1
|
Chen C, Fang J, Chen S, Rajaofera MJN, Li X, Wang B, Xia Q. The efficacy and safety of remdesivir alone and in combination with other drugs for the treatment of COVID-19: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:672. [PMID: 37814214 PMCID: PMC10563317 DOI: 10.1186/s12879-023-08525-0] [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: 10/10/2022] [Accepted: 08/09/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Remdesivir is considered to be a specific drug for treating coronavirus disease 2019. This systematic review aims to evaluate the clinical efficacy and risk of remdesivir alone and in combination with other drugs. RESEARCH DESIGN AND METHODS The PubMed, Embase, SCIE, Cochrane Library, and American Clinical trial Center databases were searched up to 1 April 2022 to identify. Randomized controlled trials (RCTs) and observational studies comparing the efficacy of remdesivir monotherapy and combination therapy with that of control drugs. RESULTS Ten RCTs and 32 observational studies were included in the analysis. Regarding the primary outcome, remdesivir use reduced mortality in patients with severe COVID-19 (RR = 0.57, 95% CI (0.48,0.68)) and shortened the time to clinical improvement (MD = -2.51, 95% CI (-2.75, -2.28)). Regarding other clinical outcomes, remdesivir use was associated with improved clinical status (RR = 1.08, 95%CI (1.01, 1.17)). Regarding safety outcomes, remdesivir use did not cause liver or kidney damage (RR = 0.87, 95%CI (0.68, 1.11)) (RR = 0.88, 95%CI (0.70,1.10)). Compared with remdesivir alone, remdesivir combined with other drugs (e.g., steroids, favipiravir, and convalescent plasma) had no effect on mortality. CONCLUSION The use of remdesivir can help to reduce the mortality of patients with severe COVID-19 and shorten the time to clinical improvement. There was no benefit of remdesivir combination therapy for other clinical outcomes. TRIAL REGISTRATION PROSPERO registration number: CRD42022322859.
Collapse
Affiliation(s)
- Chuizhe Chen
- Key Laboratory of Tropical Translational Medicine of Ministry of Education, NHC Key Laboratory of Tropical Disease Control, School of Tropical Medicine and The Second Affiliated Hospital, Hainan Medical University, Haikou, China
- Department of Pathology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Junde Fang
- Key Laboratory of Tropical Translational Medicine of Ministry of Education, NHC Key Laboratory of Tropical Disease Control, School of Tropical Medicine and The Second Affiliated Hospital, Hainan Medical University, Haikou, China
- The First Clinical College, Hainan Medical University, Haikou, China
| | - Shu Chen
- Department of Pathology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Mamy Jayne Nelly Rajaofera
- Key Laboratory of Tropical Translational Medicine of Ministry of Education, NHC Key Laboratory of Tropical Disease Control, School of Tropical Medicine and The Second Affiliated Hospital, Hainan Medical University, Haikou, China
| | - Xuemiao Li
- Key Laboratory of Tropical Translational Medicine of Ministry of Education, NHC Key Laboratory of Tropical Disease Control, School of Tropical Medicine and The Second Affiliated Hospital, Hainan Medical University, Haikou, China
| | - Bo Wang
- Department of Pathology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China.
| | - Qianfeng Xia
- Key Laboratory of Tropical Translational Medicine of Ministry of Education, NHC Key Laboratory of Tropical Disease Control, School of Tropical Medicine and The Second Affiliated Hospital, Hainan Medical University, Haikou, China.
| |
Collapse
|
2
|
Rzymski P, Pokorska-Śpiewak M, Jackowska T, Kuchar E, Nitsch-Osuch A, Pawłowska M, Babicki M, Jaroszewicz J, Szenborn L, Wysocki J, Flisiak R. Key Considerations during the Transition from the Acute Phase of the COVID-19 Pandemic: A Narrative Review. Vaccines (Basel) 2023; 11:1502. [PMID: 37766178 PMCID: PMC10537111 DOI: 10.3390/vaccines11091502] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
The COVID-19 pandemic has been met with an unprecedented response from the scientific community, leading to the development, investigation, and authorization of vaccines and antivirals, ultimately reducing the impact of SARS-CoV-2 on global public health. However, SARS-CoV-2 is far from being eradicated, continues to evolve, and causes substantial health and economic burdens. In this narrative review, we posit essential points on SARS-CoV-2 and its responsible management during the transition from the acute phase of the COVID-19 pandemic. As discussed, despite Omicron (sub)variant(s) causing clinically milder infections, SARS-CoV-2 is far from being a negligible pathogen. It requires continued genomic surveillance, particularly if one considers that its future (sub)lineages do not necessarily have to be milder. Antivirals and vaccines remain the essential elements in COVID-19 management. However, the former could benefit from further development and improvements in dosing, while the seasonal administration of the latter requires simplification to increase interest and tackle vaccine hesitancy. It is also essential to ensure the accessibility of COVID-19 pharmaceuticals and vaccines in low-income countries and improve the understanding of their use in the context of the long-term goals of SARS-CoV-2 management. Regardless of location, the primary role of COVID-19 awareness and education must be played by healthcare workers, who directly communicate with patients and serve as role models for healthy behaviors.
