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Yazar EE, Gunluoglu G, Arpinar Yigitbas B, Calikoglu M, Gulbas G, Yılmaz Demirci N, Sarioglu N, Bozkus F, Hoca NT, Ogan N, Tural Onur S, Turan MO, Kosar F, Akpinar EE, Mete B, Ozturk C. Can the ADO Index Be Used as a Predictor of Mortality from COVID-19 in Patients with COPD? Int J Chron Obstruct Pulmon Dis 2024; 19:851-858. [PMID: 38596202 PMCID: PMC11001538 DOI: 10.2147/copd.s440099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/20/2024] [Indexed: 04/11/2024] Open
Abstract
Background Several studies have shown that the risk of mortality due to COVID-19 is high in patients with COPD. However, evidence on factors predicting mortality is limited. Research Question Are there any useful markers to predict mortality in COVID-19 patients with COPD?. Study Design and Methods A total of 689 patients were included in this study from the COPET study, a national multicenter observational study investigating COPD phenotypes consisting of patients who were followed up with a spirometry-confirmed COPD diagnosis. Patients were also retrospectively examined in terms of COVID-19 and their outcomes. Results Among the study patients, 105 were diagnosed with PCR-positive COVID-19, and 19 of them died. Body mass index (p= 0.01) and ADO (age, dyspnoea, airflow obstruction) index (p= 0.01) were higher, whereas predicted FEV1 (p< 0.001) and eosinophil count (p= 0.003) were lower in patients who died of COVID-19. Each 0.755 unit increase in the ADO index increased the risk of death by 2.12 times, and each 0.007 unit increase in the eosinophil count decreased the risk of death by 1.007 times. The optimum cut-off ADO score of 3.5 was diagnostic with 94% sensitivity and 40% specificity in predicting mortality. Interpretation Our study suggested that the ADO index recorded in the stable period in patients with COPD makes a modest contribution to the prediction of mortality due to COVID-19. Further studies are needed to validate the use of the ADO index in estimating mortality in both COVID-19 and other viral respiratory infections in patients with COPD.
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Affiliation(s)
- Esra Ertan Yazar
- Department of Chest Diseases, Istanbul Medeniyet University, Medical Faculty, Istanbul, Turkey
| | - Gulsah Gunluoglu
- Department of Chest Diseases, Yedikule Chest Disease and Chest Surgery Research and Training Hospital, Istanbul, Turkey
| | - Burcu Arpinar Yigitbas
- Department of Chest Diseases, Istanbul Medeniyet University, Medical Faculty, Istanbul, Turkey
| | - Mukadder Calikoglu
- Department of Chest Diseases, Mersin University, Medical Faculty, Mersin, Turkey
| | - Gazi Gulbas
- Department of Chest Diseases, Inonu University, Medical Faculty, Malatya, Turkey
| | | | - Nurhan Sarioglu
- Department of Chest Diseases, Balikesir University, Medical Faculty, Balikesir, Turkey
| | - Fulsen Bozkus
- Department of Chest Diseases, Kahramanmaras Sutcu Imam University, Medical Faculty, Kahramanmaras, Turkey
| | - Nevin Taci Hoca
- Department of Chest Diseases, Gazi University, Medical Faculty, Ankara, Turkey
| | - Nalan Ogan
- Department of Chest Diseases, Ufuk University, Medical Faculty, Ankara, Turkey
| | - Seda Tural Onur
- Department of Chest Diseases, Yedikule Chest Disease and Chest Surgery Research and Training Hospital, Istanbul, Turkey
| | - Muzaffer Onur Turan
- Department of Chest Diseases, Prof Dr, Izmir Katip Celebi University, Atatürk Research and Training Hospital, Izmir, Turkey
| | - Filiz Kosar
- Department of Chest Diseases, Yedikule Chest Disease and Chest Surgery Research and Training Hospital, Istanbul, Turkey
| | - Evrim Eylem Akpinar
- Department of Chest Diseases, Ufuk University, Medical Faculty, Ankara, Turkey
| | - Burak Mete
- Department of Public Health Çukurova University, Medical Faculty, Adana, Turkey
| | - Can Ozturk
- Department of Chest Diseases, Gazi University, Medical Faculty, Ankara, Turkey
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Khalifa HO, Al Ramahi YM. After the Hurricane: Anti-COVID-19 Drugs Development, Molecular Mechanisms of Action and Future Perspectives. Int J Mol Sci 2024; 25:739. [PMID: 38255813 PMCID: PMC10815681 DOI: 10.3390/ijms25020739] [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] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024] Open
Abstract
Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is a new coronavirus in the Coronaviridae family. The COVID-19 pandemic, caused by SARS-CoV-2, has undoubtedly been the largest crisis of the twenty-first century, resulting in over 6.8 million deaths and 686 million confirmed cases, creating a global public health issue. Hundreds of notable articles have been published since the onset of this pandemic to justify the cause of viral spread, viable preventive measures, and future therapeutic approaches. As a result, this review was developed to provide a summary of the current anti-COVID-19 drugs, as well as their timeline, molecular mode of action, and efficacy. It also sheds light on potential future treatment options. Several medications, notably hydroxychloroquine and lopinavir/ritonavir, were initially claimed to be effective in the treatment of SARS-CoV-2 but eventually demonstrated inadequate activity, and the Food and Drug Administration (FDA) withdrew hydroxychloroquine. Clinical trials and investigations, on the other hand, have demonstrated the efficacy of remdesivir, convalescent plasma, and monoclonal antibodies, 6-Thioguanine, hepatitis C protease inhibitors, and molnupiravir. Other therapeutics, including inhaled medicines, flavonoids, and aptamers, could pave the way for the creation of novel anti-COVID-19 therapies. As future pandemics are unavoidable, this article urges immediate action and extensive research efforts to develop potent specialized anti-COVID-19 medications.
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Affiliation(s)
- Hazim O. Khalifa
- Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, United Arab Emirates University, Al Ain P.O. Box 1555, United Arab Emirates;
- Department of Pharmacology, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafrelsheikh 33516, Egypt
| | - Yousef M. Al Ramahi
- Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, United Arab Emirates University, Al Ain P.O. Box 1555, United Arab Emirates;
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Al Sulaiman K, Aljuhani O, Korayem GB, Altebainawi A, Alharbi R, Assadoon M, Vishwakarma R, Ismail NH, Alshehri AA, Al Mutairi FE, AlFaifi M, Alharthi AF, Alenazi AA, Alalawi M, Al Zumai O, Al Haji H, Al Dughaish ST, Alawaji AS, Alhaidal HA, Al Ghamdi G. Evaluation of the use of methylprednisolone and dexamethasone in asthma critically ill patients with COVID-19: a multicenter cohort study. BMC Pulm Med 2023; 23:315. [PMID: 37641042 PMCID: PMC10463591 DOI: 10.1186/s12890-023-02603-4] [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: 05/13/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Previous studies have shown mortality benefits with corticosteroids in Coronavirus disease-19 (COVID-19). However, there is inconsistency regarding the use of methylprednisolone over dexamethasone in COVID-19, and this has not been extensively evaluated in patients with a history of asthma. This study aims to investigate and compare the effectiveness and safety of methylprednisolone and dexamethasone in critically ill patients with asthma and COVID-19. METHODS The primary endpoint was the in-hospital mortality. Other endpoints include 30-day mortality, respiratory failure requiring mechanical ventilation (MV), acute kidney injury (AKI), acute liver injury, length of stay (LOS), ventilator-free days (VFDs), and hospital-acquired infections. Propensity score (PS) matching, and regression analyses were used. RESULTS A total of one hundred-five patients were included. Thirty patients received methylprednisolone, whereas seventy-five patients received dexamethasone. After PS matching (1:1 ratio), patients who received methylprednisolone had higher but insignificant in-hospital mortality in both crude and logistic regression analysis, [(35.0% vs. 18.2%, P = 0.22) and (OR 2.31; CI: 0.56 - 9.59; P = 0.25), respectively]. There were no statistically significant differences in the 30-day mortality, respiratory failure requiring MV, AKI, acute liver injury, ICU LOS, hospital LOS, and hospital-acquired infections. CONCLUSIONS Methylprednisolone in COVID-19 patients with asthma may lead to increased in-hospital mortality and shorter VFDs compared to dexamethasone; however, it failed to reach statistical significance. Therefore, it is necessary to interpret these data cautiously, and further large-scale randomized clinical trials are needed to establish more conclusive evidence and support these conclusions.
