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Malin JJ, Weibel S, Gruell H, Kreuzberger N, Stegemann M, Skoetz N. Efficacy and safety of molnupiravir for the treatment of SARS-CoV-2 infection: a systematic review and meta-analysis. J Antimicrob Chemother 2023:7160636. [PMID: 37170886 DOI: 10.1093/jac/dkad132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/19/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND The role of molnupiravir for coronavirus disease 2019 (COVID-19) treatment is unclear. METHODS We conducted a systematic review until 1 November 2022 searching for randomized controlled trials (RCTs) involving COVID-19 patients comparing molnupiravir [±standard of care (SoC)] versus SoC and/or placebo. Data were pooled in random-effects meta-analyses. Certainty of evidence was assessed according to the Grading of Recommendations, Assessment, Development and Evaluations approach. RESULTS Nine RCTs were identified, eight investigated outpatients (29 254 participants) and one inpatients (304 participants). Compared with placebo/SoC, molnupiravir does not reduce mortality [risk ratio (RR) 0.27, 95% CI 0.07-1.02, high-certainty evidence] and probably does not reduce the risk for 'hospitalization or death' (RR 0.81, 95% CI 0.55-1.20, moderate-certainty evidence) by Day 28 in COVID-19 outpatients. We are uncertain whether molnupiravir increases symptom resolution by Day 14 (RR 1.20, 95% CI 1.02-1.41, very-low-certainty evidence) but it may make no difference by Day 28 (RR 1.05, 95% CI 0.92-1.19, low-certainty evidence). In inpatients, molnupiravir may increase mortality by Day 28 compared with placebo (RR 3.78, 95% CI 0.50-28.82, low-certainty evidence). There is little to no difference in serious adverse and adverse events during the study period in COVID-19 inpatients/outpatients treated with molnupiravir compared with placebo/SoC (moderate- to high-certainty evidence). CONCLUSIONS In a predominantly immunized population of COVID-19 outpatients, molnupiravir has no effect on mortality, probably none on 'hospitalization or death' and effects on symptom resolution are uncertain. Molnupiravir was safe during the study period in outpatients although a potential increase in inpatient mortality requires careful monitoring in ongoing clinical research. Our analysis does not support routine use of molnupiravir for COVID-19 treatment in immunocompetent individuals.
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Affiliation(s)
- Jakob J Malin
- Department I of Internal Medicine, Division of Infectious Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Centre for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Stephanie Weibel
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Henning Gruell
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nina Kreuzberger
- Evidence-Based Medicine, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Miriam Stegemann
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität of Berlin, Berlin, Germany
| | - Nicole Skoetz
- Evidence-Based Medicine, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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2
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Malin JJ, Suárez I, Biehl LM, Schommers P, Knops E, Di Cristanziano V, Heger E, Pflieger E, Wyen C, Bettin D, Rybniker J, Fätkenheuer G, Lehmann C. Immune response to mRNA-based COVID-19 booster vaccination in people living with HIV. HIV Med 2023. [PMID: 36883641 DOI: 10.1111/hiv.13481] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/18/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES Our objective was to assess immune responses and their influencing factors in people living with HIV after messenger RNA (mRNA)-based COVID-19 booster vaccination (third dose). METHODS This was a retrospective cohort study of people living with HIV who received booster vaccination with BNT-162b2 or mRNA-1273 between October 2021 and January 2022. We assessed anti-spike receptor-binding domain (RBD) immunoglobulin G (IgG), virus neutralizing activity (VNA) titres reported as 100% inhibitory dilution (ID100 ), and T-cell response (using interferon-gamma-release-assay [IGRA]) at baseline and quarterly follow-up visits. Patients with reported COVID-19 during follow-up were excluded. Predictors of serological immune response were analyzed using multivariate regression models. RESULTS Of 84 people living with HIV who received an mRNA-based booster vaccination, 76 were eligible for analysis. Participants were on effective antiretroviral therapy (ART) and had a median of 670 CD4+ cells/μL (interquartile range [IQR] 540-850). Following booster vaccination, median anti-spike RBD IgG increased by 705.2 binding antibody units per millilitre (BAU/mL) and median VNA titres increased by 1000 ID100 at the follow-up assessment (median 13 weeks later). Multivariate regression revealed that time since second vaccination was a predictor of stronger serological responses (p < 0.0001). No association was found for other factors, including CD4+ status, choice of mRNA vaccine, or concomitant influenza vaccination. In total, 45 patients (59%) had a reactive baseline IGRA, of whom two lost reactivity during follow-up. Of 31 patients (41%) with non-reactive baseline IGRA, 17 (55%) converted to reactive and seven (23%) remained unchanged following booster vaccination. CONCLUSIONS People living with HIV with ≥500 CD4+ cells/μL showed favourable immune responses to mRNA-based COVID-19 booster vaccination. A longer time (up to 29 weeks) since second vaccination was associated with higher serological responses, whereas choice of mRNA vaccine or concomitant influenza vaccination had no impact.