Collapse
Affiliation(s)
- Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806 Poznań, Poland
| | - Maria Pokorska-Śpiewak
- Department of Children’s Infectious Diseases, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Teresa Jackowska
- Department of Pediatrics, Centre for Postgraduate Medical Education, 01-813 Warsaw, Poland;
| | - Ernest Kuchar
- Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Aneta Nitsch-Osuch
- Department of Social Medicine and Public Health, Medical University of Warsaw, 02-007 Warsaw, Poland;
| | - Małgorzata Pawłowska
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland;
| | - Mateusz Babicki
- Department of Family Medicine, Wroclaw Medical University, 51-141 Wroclaw, Poland;
| | - Jerzy Jaroszewicz
- Department of Infectious Diseases and Hepatology, Medical University of Silesia, 41-902 Bytom, Poland;
| | - Leszek Szenborn
- Department of Pediatric Infectious Diseases, Wrocław Medical University, 50-367 Wroclaw, Poland;
| | - Jacek Wysocki
- Department of Preventive Medicine, Poznan University of Medical Sciences, 61-701 Poznań, Poland;
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15-089 Bialystok, Poland;
| |
Collapse
|
3
|
Kandula UR, Tuji TS, Gudeta DB, Bulbula KL, Mohammad AA, Wari KD, Abbas A. Effectiveness of COVID-19 Convalescent Plasma (CCP) During the Pandemic Era: A Literature Review. J Blood Med 2023; 14:159-187. [PMID: 36855559 PMCID: PMC9968437 DOI: 10.2147/jbm.s397722] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
Worldwide pandemic with coronavirus disease-2019 (COVID-19) was caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). As November 2, 2022, World Health Organization (WHO) received 628,035,553 reported incidents on COVID-19, with 6,572,800 mortalities and, with a total 12,850,970,971 vaccine doses have been delivered as of October 31, 2022. The infection can cause mild or self-limiting symptoms of pulmonary and severe infections or death may be caused by SARS-CoV-2 infection. Simultaneously, antivirals, corticosteroids, immunological treatments, antibiotics, and anticoagulants have been proposed as potential medicines to cure COVID-19 affected patients. Among these initial treatments, COVID-19 convalescent plasma (CCP), which was retrieved from COVID-19 recovered patients to be used as passive immune therapy, in which antibodies from cured patients were given to infected patients to prevent illness. Such treatment has yielded the best results in earlier with preventative or early stages of illness. Convalescent plasma (CP) is the first treatment available when infectious disease initially appears, although few randomized controlled trials (RCTs) were conducted to evaluate its effectiveness. The historical record suggests with potential benefit for other respiratory infections, as coronaviruses like Severe Acute Respiratory Syndrome-CoV-I (SARS-CoV-I) and Middle Eastern Respiratory Syndrome (MERS), though the analysis of such research is constrained by some non-randomized experiments (NREs). Rigorous studies on CP are made more demanding by the following with the immediacy of the epidemics, CP use may restrict the ability to utilize it for clinical testing, non-homogenous nature of product, highly decentralized manufacturing process; constraints with capacity to measure biologic function, ultimate availability of substitute therapies, as antivirals, purified immune globulins, or monoclonal antibodies. Though, it is still not clear how effectively CCP works among hospitalized COVID-19 patients. The current review tries to focus on its efficiency and usage in clinical scenarios and identifying existing benefits of implementation during pandemic or how it may assist with future pandemic preventions.
Collapse
Affiliation(s)
- Usha Rani Kandula
- Department of Nursing, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Techane Sisay Tuji
- Department of Nursing, College of Health Sciences, Arsi University, Asella, Ethiopia
| | | | - Kassech Leta Bulbula
- Department of Nursing, College of Health Sciences, Arsi University, Asella, Ethiopia
| | | | - Ketema Diriba Wari
- Department of Nursing, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Ahmad Abbas
- Department of Nursing, College of Health Sciences, Arsi University, Asella, Ethiopia
| |
Collapse
|
4
|
Fodor E, Müller V, Iványi Z, Berki T, Kuten Pella O, Hornyák I, Ambrus M, Sárkány Á, Skázel Á, Madár Á, Kardos D, Kemenesi G, Földes F, Nagy S, Matusovits A, János N, Tordai A, Jakab F, Lacza Z. Early Transfusion of Convalescent Plasma Improves the Clinical Outcome in Severe SARS-CoV2 Infection. Infect Dis Ther 2022; 11:293-304. [PMID: 34817840 PMCID: PMC8611245 DOI: 10.1007/s40121-021-00514-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/26/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Plasma harvested from convalescent COVID-19 patients (CCP) has been applied as first-line therapy in the early phase of the SARS-CoV2 pandemic through clinical studies using various protocols. METHODS We present data from a cohort of 267 hospitalized severe COVID-19 patients who received CCP. No transfusion-related complications were reported, indicating the overall safety of CCP therapy. RESULTS Patients who eventually died from COVID-19 received CCP significantly later (3.95 versus 5.22 days after hospital admission) and had higher interleukin 6 (IL-6) levels (28.9 pg/ml versus 102.5 pg/ml) than those who survived. In addition, CCP transfusion caused a significant reduction in the overall inflammatory status of the patients regardless of the severity of disease or outcome, as evidenced by decreasing C-reactive protein, IL6 and ferritin levels. CONCLUSION We conclude that CCP transfusion is a safe and effective supplementary treatment modality for hospitalized COVID-19 patients characterized by better expected outcome if applied as early as possible. We also observed that IL-6 may be a suitable laboratory parameter for patient selection and monitoring of CCP therapy effectiveness.