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Affiliation(s)
- Khalid Al Sulaiman
- Pharmaceutical Care Department, King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia.
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia.
- King Abdullah International Medical Research Center (KAIMRC), KSAU-HS, PO Box 22490, Riyadh, 11426, Saudi Arabia.
- Saudi Critical Care Pharmacy Research (SCAPE) Platform, Riyadh, Saudi Arabia.
| | - Ohoud Aljuhani
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ghazwa B Korayem
- Department of Pharmacy Practice, Princess Nourah bint Abdulrahman University, Riyadh, P.O.Box 84428, 11671, Saudi Arabia
| | - Ali Altebainawi
- Pharmaceutical Care Services, King Khalid Hospital, Hail, Saudi Arabia
| | - Reham Alharbi
- College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Maha Assadoon
- Pharmaceutical Care Department, King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia
| | | | - Nadia H Ismail
- King Fahad Hospital of the University, AL-Khobar, Saudi Arabia
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Asma A Alshehri
- Pharmaceutical Care Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Faisal E Al Mutairi
- Pharmaceutical Care Department, King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia
| | - Mashael AlFaifi
- Pharmaceutical Services Administration, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Abeer A Alenazi
- Pharmaceutical Care Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mai Alalawi
- Pharmaceutical Care Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Omar Al Zumai
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Respiratory Department Services, King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia
- College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Hussain Al Haji
- King Abdullah International Medical Research Center (KAIMRC), KSAU-HS, PO Box 22490, Riyadh, 11426, Saudi Arabia
- Respiratory Department Services, King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia
- College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Sarah T Al Dughaish
- Pharmaceutical Care Department, King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Abdulrahman S Alawaji
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Haifa A Alhaidal
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), KSAU-HS, PO Box 22490, Riyadh, 11426, Saudi Arabia
| | - Ghassan Al Ghamdi
- King Abdullah International Medical Research Center (KAIMRC), KSAU-HS, PO Box 22490, Riyadh, 11426, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Kuo KC, Chen CH, Wang CJ, Wu JC, Chung HP, Chen YT, Tang YH, Chang WK, Lin CY, Wu CL. Clinical benefits of inhaled ciclesonide for hospitalized patients with COVID-19 infection: a retrospective study. BMC Pulm Med 2022; 22:368. [PMID: 36171597 PMCID: PMC9517967 DOI: 10.1186/s12890-022-02168-8] [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: 04/28/2022] [Accepted: 09/20/2022] [Indexed: 01/08/2023] Open
Abstract
Background The successful management of patients infected with coronavirus disease 2019 (COVID-19) with inhaled ciclesonide has been reported, however few studies have investigated its application among hospitalized patients. Methods This retrospective cohort study enrolled all adult patients admitted to our hospital with confirmed COVID-19 infection from May to June 2021. Critical patients who received mechanical ventilation within 24 h after admission and those who started ciclesonide more than 14 days after symptom onset were excluded. The in-hospital mortality rate was compared between those who did and did not receive inhaled ciclesonide. Results A total of 269 patients were enrolled, of whom 184 received inhaled ciclesonide and 85 did not. The use of ciclesonide was associated with lower in-hospital mortality (7.6% vs. 23.5%, p = 0.0003) and a trend of shorter hospital stay (12.0 (10.0–18.0) days vs. 13.0 (10.0–25.3) days, p = 0.0577). In subgroup analysis, the use of inhaled ciclesonide significantly reduced mortality in the patients with severe COVID-19 infection (6.8% vs. 50.0%, p < 0.0001) and in those with a high risk of mortality (16.4% vs. 43.2%, p = 0.0037). The use of inhaled ciclesonide also reduced the likelihood of receiving mechanical ventilation in the patients with severe COVID-19 infection. After multivariate analysis, inhaled ciclesonide remained positively correlated with a lower risk of in-hospital mortality (odds ratio: 0.2724, 95% confidence interval: 0.087–0.8763, p = 0.0291). Conclusions The use of inhaled ciclesonide in hospitalized patients with COVID-19 infection can reduce in-hospital mortality. Further randomized studies in patients with moderate to severe COVID-19 infection are urgently needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02168-8.
