation(s)
- Alberto Boretti
- Deanship of Research, Prince Mohammad Bin Fahd University, P.O. Box 1664, Al Khobar, 31952 Kingdom of Saudi Arabia
| |
Collapse
|
45
|
Ogunleye OO, Godman B, Fadare JO, Mudenda S, Adeoti AO, Yinka-Ogunleye AF, Ogundele SO, Oyawole MR, Schönfeldt M, Rashed WM, Galal AM, Masuka N, Zaranyika T, Kalungia AC, Malande OO, Kibuule D, Massele A, Chikowe I, Khuluza F, Taruvinga T, Alfadl A, Malik E, Oluka M, Opanga S, Ankrah DNA, Sefah IA, Afriyie D, Tagoe ET, Amu AA, Msibi MP, Etando A, Alabi ME, Okwen P, Niba LL, Mwita JC, Rwegerera GM, Kgatlwane J, Jairoun AA, Ejekam C, Mavenyengwa RT, Murimi-Worstell I, Campbell SM, Meyer JC. Coronavirus Disease 2019 (COVID-19) Pandemic across Africa: Current Status of Vaccinations and Implications for the Future. Vaccines (Basel) 2022; 10:1553. [PMID: 36146631 PMCID: PMC9504201 DOI: 10.3390/vaccines10091553] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/06/2022] [Accepted: 09/10/2022] [Indexed: 12/15/2022] Open
Abstract
The introduction of effective vaccines in December 2020 marked a significant step forward in the global response to COVID-19. Given concerns with access, acceptability, and hesitancy across Africa, there is a need to describe the current status of vaccine uptake in the continent. An exploratory study was undertaken to investigate these aspects, current challenges, and lessons learnt across Africa to provide future direction. Senior personnel across 14 African countries completed a self-administered questionnaire, with a descriptive analysis of the data. Vaccine roll-out commenced in March 2021 in most countries. COVID-19 vaccination coverage varied from low in Cameroon and Tanzania and up to 39.85% full coverage in Botswana at the end of 2021; that is, all doses advocated by initial protocols versus the total population, with rates increasing to 58.4% in Botswana by the end of June 2022. The greatest increase in people being fully vaccinated was observed in Uganda (20.4% increase), Botswana (18.5% increase), and Zambia (17.9% increase). Most vaccines were obtained through WHO-COVAX agreements. Initially, vaccination was prioritised for healthcare workers (HCWs), the elderly, adults with co-morbidities, and other at-risk groups, with countries now commencing vaccination among children and administering booster doses. Challenges included irregular supply and considerable hesitancy arising from misinformation fuelled by social media activities. Overall, there was fair to reasonable access to vaccination across countries, enhanced by government initiatives. Vaccine hesitancy must be addressed with context-specific interventions, including proactive programmes among HCWs, medical journalists, and the public.
Collapse
Affiliation(s)
- Olayinka O. Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Lagos 100271, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Lagos 100271, Nigeria
| | - Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 02084, South Africa
| | - Joseph O. Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado Ekiti 362103, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado Ekiti 360211, Nigeria
| | - Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka P.O. Box 32379, Zambia
| | - Adekunle O. Adeoti
- Department of Medicine, Ekiti State University Teaching Hospital, Ado Ekiti 360211, Nigeria
| | | | - Sunday O. Ogundele
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Lagos 100271, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Lagos 100271, Nigeria
| | - Modupe R. Oyawole
- Department of Pharmacy, Lagos State University Teaching Hospital, Lagos 100271, Nigeria
| | - Marione Schönfeldt
- Child, Youth and School Health Directorate, National Department of Health, Pretoria 0083, South Africa
| | - Wafaa M. Rashed
- Children’s Cancer Hospital, Egypt-57357 (CCHE-57357), Cairo 11441, Egypt
| | - Ahmad M. Galal
- Biomedical Research Department, Armed Forces College of Medicine, Cairo 11774, Egypt
| | - Nyasha Masuka
- CIMAS, Cimas House, Borrowdale Office Park, Borrowdale Road, Harare P.O. Box 1243, Zimbabwe
| | - Trust Zaranyika
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare P.O. Box MP167, Zimbabwe
| | - Aubrey C. Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka P.O. Box 50110, Zambia
| | - Oliver O. Malande