Collapse
Affiliation(s)
- Eszter Fodor
- Orthosera Kft, Budapest, 1149 Hungary
- Univesity of Physical Education, Budapest, 1223 Hungary
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, 1083 Hungary
| | - Zsolt Iványi
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, 1082 Hungary
| | - Tímea Berki
- Department of Immunology and Biotechnology, University of Pécs, Budapest, 7643 Hungary
| | | | - István Hornyák
- Instute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Mira Ambrus
- Univesity of Physical Education, Budapest, 1223 Hungary
| | - Ágnes Sárkány
- Szent György University Teaching Hospital, Székesfehérvár, 8000 Hungary
| | - Árpád Skázel
- Szent György University Teaching Hospital, Székesfehérvár, 8000 Hungary
| | - Ágnes Madár
- Univesity of Physical Education, Budapest, 1223 Hungary
| | | | - Gábor Kemenesi
- Szentágothai Research Center, National Laboratory of Virology, Univesity of Pécs, Pécs, 7622 Hungary
| | - Fanni Földes
- Szentágothai Research Center, National Laboratory of Virology, Univesity of Pécs, Pécs, 7622 Hungary
| | - Sándor Nagy
- Hungarian National Blood Transfusion Service, Budapest, 1113 Hungary
| | - Andrea Matusovits
- Hungarian National Blood Transfusion Service, Budapest, 1113 Hungary
| | - Nacsa János
- Hungarian National Blood Transfusion Service, Budapest, 1113 Hungary
| | - Attila Tordai
- Department of Transfusiology, Semmelweis University, Budapest, 1089 Hungary
| | - Ferenc Jakab
- Szentágothai Research Center, National Laboratory of Virology, Univesity of Pécs, Pécs, 7622 Hungary
| | - Zsombor Lacza
- Orthosera Kft, Budapest, 1149 Hungary
- Department of Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Univesity of Physical Education, Budapest, 1223 Hungary
| |
Collapse
|
5
|
Lessons learned from the use of convalescent plasma for the treatment of COVID-19 and specific considerations for immunocompromised patients. Transfus Apher Sci 2022; 61:103355. [PMID: 35063360 PMCID: PMC8757642 DOI: 10.1016/j.transci.2022.103355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/10/2022] [Indexed: 12/11/2022]
|
6
|
Rahmah L, Abarikwu SO, Arero AG, Essouma M, Jibril AT, Fal A, Flisiak R, Makuku R, Marquez L, Mohamed K, Ndow L, Zarębska-Michaluk D, Rezaei N, Rzymski P. Oral antiviral treatments for COVID-19: opportunities and challenges. Pharmacol Rep 2022; 74:1255-1278. [PMID: 35871712 PMCID: PMC9309032 DOI: 10.1007/s43440-022-00388-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/24/2022] [Accepted: 07/06/2022] [Indexed: 01/18/2023]
Abstract
The use of antiviral COVID-19 medications can successfully inhibit SARS-CoV-2 replication and prevent disease progression to a more severe form. However, the timing of antiviral treatment plays a crucial role in this regard. Oral antiviral drugs provide an opportunity to manage SARS-CoV-2 infection without a need for hospital admission, easing the general burden that COVID-19 can have on the healthcare system. This review paper (i) presents the potential pharmaceutical antiviral targets, including various host-based targets and viral-based targets, (ii) characterizes the first-generation anti-SARS-CoV-2 oral drugs (nirmatrelvir/ritonavir and molnupiravir), (iii) summarizes the clinical progress of other oral antivirals for use in COVID-19, (iv) discusses ethical issues in such clinical trials and (v) presents challenges associated with the use of oral antivirals in clinical practice. Oral COVID-19 antivirals represent a part of the strategy to adapt to long-term co-existence with SARS-CoV-2 in a manner that prevents healthcare from being overwhelmed. It is pivotal to ensure equal and fair global access to the currently available oral antivirals and those authorized in the future.
