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Tsiakos K, Tsakiris A, Tsibris G, Voutsinas PM, Panagopoulos P, Kosmidou M, Petrakis V, Gravvani A, Gkavogianni T, Klouras E, Katrini K, Koufargyris P, Rapti I, Karageorgos A, Vrentzos E, Damoulari C, Zarkada V, Sidiropoulou C, Artemi S, Ioannidis A, Papapostolou A, Michelakis E, Georgiopoulou M, Myrodia DM, Tsiamalos P, Syrigos K, Chrysos G, Nitsotolis T, Milionis H, Poulakou G, Giamarellos-Bourboulis EJ. Early Start of Oral Clarithromycin Is Associated with Better Outcome in COVID-19 of Moderate Severity: The ACHIEVE Open-Label Single-Arm Trial. Infect Dis Ther 2021; 10:2333-2351. [PMID: 34363189 PMCID: PMC8345236 DOI: 10.1007/s40121-021-00505-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/16/2021] [Indexed: 12/27/2022] Open
Abstract
Introduction The anti-inflammatory effect of macrolides prompted the study of oral clarithromycin in moderate COVID-19. Methods An open-label non-randomized trial in 90 patients with COVID-19 of moderate severity was conducted between May and October 2020. The primary endpoint was defined at the end of treatment (EOT) as no need for hospital re-admission and no progression into lower respiratory tract infection (LRTI) for patients with upper respiratory tract infection and as at least 50% decrease of the respiratory symptoms score without progression into severe respiratory failure (SRF) for patients with LRTI. Viral load, biomarkers, the function of mononuclear cells and safety were assessed. Results The primary endpoint was attained in 86.7% of patients treated with clarithromycin (95% CIs 78.1–92.2%); this was 91.7% and 81.4% among patients starting clarithromycin the first 5 days from symptoms onset or later (odds ratio after multivariate analysis 6.62; p 0.030). The responses were better for patients infected by non-B1.1 variants. Clarithromycin use was associated with decreases in circulating C-reactive protein, tumour necrosis factor-alpha and interleukin (IL)-6; by increase of production of interferon-gamma and decrease of production of interleukin-6 by mononuclear cells; and by suppression of SARS-CoV-2 viral load. No safety concerns were reported. Conclusions Early clarithromycin treatment provides most of the clinical improvement in moderate COVID-19. Trial Registration ClinicalTrials.gov, NCT04398004 Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00505-8.
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Affiliation(s)
- Konstantinos Tsiakos
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - Antonios Tsakiris
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Georgios Tsibris
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Pantazis-Michael Voutsinas
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Periklis Panagopoulos
- 2nd Department of Internal Medicine, Medical School, Democritus University of Thrace, 681 00, Alexandroupolis, Greece
| | - Maria Kosmidou
- 1st Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Ioannina, 455 00, Ioannina, Greece
| | - Vasileios Petrakis
- 2nd Department of Internal Medicine, Medical School, Democritus University of Thrace, 681 00, Alexandroupolis, Greece
| | - Areti Gravvani
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - Theologia Gkavogianni
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Eleftherios Klouras
- 1st Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Ioannina, 455 00, Ioannina, Greece
| | - Konstantina Katrini
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Panagiotis Koufargyris
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Iro Rapti
- 1st Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Ioannina, 455 00, Ioannina, Greece
| | - Athanassios Karageorgos
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Emmanouil Vrentzos
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Christina Damoulari
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Vagia Zarkada
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | | | - Sofia Artemi
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Anastasios Ioannidis
- Department of Nursing, Faculty of Health Sciences, University of Peloponnese, Tripoli, Greece
| | - Androniki Papapostolou
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Evangelos Michelakis
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Maria Georgiopoulou
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece
| | - Dimitra-Melia Myrodia
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - Panteleimon Tsiamalos
- 2nd Department of Internal Medicine, Tzaneion General Hospital of Piraeus, Piraeus, Greece
| | - Konstantinos Syrigos
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - George Chrysos
- 2nd Department of Internal Medicine, Tzaneion General Hospital of Piraeus, Piraeus, Greece
| | - Thomas Nitsotolis
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - Haralampos Milionis
- 1st Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Ioannina, 455 00, Ioannina, Greece
| | - Garyphallia Poulakou
- 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - Evangelos J Giamarellos-Bourboulis
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece.
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