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 02084, South Africa
- Department of Child Health and Paediatrics, Egerton University, Nakuru P.O.Box 536, Kenya
- East Africa Centre for Vaccines and Immunization (ECAVI), Namela House, Naguru, Kampala P.O. Box 3040, Uganda
| | - Dan Kibuule
- Department of Pharmacology & Therapeutics, Busitema University, Mbale P.O. Box 236, Uganda
| | - Amos Massele
- Department of Clinical Pharmacology and Therapeutics, Hurbert Kairuki Memorial University, 70 Chwaku Road Mikocheni, Dar Es Salaam P.O. Box 65300, Tanzania
| | - Ibrahim Chikowe
- Pharmacy Department, Formerly College of Medicine, Kamuzu University of Health Sciences (KUHeS), Blantyre P.O. Box 278, Malawi
| | - Felix Khuluza
- Pharmacy Department, Formerly College of Medicine, Kamuzu University of Health Sciences (KUHeS), Blantyre P.O. Box 278, Malawi
| | - Tinotenda Taruvinga
- Department of Global Health and Development (GHD), London School of Hygiene and Tropical Medicine (LSHTM), London WC1E 7TH, UK
| | - Abubakr Alfadl
- National Medicines and Poisons Board, Federal Ministry of Health, Khartoum P.O. Box 303, Sudan
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah 51911, Saudi Arabia
| | - Elfatih Malik
- Department of Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum 11111, Sudan
| | - Margaret Oluka
- Department of Pharmacology & Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi P.O. Box 19676-00202, Kenya
| | - Sylvia Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi P.O. Box 19676-00202, Kenya
| | - Daniel N. A. Ankrah
- Department of Pharmacy, Korle Bu Teaching Hospital, Accra P.O. Box 77, Ghana
| | - Israel A. Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Hohoe PMB 31, Ghana
| | - Daniel Afriyie
- Pharmacy Department, Ghana Police Hospital, Accra P.O. Box CT104, Ghana
| | - Eunice T. Tagoe
- Department of Management Science, University of Strathclyde, Glasgow G4 0QU, UK
| | - Adefolarin A. Amu
- Pharmacy Department, Eswatini Medical Christian University, P.O. Box A624, Swazi Plaza, Mbabane H100, Eswatini
| | - Mlungisi P. Msibi
- Faculty of Health Sciences, Department of Medical Laboratory Sciences, Eswatini Medical Christian University, Swazi Plaza P.O. Box A624, Mbabane H100, Eswatini
| | - Ayukafangha Etando
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, Eswatini Medical Christian University, Swazi Plaza P.O. Box A624, Mbabane H100, Eswatini
| | - Mobolaji E. Alabi
- School of Pharmaceutical Sciences, College of Health Sciences, University of Kwazulu-natal (UKZN), Durban 4001, South Africa
| | - Patrick Okwen
- Effective Basic Services (eBASE) Africa, Ndamukong Street, Bamenda 5175, Cameroon
- Faculty of Health and Medical Sciences, Adelaide University, Adelaide 5005, Australia
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Ndamukong Street, Bamenda 5175, Cameroon
- Department of Public Health, University of Bamenda, Bambili P.O. Box 39, Cameroon
| | - Julius C. Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone P.O. Box 70480, Botswana
| | - Godfrey M. Rwegerera
- Department of Medicine, Sir Ketumile Masire Teaching Hospital, Gaborone P.O. Box 70480, Botswana
| | - Joyce Kgatlwane
- Department of Pharmacy, University of Botswana, Gaborone P.O. Box 70480, Botswana
| | - Ammar A. Jairoun
- Health and Safety Department, Dubai Municipality, Dubai P.O. Box 67, United Arab Emirates
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Chioma Ejekam
- Department of Community Health, Lagos University Teaching Hospital, Idi-Araba, Lagos PMB 21266, Nigeria
| | - Rooyen T. Mavenyengwa
- Medical Microbiology Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare P.O. Box MP167, Zimbabwe
| | - Irene Murimi-Worstell
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences, Boston, MA 02115, USA
| | - Stephen M. Campbell
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 02084, South Africa
- Centre for Epidemiology and Public Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Johanna C. Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 02084, South Africa
| |
Collapse
|
46
|