Collapse
Affiliation(s)
- Laila Rahmah
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran ,Universal Scientific Education and Research Network (USERN), Jakarta, Indonesia
| | - Sunny O. Abarikwu
- Department of Biochemistry, University of Port Harcourt, Choba, Nigeria ,Universal Scientific Education and Research Network (USERN), Choba, Nigeria
| | - Amanuel Godana Arero
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran ,Universal Scientific Education and Research Network (USERN), Addis Ababa, Ethiopia
| | - Mickael Essouma
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon ,Universal Scientific Education and Research Network, Yaoundé, Cameroon
| | - Aliyu Tijani Jibril
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran ,Nutritional and Health Team (NHT), Universal Scientific Education and Research Network (USERN), Tehran, Iran ,Universal Scientific Education and Research Network (USERN), Accra, Ghana
| | - Andrzej Fal
- Department of Population Health, Division of Public Health, Wroclaw Medical University, Wroclaw, Poland ,Collegium Medicum, Warsaw Faculty of Medicine, Cardinal Stefan Wyszyński University, Warsaw, Poland ,Integrated Science Association (ISA), Universal Scientific Education and Research Network (USERN), Poznań, Poland
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, Białystok, Poland
| | - Rangarirai Makuku
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran ,Universal Scientific Education and Research Network (USERN), Harare, Zimbabwe
| | - Leander Marquez
- College of Social Sciences and Philosophy, University of the Philippines Diliman, Quezon City, Philippines ,Education and Research Network (USERN), Universal Scientific, Quezon City, Philippines
| | - Kawthar Mohamed
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran ,Universal Scientific Education and Research Network (USERN), Manama, Bahrain
| | - Lamin Ndow
- National Health Laboratory Service, Kotu, Gambia ,Universal Scientific Education and Research Network (USERN), Banjul, Gambia
| | | | - Nima Rezaei
- Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran ,Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran ,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Piotr Rzymski
- Integrated Science Association (ISA), Universal Scientific Education and Research Network (USERN), Poznań, Poland ,Department of Environmental Medicine, Poznan University of Medical Sciences, Poznań, Poland
| |
Collapse
|
7
|
Perenc L, Pęczkowski R. Knowledge and Attitudes of Young Adults Towards Donation of COVID-19 Convalescent Plasma and Its Therapeutic Properties. J Blood Med 2021; 12:709-717. [PMID: 34408520 PMCID: PMC8364396 DOI: 10.2147/jbm.s319652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/30/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The aim of this study is to investigate the level of knowledge of the young adults towards the possible use of the convalescent plasma (CP) in the treatment of COVID-19 infection and their attitudes towards its donation. METHODS Cross-sectional questionnaire was administered online to 1058 university students, representing 4 different colleges. The questionnaire included demographic data and 20 questions related to the knowledge and attitudes of respondents about possible use of the convalescent plasma in the treatment of COVID-19 infection and its donation. Comparative analyses were made using the Mann-Whitney and Kruskal-Wallis tests and the Spearman correlation coefficient. RESULTS Significant relationships were found between dependent variables (level of knowledge and intensity of attitude) and gender, age, and student's college affiliation. There was no statistically significant correlation between dependent variables and respondents' social background and religious commitment. Studied young adults show a satisfactory knowledge relating to the therapeutic and preventive properties of the COVID-19 convalescent plasma. They also express a sufficient intensity of positive attitude towards CP donation. CONCLUSION This study confirms the need for appropriate health promotional campaigns and educational programs aimed at popularization of CP donation in the general public, which would increase the chances of involving more patients recovered from COVID-19 disease.
Collapse
Affiliation(s)
- Lidia Perenc
- Institute of Health Sciences, University of Rzeszow, Rzeszow, 35-310, Poland
| | | |
Collapse
|
8
|
Zarębska-Michaluk D, Jaroszewicz J, Rogalska M, Martonik D, Pabjan P, Berkan-Kawińska A, Bolewska B, Oczko-Grzesik B, Kozielewicz D, Tudrujek-Zdunek M, Kowalska J, Moniuszko-Malinowska A, Kłos K, Rorat M, Leszczyński P, Piekarska A, Polańska J, Flisiak R. Effectiveness of Tocilizumab with and without Dexamethasone in Patients with Severe COVID-19: A Retrospective Study. J Inflamm Res 2021; 14:3359-3366. [PMID: 34295173 PMCID: PMC8291861 DOI: 10.2147/jir.s322645] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/05/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose The pathogenesis of coronavirus disease 2019 (COVID-19) is complicated, and in addition to antiviral therapy and combating coagulopathy, treatment should also include inhibition of the proinflammatory cytokines overproduction. The purpose of this study is to compare the effectiveness of tocilizumab (TCZ) and dexamethasone (DEX) administered alone or in combination in patients with severe COVID-19. Patients and Methods Patients were selected from the SARSTer database, containing 3330 individuals with COVID-19 treated between 1 March 2020 and 10 March 2021. The current study included adult patients with baseline oxygen saturation (SpO2) ≤90%, requiring regular or non-invasive high-flow oxygen supplementation. Results Among included 460 patients, 59 were treated with TCZ, 125 with TCZ and DEX, 169 with DEX, and 107 did not receive TCZ nor DEX. The groups were balanced regarding demographics, coexisting diseases, baseline SpO2, and comedications with remdesivir or low-molecular-weight heparin. The death rate of 6.8% was significantly lower in patients receiving TCZ alone than each arm (19.6%–23.1%), particularly in patients with interleukin-6 concentration exceeding 100pg/mL (5% vs 22.9%–51.7%, respectively). Analysis of clinical improvement demonstrated doubled, significantly higher rate after 21 and 28 days in patients treated with TCZ alone (60% and 75%, respectively) compared to DEX (27.6% and 37.9%, respectively). The need for mechanical ventilation was similar in all arms. Conclusion In patients with severe course of COVID-19, particularly those developing cytokine storm, administration of TCZ provides a significantly better effect than DEX regarding survival, clinical improvement, and hospital discharge rate. The combination of TCZ and DEX does not improve therapy effectiveness in patients with severe COVID-19 compared to the administration of TCZ alone.