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Affiliation(s)
- Jakob J Malin
- Department I of Internal Medicine, Division of Infectious Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Isabelle Suárez
- Department I of Internal Medicine, Division of Infectious Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lena M Biehl
- Department I of Internal Medicine, Division of Infectious Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), Site Bonn-Cologne, Cologne, Germany
| | - Philipp Schommers
- Department I of Internal Medicine, Division of Infectious Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), Site Bonn-Cologne, Cologne, Germany
| | - Elena Knops
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Veronica Di Cristanziano
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Eva Heger
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Eva Pflieger
- Department I of Internal Medicine, Division of Infectious Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christoph Wyen
- Department I of Internal Medicine, Division of Infectious Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Daniel Bettin
- Department I of Internal Medicine, Division of Infectious Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan Rybniker
- Department I of Internal Medicine, Division of Infectious Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Gerd Fätkenheuer
- Department I of Internal Medicine, Division of Infectious Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Clara Lehmann
- Department I of Internal Medicine, Division of Infectious Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), Site Bonn-Cologne, Cologne, Germany
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3
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Malin JJ, von Wintersdorff CJH, Penders J, Savelkoul PHM, Wolffs PFG. Longitudinal fluctuations of common antimicrobial resistance genes in the gut microbiomes of healthy Dutch individuals. Int J Antimicrob Agents 2023; 61:106716. [PMID: 36640847 DOI: 10.1016/j.ijantimicag.2023.106716] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 11/22/2022] [Accepted: 12/31/2022] [Indexed: 01/13/2023]
Abstract
The human gut microbiome is an important reservoir of antimicrobial resistance genes (ARGs), collectively termed the 'resistome'. To date, few studies have examined the dynamics of the human gut resistome in healthy individuals. Previously, the authors observed high rates of ARG acquisition and significant abundance shifts during international travel. In order to provide insight into commonly occurring dynamics, this study investigated longitudinal fluctuations in prevalent ARGs (cfxA, tetM and ermB) in the resistomes of non-travelling healthy volunteers. In addition, this study assessed the prevalence of acquirable ARGs (blaCTX-M, qnrB, qnrS, vanA and vanB) over time. Faecal samples from 23 participants were collected at baseline and after 2 and 4 weeks. DNA was isolated, and ARG quantification was performed by quantitative polymerase chain reaction adjusting for the total amount of bacterial 16S rDNA. vanA and qnrS were not detected in any of the samples, while the prevalence rates of vanB of non-enterococcal origin and qnrB were 73.9% and 5.7%, respectively. The ß-lactamase encoding blaCTX-M was detected in 17.4% of healthy participants. The results were compared with previous data from 122 travellers. ARG acquisitions observed in travellers were rare in non-travelling individuals during 4 weeks of follow-up, supporting the hypothesis of ARG acquisition during international travel. However, median -1.04- to 1.04-fold abundance changes were observed for 100% of cfxA, tetM and ermB, which did not differ from those found in travellers. Thus, common abundance shifts in prevalent ARGs of the gut resistome were found to occur independent of travel behaviour.