Castillejos-López M, Torres-Espíndola LM, Huerta-Cruz JC, Flores-Soto E, Romero-Martinez BS, Velázquez-Cruz R, Higuera-Iglesias A, Camarena Á, Torres-Soria AK, Salinas-Lara C, Fernández-Plata R, Alvarado-Vásquez N, Solís-Chagoyán H, Ruiz V, Aquino-Gálvez A. Ivermectin: A Controversial Focal Point during the COVID-19 Pandemic. Life (Basel) 2022; 12:1384. [PMID: 36143420 PMCID: PMC9502658 DOI: 10.3390/life12091384] [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: 08/03/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 01/08/2023] Open
Abstract
The SARS-CoV-2 pandemic has confirmed the apocalyptic predictions that virologists have been making for several decades. The challenge the world is facing is that of trying to find a possible treatment, and a viable and expedient option for addressing this challenge is the repurposing of drugs. However, in some cases, although these drugs are approved for use in humans, the mechanisms of action involved are unknown. In this sense, to justify its therapeutic application to a new disease, it is ideal, but not necessary, to know the basic mechanisms of action involved in a drug's biological effects. This review compiled the available information regarding the various effects attributed to Ivermectin. The controversy over its use for the treatment of COVID-19 is demonstrated by this report that considers the proposal unfeasible because the therapeutic doses proposed to achieve this effect cannot be achieved. However, due to the urgent need to find a treatment, an exhaustive and impartial review is necessary in order to integrate the knowledge that exists, to date, of the possible mechanisms through which the treatment may be helpful in defining safe doses and schedules of Ivermectin.
Collapse
Affiliation(s)
- Manuel Castillejos-López
- Departamento de Epidemiología y Estadística, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico
| | | | - Juan Carlos Huerta-Cruz
- Unidad de Investigación en Farmacología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City 14080, Mexico
| | - Edgar Flores-Soto
- Departamento de Farmacología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Bianca S. Romero-Martinez
- Departamento de Farmacología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Rafael Velázquez-Cruz
- Laboratorio de Genómica del Metabolismo Óseo, Instituto Nacional de Medicina Genómica, Mexico City 14610, Mexico
| | - Anjarath Higuera-Iglesias
- Departamento de Investigación en Epidemiología Clínica, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico
| | - Ángel Camarena
- Laboratorio de HLA, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico
| | - Ana Karen Torres-Soria
- Red MEDICI, Carrera de Médico Cirujano, Facultad de Estudios Superiores de Iztacala UNAM, Mexico City 54090, Mexico
| | - Citlaltepetl Salinas-Lara
- Red MEDICI, Carrera de Médico Cirujano, Facultad de Estudios Superiores de Iztacala UNAM, Mexico City 54090, Mexico
| | - Rosario Fernández-Plata
- Departamento de Epidemiología y Estadística, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico
| | - Noé Alvarado-Vásquez
- Departamento de Bioquímica, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City 14080, Mexico
| | - Héctor Solís-Chagoyán
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
| | - Víctor Ruiz
- Laboratorio de Biología Molecular, Departamento de Fibrosis Pulmonar, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico
| | - Arnoldo Aquino-Gálvez
- Laboratorio de Biología Molecular, Departamento de Fibrosis Pulmonar, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico
| |
Collapse
|
47
|
Biber A, Harmelin G, Lev D, Ram L, Shaham A, Nemet I, Kliker L, Erster O, Mandelboim M, Schwartz E. The effect of ivermectin on the viral load and culture viability in early treatment of nonhospitalized patients with mild COVID-19 - a double-blind, randomized placebo-controlled trial. Int J Infect Dis 2022; 122:733-740. [PMID: 35811080 PMCID: PMC9262706 DOI: 10.1016/j.ijid.2022.