Collapse
Affiliation(s)
| | - Jerzy Jaroszewicz
- Department of Infectious Diseases and Hepatology, Medical University of Silesia, Katowice, 40-055, Poland
| | - Magdalena Rogalska
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, Białystok, 15-089, Poland
| | - Diana Martonik
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, Białystok, 15-089, Poland
| | - Paweł Pabjan
- Department of Infectious Diseases, Jan Kochanowski University, Kielce, 25-369, Poland
| | | | - Beata Bolewska
- Department of Infectious Diseases, University of Medical Sciences, Poznań, 61-701, Poland
| | - Barbara Oczko-Grzesik
- Department of Infectious Diseases and Hepatology, Medical University of Silesia, Katowice, 40-055, Poland
| | - Dorota Kozielewicz
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, 87-100, Poland
| | - Magdalena Tudrujek-Zdunek
- Department of Infectious Diseases and Hepatology, Medical University of Lublin, Lublin, 20-059, Poland
| | - Justyna Kowalska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Warsaw, 02-091, Poland
| | - Anna Moniuszko-Malinowska
- Department of Infectious Diseases and Neuroinfections, Medical University of Białystok, Białystok, 15-089, Poland
| | - Krzysztof Kłos
- Department of Infectious Diseases and Allergology, Military Institute of Medicine, Warsaw, 04-141, Poland
| | - Marta Rorat
- Department of Forensic Medicine, Wrocław Medical University, Wrocław, 50-367, Poland.,First Infectious Diseases Ward, Gromkowski Regional Specialist Hospital in Wrocław, Wrocław, 51-149, Poland
| | - Piotr Leszczyński
- Department of Rheumatology, Rehabilitation and Internal Medicine, Poznan University of Medical Sciences, Poznań, 61-701, Poland.,Department of Rheumatology and Osteoporosis, Szpital im. J. Strusia w Poznaniu, Poznań, 61-285, Poland
| | - Anna Piekarska
- Department of Infectious Diseases and Hepatology, Medical University of Łódź, Łódź, 90-549, Poland
| | | | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, Białystok, 15-089, Poland
| |
Collapse
|
9
|
Klassen SA, Senefeld JW, Senese KA, Johnson PW, Wiggins CC, Baker SE, van Helmond N, Bruno KA, Pirofski LA, Shoham S, Grossman BJ, Henderson JP, Wright RS, Fairweather D, Paneth NS, Carter RE, Casadevall A, Joyner MJ. Convalescent Plasma Therapy for COVID-19: A Graphical Mosaic of the Worldwide Evidence. Front Med (Lausanne) 2021; 8:684151. [PMID: 34164419 PMCID: PMC8215127 DOI: 10.3389/fmed.2021.684151] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/04/2021] [Indexed: 12/15/2022] Open
Abstract
Convalescent plasma has been used worldwide to treat patients hospitalized with coronavirus disease 2019 (COVID-19) and prevent disease progression. Despite global usage, uncertainty remains regarding plasma efficacy, as randomized controlled trials (RCTs) have provided divergent evidence regarding the survival benefit of convalescent plasma. Here, we argue that during a global health emergency, the mosaic of evidence originating from multiple levels of the epistemic hierarchy should inform contemporary policy and healthcare decisions. Indeed, worldwide matched-control studies have generally found convalescent plasma to improve COVID-19 patient survival, and RCTs have demonstrated a survival benefit when transfused early in the disease course but limited or no benefit later in the disease course when patients required greater supportive therapies. RCTs have also revealed that convalescent plasma transfusion contributes to improved symptomatology and viral clearance. To further investigate the effect of convalescent plasma on patient mortality, we performed a meta-analytical approach to pool daily survival data from all controlled studies that reported Kaplan-Meier survival plots. Qualitative inspection of all available Kaplan-Meier survival data and an aggregate Kaplan-Meier survival plot revealed a directionally consistent pattern among studies arising from multiple levels of the epistemic hierarchy, whereby convalescent plasma transfusion was generally associated with greater patient survival. Given that convalescent plasma has a similar safety profile as standard plasma, convalescent plasma should be implemented within weeks of the onset of future infectious disease outbreaks.