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Affiliation(s)
- Jakob J Malin
- Department of Medical Microbiology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Christian J H von Wintersdorff
- Department of Medical Microbiology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | - John Penders
- Department of Medical Microbiology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Medical Microbiology, Care and Public Health Research Institute CAPHRI, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Paul H M Savelkoul
- Department of Medical Microbiology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Medical Microbiology, Care and Public Health Research Institute CAPHRI, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Petra F G Wolffs
- Department of Medical Microbiology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Medical Microbiology, Care and Public Health Research Institute CAPHRI, Maastricht University Medical Centre, Maastricht, the Netherlands
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4
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Jordans CC, Vasylyev M, Rae C, Jakobsen ML, Vassilenko A, Dauby N, Grevsen AL, Jakobsen SF, Raahauge A, Champenois K, Papot E, Malin JJ, Boender TS, Behrens GM, Gruell H, Neumann A, Spinner CD, Valbert F, Akinosoglou K, Kostaki EG, Nozza S, Giacomelli A, Lapadula G, Mazzitelli M, Torti C, Matulionyte R, Matulyte E, Van Welzen BJ, Hensley KS, Thompson M, Ankiersztejn-Bartczak M, Skrzat-Klapaczyńska A, Săndulescu O, Streinu-Cercel A, Streinu-Cercel A, Miron VD, Pokrovskaya A, Hachfeld A, Dorokhina A, Sukach M, Lord E, Sullivan AK, Rokx C. National medical specialty guidelines of HIV indicator conditions in Europe lack adequate HIV testing recommendations: a systematic guideline review. Euro Surveill 2022; 27:2200338. [PMID: 36695464 PMCID: PMC9716648 DOI: 10.2807/1560-7917.es.2022.27.48.2200338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BackgroundAdequate identification and testing of people at risk for HIV is fundamental for the HIV care continuum. A key strategy to improve timely testing is HIV indicator condition (IC) guided testing.AimTo evaluate the uptake of HIV testing recommendations in HIV IC-specific guidelines in European countries.MethodsBetween 2019 and 2021, European HIV experts reviewed guideline databases to identify all national guidelines of 62 HIV ICs. The proportion of HIV IC guidelines recommending HIV testing was reported, stratified by subgroup (HIV IC, country, eastern/western Europe, achievement of 90-90-90 goals and medical specialty).ResultsOf 30 invited European countries, 15 participated. A total of 791 HIV IC guidelines were identified: median 47 (IQR: 38-68) per country. Association with HIV was reported in 69% (545/791) of the guidelines, and 46% (366/791) recommended HIV testing, while 42% (101/242) of the AIDS-defining conditions recommended HIV testing. HIV testing recommendations were observed more frequently in guidelines in eastern (53%) than western (42%) European countries and in countries yet to achieve the 90-90-90 goals (52%) compared to those that had (38%). The medical specialties internal medicine, neurology/neurosurgery, ophthalmology, pulmonology and gynaecology/obstetrics had an HIV testing recommendation uptake below the 46% average. None of the 62 HIV ICs, countries or medical specialties had 100% accurate testing recommendation coverage in all their available HIV IC guidelines.ConclusionFewer than half the HIV IC guidelines recommended HIV testing. This signals an insufficient adoption of this recommendation in non-HIV specialty guidelines across Europe.
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Affiliation(s)
- Carlijn C.E. Jordans
- Erasmus University Medical Center, Department of Internal Medicine and Department of Medical Microbiology and Infectious Diseases, Rotterdam, the Netherlands
| | | | - Caroline Rae
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Marie Louise Jakobsen
- Centre of Excellence for Health, Immunity & Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anna Vassilenko
- Republican Scientific and Practical Center of Medical Technologies, Informatization, Management and Economics of Public Health, Minsk, Belarus
| | - Nicolas Dauby
- CHU Saint-Pierre, Université Libre de Bruxelles (ULB), and School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Anne Louise Grevsen
- Centre of Excellence for Health, Immunity & Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Stine Finne Jakobsen
- Centre of Excellence for Health, Immunity & Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anne Raahauge
- Centre of Excellence for Health, Immunity & Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Jakob J. Malin
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | - T. Sonia Boender
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany,ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Georg M.N Behrens
- Hannover Medical School, Department for Rheumatology and Immunology, Hannover, Germany
| | - Henning Gruell
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anja Neumann