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/19/2022] [Accepted: 07/02/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES Ivermectin, an antiparasitic agent, also has antiviral properties. In this study, we aimed to assess whether ivermectin has anti-SARS-CoV-2 activity. METHODS In this double-blinded trial, we compared patients receiving ivermectin for 3 days versus placebo in nonhospitalized adult patients with COVID-19. A reverse transcriptase-polymerase chain reaction from a nasopharyngeal swab was obtained at recruitment and every 2 days for at least 6 days. The primary endpoint was a reduction of viral load on the sixth day as reflected by cycle threshold level >30 (noninfectious level). The primary outcome was supported by the determination of viral-culture viability. RESULTS Of 867 patients screened, 89 were ultimately evaluated per-protocol (47 ivermectin and 42 placeboes). On day 6, the odds ratio (OR) was 2.62 (95% confidence interval [CI]: 1.09-6.31) in the ivermectin arm, reaching the endpoint. In a multivariable logistic regression model, the odds of a negative test on day 6 were 2.28 times higher in the ivermectin group but reached significance only on day 8 (OR 3.70; 95% CI: 1.19-11.49, P = 0.02). Culture viability on days 2 to 6 was positive in 13.0% (3/23) of ivermectin samples versus 48.2% (14/29) in the placebo group (P = 0.008). CONCLUSION There were lower viral loads and less viable cultures in the ivermectin group, which shows its anti-SARS-CoV-2 activity. It could reduce transmission in these patients and encourage further studies with this drug.
Collapse
Affiliation(s)
- Asaf Biber
- The Center for Geographic Medicine and Tropical Diseases, Sheba Medical Center, Ramat Gan, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Geva Harmelin
- Emergency Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Dana Lev
- The Center for Geographic Medicine and Tropical Diseases, Sheba Medical Center, Ramat Gan, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Li Ram
- Emergency Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Amit Shaham
- Emergency Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Ital Nemet
- Central Virology Laboratory, Ministry of Health, Ramat Gan, Israel
| | - Limor Kliker
- Central Virology Laboratory, Ministry of Health, Ramat Gan, Israel
| | - Oran Erster
- Central Virology Laboratory, Ministry of Health, Ramat Gan, Israel
| | - Michal Mandelboim
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Central Virology Laboratory, Ministry of Health, Ramat Gan, Israel
| | - Eli Schwartz
- The Center for Geographic Medicine and Tropical Diseases, Sheba Medical Center, Ramat Gan, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Corresponding author: Eli Schwartz, The Center for Geographic Medicine and Tropical Diseases, The Chaim Sheba Medical Center, Tel Hashomer 52621, Israel. Tel/Fax:+ 972-3-5308456
| |
Collapse
|
48
|
Alfaidi M, Zhang H, Oliveira SD. Fostering New Scientific Networks in the COVID Era and Beyond. Arterioscler Thromb Vasc Biol 2022; 42:1113-1120. [PMID: 35861068 PMCID: PMC9420830 DOI: 10.1161/atvbaha.122.317452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/08/2022] [Indexed: 11/16/2022]
Abstract
Over the last 2 years, the COVID-19 pandemic has stimulated the scientific community by starting a race to develop new vaccines and therapeutic approaches to fight this life-threatening illness. At the same time, the pandemic also evoked an urge for innovative communication strategies to maintain scientific networking and data sharing among investigators. Communication through audiovisual platforms has quickly become a unique tool to sustain scientific interaction, whereas social media has turned into an unmistakable pivotal environment for sharing scientific data and combating misinformation around SARS-CoV-2 infection, prevention, and therapy. Amid this challenging scenario, the scientific community organically established new roles, such as a social media ambassador, a conference-associated role to virtually promote breakthrough science while reconnecting investigators and forging new scientific networks via social media. Moreover, in response to the COVID-19 pandemic, it also became clear the critical need for the scientific community to support efforts to empower flexibility, creativity, and the inclusion of new forms of communication to advance science. Thus, the goal of this brief article is to provide a structured follow-up on the importance for researchers to occupy the internet to promote scientific findings and events, to combat science mistrust by stimulating communication among nonscientists to scientists, and to provide essential strategies for young and senior investigators on how to virtually expand their professional networks within and across research and clinical areas of the cardiovascular field.