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Affiliation(s)
- Kuan-Chih Kuo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, No. 45, Minsheng Rd., Tamshui District, New Taipei City, 25160, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chao-Hsien Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, No. 45, Minsheng Rd., Tamshui District, New Taipei City, 25160, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chieh-Jen Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, No. 45, Minsheng Rd., Tamshui District, New Taipei City, 25160, Taiwan. .,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
| | - Jou-Chun Wu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, No. 45, Minsheng Rd., Tamshui District, New Taipei City, 25160, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Hsin-Pei Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, No. 45, Minsheng Rd., Tamshui District, New Taipei City, 25160, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Yen-Ting Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, No. 45, Minsheng Rd., Tamshui District, New Taipei City, 25160, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Yen-Hsiang Tang
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.,Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Wen-Kuei Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, No. 45, Minsheng Rd., Tamshui District, New Taipei City, 25160, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chang-Yi Lin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, No. 45, Minsheng Rd., Tamshui District, New Taipei City, 25160, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chien-Liang Wu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, No. 45, Minsheng Rd., Tamshui District, New Taipei City, 25160, Taiwan
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Saha T, Quiñones-Mateu ME, Das SC. Inhaled therapy for COVID-19: Considerations of drugs, formulations and devices. Int J Pharm 2022; 624:122042. [PMID: 35868481 PMCID: PMC9296254 DOI: 10.1016/j.ijpharm.2022.122042] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/04/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiological agent responsible for the COVID-19 pandemic, has outspread at full tilt across the world. Although several effective vaccines continue to be deployed, reliable antiviral treatments have yet to be developed against this disease. Currently, available therapeutics for COVID-19 include repurposed, and a few novel drugs. Many drugs have been promising in preclinical studies, but a majority of these drugs have shown little or no efficacy in clinical studies. One of the major reasons is the insufficient drug concentration in the lung, the primary target site of infection for SARS-CoV-2, from the administration of drugs through oral or intravenous routes. Higher effective doses administered through these routes could also lead to adverse side effects. For this reason, inhaled treatments are being tested as an efficient approach for COVID-19, allowing lower doses of drugs ensuring higher concentrations of the drug(s) in the lung. The inhaled treatment combining two or more antiviral drugs will increase potency and reduce the possibility of selecting for SARS-CoV-2 variants with reduced drug susceptibility. Finally, the appropriate drug combination needs to be delivered using a suitable system. Here, we review the current treatment for COVID-19 and their limitations, discussing the advantages of mono and combinational inhaled therapy with a brief outline of the recently reformulated anti-SARS-CoV-2 agents as inhaled formulations. The selection of appropriate delivery devices for inhalation and associated key considerations including the formulation challenges are also discussed.
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Affiliation(s)
- Tushar Saha
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Miguel E Quiñones-Mateu
- Department of Microbiology and Immunology, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand; Webster Centre for Infectious Diseases, University of Otago, Dunedin, New Zealand
| | - Shyamal C Das
- School of Pharmacy, University of Otago, Dunedin, New Zealand.
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