Collapse
Affiliation(s)
- Stephen A. Klassen
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| | - Jonathon W. Senefeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| | - Katherine A. Senese
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| | - Patrick W. Johnson
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, United States
| | - Chad C. Wiggins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| | - Sarah E. Baker
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| | - Noud van Helmond
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ, United States
| | - Katelyn A. Bruno
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Liise-anne Pirofski
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, United States
| | - Shmuel Shoham
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Brenda J. Grossman
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Jeffrey P. Henderson
- Division of Infectious Diseases, Department of Medicine, Department of Molecular Microbiology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - R. Scott Wright
- Department of Cardiovascular Medicine, Human Research Protection Program, Mayo Clinic, Rochester, MN, United States
| | - DeLisa Fairweather
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Nigel S. Paneth
- Department of Epidemiology and Biostatistics, Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | - Rickey E. Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, United States
| | - Arturo Casadevall
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael J. Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
10
|
Cimolai N. Passive Immunity Should and Will Work for COVID-19 for Some Patients. Clin Hematol Int 2021; 3:47-68. [PMID: 34595467 PMCID: PMC8432400 DOI: 10.2991/chi.k.210328.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 03/02/2021] [Indexed: 12/12/2022] Open
Abstract
In the absence of effective antiviral chemotherapy and still in the context of emerging vaccines for severe acute respiratory syndrome-CoV-2 infections, passive immunotherapy remains a key treatment and possible prevention strategy. What might initially be conceived as a simplified donor-recipient process, the intricacies of donor plasma, IV immunoglobulins, and monoclonal antibody modality applications are becoming more apparent. Key targets of such treatment have largely focused on virus neutralization and the specific viral components of the attachment Spike protein and its constituents (e.g., receptor binding domain, N-terminal domain). The cumulative laboratory and clinical experience suggests that beneficial protective and treatment outcomes are possible. Both a dose- and a time-dependency emerge. Lesser understood are the concepts of bioavailability and distribution. Apart from direct antigen binding from protective immunoglobulins, antibody effector functions have potential roles in outcome. In attempting to mimic the natural but variable response to infection or vaccination, a strong functional polyclonal approach attracts the potential benefits of attacking antigen diversity, high antibody avidity, antibody persistence, and protection against escape viral mutation. The availability and ease of administration for any passive immunotherapy product must be considered in the current climate of need. There is never a perfect product, but yet there is considerable room for improving patient outcomes. Given the variability of human genetics, immunity, and disease, and given the nuances of the virus and its potential for change, passive immunotherapy can be developed that will be effective for some but not all patients. An understanding of such patient variability and limitations is just as important as the understanding of the direct interactions between immunotherapy and virus.
Collapse
Affiliation(s)
- Nevio Cimolai
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, Children’s and Women’s Health Centre of British Columbia, 4480 Oak Street, Vancouver, BC, Canada V6H 3V4
| |
Collapse
|
11
|
Klassen SA, Senefeld JW, Johnson PW, Carter RE, Wiggins CC, Shoham S, Grossman BJ, Henderson JP, Musser J, Salazar E, Hartman WR, Bouvier NM, Liu STH, Pirofski LA, Baker SE, van Helmond N, Wright RS, Fairweather D, Bruno KA, Wang Z, Paneth NS, Casadevall A, Joyner MJ. The Effect of Convalescent Plasma Therapy on Mortality Among Patients With COVID-19: Systematic Review and Meta-analysis. Mayo Clin Proc 2021; 96:1262-1275. [PMID: 33958057 PMCID: PMC7888247 DOI: 10.1016/j.mayocp.2021.02.008] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/01/2021] [Accepted: 02/11/2021] [Indexed: 02/07/2023]
Abstract
To determine the effect of COVID-19 convalescent plasma on mortality, we aggregated patient outcome data from 10 randomized clinical trials, 20 matched control studies, 2 dose-response studies, and 96 case reports or case series. Studies published between January 1, 2020, and January 16, 2021, were identified through a systematic search of online PubMed and MEDLINE databases. Random effects analyses of randomized clinical trials and matched control data demonstrated that patients with COVID-19 transfused with convalescent plasma exhibited a lower mortality rate compared with patients receiving standard treatments. Additional analyses showed that early transfusion (within 3 days of hospital admission) of higher titer plasma is associated with lower patient mortality. These data provide evidence favoring the efficacy of human convalescent plasma as a therapeutic agent in hospitalized patients with COVID-19.