Collapse
Affiliation(s)
- Mabruka Alfaidi
- Department of Internal Medicine, Division of Cardiology, Center for Cardiovascular Diseases and Sciences, LSU Health - Shreveport, LA (M.A.)
| | - Hanrui Zhang
- Cardiometabolic Genomics Program, Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York (H.Z.)
| | - Suellen D Oliveira
- College of Medicine, Department of Anesthesiology, University of Illinois at Chicago (S.D.O.)
| |
Collapse
|
49
|
Na-Bangchang K, Porasuphatana S, Karbwang J. Perspective: repurposed drugs for COVID-19. Arch Med Sci 2022; 18:1378-1391. [PMID: 36160358 PMCID: PMC9479713 DOI: 10.5114/aoms/152467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/28/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction The article aims to emphasize the necessity of proper research design, both scientifically and ethically, in order to provide good evidence for physicians to base their decisions on when prescribing drug treatment. Methods Research articles and guidelines related to therapy of COVID-19 were searched from the PubMed database. Results Only remdesivir and tocilizumab are medicines that have been approved by the US FDA's decision to approve their clinical use in moderate and severe COVID-19. Conclusions Favipiravir, ivermectin and andrographolide need further well-conducted research to confirm the efficacy and safety against COVID-19 at different stages.
Collapse
Affiliation(s)
- Kesara Na-Bangchang
- Drug Discovery and Development Center, Office of Advanced Science and Technology, Thammasat University, Pathumthani, Thailand
| | - Supatra Porasuphatana
- Department of Pharmacognosy and Toxicology, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Juntra Karbwang
- Drug Discovery and Development Center, Office of Advanced Science and Technology, Thammasat University, Pathumthani, Thailand
| |
Collapse
|
50
|
Manomaipiboon A, Pholtawornkulchai K, Poopipatpab S, Suraamornkul S, Maneerit J, Ruksakul W, Phumisantiphong U, Trakarnvanich T. Efficacy and safety of ivermectin in the treatment of mild to moderate COVID-19 infection: a randomized, double-blind, placebo-controlled trial. Trials 2022; 23:714. [PMID: 36028897 PMCID: PMC9412770 DOI: 10.1186/s13063-022-06649-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 08/07/2022] [Indexed: 12/23/2022] Open
Abstract
Background The emergent outbreak of coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has emphasized the requirement for therapeutic opportunities to overcome this pandemic. Ivermectin is an antiparasitic drug that has shown effectiveness against various agents, including SARS-CoV-2. This study aimed to assess the efficacy of ivermectin treatment compared with the standard of care (SOC) among people with mild to moderate COVID-19 symptoms. Methods In this randomized, double-blind, placebo-controlled, single-center, parallel-arm, superiority trial among adult hospitalized patients with mild to moderate COVID-19, 72 patients (mean age 48.57 ± 14.80 years) were randomly assigned to either the ivermectin (n=36) or placebo (n=36) group, along with receiving standard care. We aimed to compare the negativity of reverse transcription polymerase chain reaction (RT-PCR) result at days 7 and 14 of enrolment as the primary outcome. The secondary outcomes were duration of hospitalization, frequency of clinical worsening, survival on day 28, and adverse events. Results At days 7 and 14, no differences were observed in the proportion of PCR-positive patients (RR 0.97 at day 7 (p=0.759) and 0.95 at day 14 (p=0.813). No significant differences were found between the groups for any of the secondary endpoints, and no adverse events were reported. Conclusion No difference was found in the proportion of PCR-positive cases after treatment with ivermectin compared with standard care among patients with mild to moderate COVID-19 symptoms. However, early symptomatic recovery was observed without side effects. Trial registration ClinicalTrials.gov NCT05076253. Registered on 8 October 2021, prospectively. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06649-3.
Collapse
Affiliation(s)
- Anan Manomaipiboon
- Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | | | - Sujaree Poopipatpab
- Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | - Swangjit Suraamornkul
- Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | - Jakravoot Maneerit
- Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | - Wiroj Ruksakul
- Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand
| | | | - Thananda Trakarnvanich
- Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Dusit, Bangkok, Thailand.
| |
Collapse
|