Collapse
Affiliation(s)
- Stephen A Klassen
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Jonathon W Senefeld
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Patrick W Johnson
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
| | - Rickey E Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL
| | - Chad C Wiggins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Shmuel Shoham
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Brenda J Grossman
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Jeffrey P Henderson
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Molecular Microbiology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - James Musser
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX; Center for Molecular and Translational Human Infectious Diseases, Houston Methodist Research Institute, Houston, TX; Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY
| | - Eric Salazar
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX; Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY
| | - William R Hartman
- Department of Anesthesiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nicole M Bouvier
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sean T H Liu
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Liise-Anne Pirofski
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Sarah E Baker
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Noud van Helmond
- Department of Anesthesiology, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ
| | - R Scott Wright
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Director, Human Research Protection Program, Mayo Clinic, Rochester, MN
| | | | - Katelyn A Bruno
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | - Zhen Wang
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Nigel S Paneth
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing; Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Michael J Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
| |
Collapse
|
12
|
The Three Pillars of COVID-19 Convalescent Plasma Therapy. Life (Basel) 2021; 11:life11040354. [PMID: 33919577 PMCID: PMC8073137 DOI: 10.3390/life11040354] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/30/2021] [Accepted: 04/14/2021] [Indexed: 12/26/2022] Open
Abstract
The new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread rapidly around the world in the last year causing the coronavirus disease 2019 (COVID-19), which still is a severe threat for public health. The therapeutic management of COVID-19 is challenging as, up until now, no specific and efficient pharmacological therapy has been validated. Translating the experience from previous viral epidemics, passive immunotherapy by means of plasma from individuals recovered from COVID-19 has been intensively investigated since the beginning of the pandemic. In this narrative review, we critically analyze the three factors, named “pillars”, that play a key role in determining the clinical effectiveness of this biologic therapy: the convalescent plasma, the disease (COVID-19), and the patients.
Collapse
|
13
|
Das SK, Ranabhat K, Bhattarai S, Karki KB, Gyanwali P, Paneru HR, Nepal B, Dumre SP, Acharya SP. Combination of convalescent plasma therapy and repurposed drugs to treat severe COVID-19 patient with multimorbidity. Clin Case Rep 2021; 9:2132-2137. [PMID: 33821192 PMCID: PMC8013972 DOI: 10.1002/ccr3.3964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/03/2021] [Accepted: 02/08/2021] [Indexed: 12/15/2022] Open
Abstract
Combination of convalescent plasma therapy and repurposed drugs such as dexamethasone and remdesivir could be beneficial for severe COVID-19 patients with obesity and chronic diseases such as diabetes and hypertension.
Collapse
Affiliation(s)
- Santa Kumar Das
- Institute of MedicineTribhuvan University Teaching HospitalKathmanduNepal
| | - Kamal Ranabhat
- Institute of MedicineTribhuvan University Teaching HospitalKathmanduNepal
- Ministry of Health and PopulationKathmanduNepal
| | - Suraj Bhattarai
- Global Institute for Interdisciplinary StudiesKathmanduNepal
| | - Khem Bahadur Karki
- Institute of MedicineTribhuvan University Teaching HospitalKathmanduNepal
| | - Pradip Gyanwali
- Institute of MedicineTribhuvan University Teaching HospitalKathmanduNepal
| | - Hem Raj Paneru
- Institute of MedicineTribhuvan University Teaching HospitalKathmanduNepal
| | | | - Shyam Prakash Dumre
- Central Department of MicrobiologyTribhuvan UniversityKathmanduNepal
- Institute of Tropical MedicineNagasaki UniversityNagasakiJapan
| | | |
Collapse
|
14
|
Małecki P, Faltin K, Mania A, Mazur-Melewska K, Cwalińska A, Zawadzka A, Bukowska A, Lisowska K, Graniczna K, Figlerowicz M. Effects and Safety of Convalescent Plasma Administration in a Group of Polish Pediatric Patients with COVID-19: A Case Series. Life (Basel) 2021; 11:life11030247. [PMID: 33802763 PMCID: PMC8002380 DOI: 10.3390/life11030247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/13/2021] [Accepted: 03/15/2021] [Indexed: 12/24/2022] Open
Abstract
Despite the enormous advances in knowledge about the SARS-CoV-2 infection, the optimal treatment for COVID-19 is still not well defined. The use of convalescent plasma seems to be a promising method of treatment but requires further evaluation. Although it is usually mild, in children with underlying chronic diseases, the course of SARS-CoV-2 infection may be very severe. We described a series of 13 pediatric patients (mean age 10.4 years, median 12) treated with convalescent plasma as a method of COVID-19 therapy. Medical history, with particular emphasis on comorbidities, clinical course, laboratory parameters, supportive treatment and virus elimination time, were analyzed. The mean hospitalization time was 22.6 days (median 20). The most common abnormalities included increased levels of C-reactive protein, D-dimer, and lymphopenia. Median time from symptom onset to convalescent plasma transfusion was 10.6 days (median 7 days). Six patients (46.2%) had a viral clearance on RT-PCR method from a nasopharyngeal swab within 3 days of transfusion, while in the remaining patients the mean elimination time was 12.1 days (median 6 days). Clinical improvement was achieved in all patients; no adverse effects were found in any of the cases. Convalescent plasma may be a promising treatment for COVID-19 in children.
Collapse
Affiliation(s)
- Paweł Małecki
- Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, Szpitalna Street 27/33, 60-572 Poznań, Greater Poland Voivodeship, Poland; (P.M.); (K.F.); (A.M.); (K.M.-M.); (A.C.)
| | - Kamil Faltin
- Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, Szpitalna Street 27/33, 60-572 Poznań, Greater Poland Voivodeship, Poland; (P.M.); (K.F.); (A.M.); (K.M.-M.); (A.C.)
| | - Anna Mania
- Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, Szpitalna Street 27/33, 60-572 Poznań, Greater Poland Voivodeship, Poland; (P.M.); (K.F.); (A.M.); (K.M.-M.); (A.C.)
| | - Katarzyna Mazur-Melewska
- Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, Szpitalna Street 27/33, 60-572 Poznań, Greater Poland Voivodeship, Poland; (P.M.); (K.F.); (A.M.); (K.M.-M.); (A.C.)
| | - Agnieszka Cwalińska
- Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, Szpitalna Street 27/33, 60-572 Poznań, Greater Poland Voivodeship, Poland; (P.M.); (K.F.); (A.M.); (K.M.-M.); (A.C.)
| | - Anna Zawadzka
- Regional Blood Center, Marcelinska Street 44, 60-354 Poznań, Greater Poland Voivodeship, Poland; (A.Z.); (A.B.); (K.L.); (K.G.)
| | - Alicja Bukowska
- Regional Blood Center, Marcelinska Street 44, 60-354 Poznań, Greater Poland Voivodeship, Poland; (A.Z.); (A.B.); (K.L.); (K.G.)
| | - Katarzyna Lisowska
- Regional Blood Center, Marcelinska Street 44, 60-354 Poznań, Greater Poland Voivodeship, Poland; (A.Z.); (A.B.); (K.L.); (K.G.)
| | - Katarzyna Graniczna
- Regional Blood Center, Marcelinska Street 44, 60-354 Poznań, Greater Poland Voivodeship, Poland; (A.Z.); (A.B.); (K.L.); (K.G.)
| | - Magdalena Figlerowicz
- Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, Szpitalna Street 27/33, 60-572 Poznań, Greater Poland Voivodeship, Poland; (P.M.); (K.F.); (A.M.); (K.M.-M.); (A.C.)
- Correspondence: ; Tel.: +48-618-491-362
| |
Collapse
|
15
|
Indari O, Jakhmola S, Manivannan E, Jha HC. An Update on Antiviral Therapy Against SARS-CoV-2: How Far Have We Come? Front Pharmacol 2021; 12:632677. [PMID: 33762954 PMCID: PMC7982669 DOI: 10.3389/fphar.2021.632677] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/15/2021] [Indexed: 12/15/2022] Open
Abstract
COVID-19 pandemic has spread worldwide at an exponential rate affecting millions of people instantaneously. Currently, various drugs are under investigation to treat an enormously increasing number of COVID-19 patients. This dreadful situation clearly demands an efficient strategy to quickly identify drugs for the successful treatment of COVID-19. Hence, drug repurposing is an effective approach for the rapid discovery of frontline arsenals to fight against COVID-19. Successful application of this approach has resulted in the repurposing of some clinically approved drugs as potential anti-SARS-CoV-2 candidates. Several of these drugs are either antimalarials, antivirals, antibiotics or corticosteroids and they have been repurposed based on their potential to negate virus or reduce lung inflammation. Large numbers of clinical trials have been registered to evaluate the effectiveness and clinical safety of these drugs. Till date, a few clinical studies are complete and the results are primary. WHO also conducted an international, multi-country, open-label, randomized trials-a solidarity trial for four antiviral drugs. However, solidarity trials have few limitations like no placebos were used, additionally any drug may show effectiveness for a particular population in a region which may get neglected in solidarity trial analysis. The ongoing randomized clinical trials can provide reliable long-term follow-up results that will establish both clinical safety and clinical efficacy of these drugs with respect to different regions, populations and may aid up to worldwide COVID-19 treatment research. This review presents a comprehensive update on majorly repurposed drugs namely chloroquine, hydroxychloroquine, remdesivir, lopinavir-ritonavir, favipiravir, ribavirin, azithromycin, umifenovir, oseltamivir as well as convalescent plasma therapy used against SARS-CoV-2. The review also summarizes the data recorded on the mechanism of anti-SARS-CoV-2 activity of these repurposed drugs along with the preclinical and clinical findings, therapeutic regimens, pharmacokinetics, and drug-drug interactions.
Collapse
Affiliation(s)
- Omkar Indari
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Indore, India
| | - Shweta Jakhmola
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Indore, India
| | | | - Hem Chandra Jha
- Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Indore, India
| |
Collapse
|
16
|
Miller AC, Ghadermarzi S, Venkatachalam S. What's new in critical illness and injury science? Convalescent plasma for coronavirus disease-2019 patients with severe or critical illness. Int J Crit Illn Inj Sci 2021; 11:1-3. [PMID: 34159128 PMCID: PMC8183370 DOI: 10.4103/ijciis.ijciis_26_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/11/2020] [Indexed: 12/16/2022] Open
Affiliation(s)
- Andrew Carl Miller
- Department of Emergency Medicine, Nazareth Hospital, Philadelphia, PA, USA
| | - Shadi Ghadermarzi
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | | |
Collapse
|