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Christoph D. Spinner
- Technical University of Munich, School of Medicine, University hospital rechts der Isar, Department of Internal Medicine II, Munich, Germany
| | - Frederik Valbert
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Karolina Akinosoglou
- Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, Patras, Greece
| | - Evangelia G. Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Andrea Giacomelli
- III Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Via G.B. Grassi, Milan, Italy
| | - Giuseppe Lapadula
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Maria Mazzitelli
- Magna Graecia University of Cantanzaro, Catanzaro, Italy,Infectious and Tropical Diseases Unit, University Hospital, Padua, Italy
| | - Carlo Torti
- University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Raimonda Matulionyte
- Department of Infectious Diseases and Dermatovenerology, Faculty of Medicine, Vilnius University; Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Elzbieta Matulyte
- Department of Infectious Diseases and Dermatovenerology, Faculty of Medicine, Vilnius University; Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Berend J. Van Welzen
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, Netherlands
| | - Kathryn S. Hensley
- Erasmus University Medical Center, Department of Internal Medicine and Department of Medical Microbiology and Infectious Diseases, Rotterdam, the Netherlands
| | | | | | - Agata Skrzat-Klapaczyńska
- Hospital for Infectious Diseases Warsaw, Medical University of Warsaw, Department of Adults’ Infectious Diseases, Warsaw, Poland
| | - Oana Săndulescu
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,National Institute for Infectious Diseases “Prof.Dr. Matei Bals”, Bucharest, Romania
| | - Adrian Streinu-Cercel
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,National Institute for Infectious Diseases “Prof.Dr. Matei Bals”, Bucharest, Romania
| | - Anca Streinu-Cercel
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania,National Institute for Infectious Diseases “Prof.Dr. Matei Bals”, Bucharest, Romania
| | | | - Anastasia Pokrovskaya
- Central Research Institute of Epidemiology of Rospotrebnadzor, Moscow, Russian Federation
| | - Anna Hachfeld
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Antonina Dorokhina
- National Children's Specialized Hospital “OKHMATDYT” of Ministry of Health of Ukraine, Kyiv, Ukraine,O.O.Bogomolets’ National Medical University, Kyiv, Ukraine
| | - Maryna Sukach
- O.O.Bogomolets’ National Medical University, Kyiv, Ukraine
| | - Emily Lord
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Ann K. Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Casper Rokx
- Erasmus University Medical Center, Department of Internal Medicine and Department of Medical Microbiology and Infectious Diseases, Rotterdam, the Netherlands
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5
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Theobald SJ, Simonis A, Mudler JM, Göbel U, Acton R, Kohlhas V, Albert MC, Hellmann AM, Malin JJ, Winter S, Hallek M, Walczak H, Nguyen PH, Koch M, Rybniker J. Spleen tyrosine kinase mediates innate and adaptive immune crosstalk in SARS-CoV-2 mRNA vaccination. EMBO Mol Med 2022; 14:e15888. [PMID: 35785445 PMCID: PMC9349614 DOI: 10.15252/emmm.202215888] [Citation(s) in RCA: 4] [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: 02/14/2022] [Revised: 06/11/2022] [Accepted: 06/14/2022] [Indexed: 12/15/2022] Open
Abstract
Durable cell‐mediated immune responses require efficient innate immune signaling and the release of pro‐inflammatory cytokines. How precisely mRNA vaccines trigger innate immune cells for shaping antigen specific adaptive immunity remains unknown. Here, we show that SARS‐CoV‐2 mRNA vaccination primes human monocyte‐derived macrophages for activation of the NLRP3 inflammasome. Spike protein exposed macrophages undergo NLRP3‐driven pyroptotic cell death and subsequently secrete mature interleukin‐1β. These effects depend on activation of spleen tyrosine kinase (SYK) coupled to C‐type lectin receptors. Using autologous cocultures, we show that SYK and NLRP3 orchestrate macrophage‐driven activation of effector memory T cells. Furthermore, vaccination‐induced macrophage priming can be enhanced with repetitive antigen exposure providing a rationale for prime‐boost concepts to augment innate immune signaling in SARS‐CoV‐2 vaccination. Collectively, these findings identify SYK as a regulatory node capable of differentiating between primed and unprimed macrophages, which modulate spike protein‐specific T cell responses.
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Affiliation(s)
- Sebastian J Theobald
- Department I of Internal Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Alexander Simonis
- Department I of Internal Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Julie M Mudler
- Department I of Internal Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Ulrike Göbel
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Richard Acton
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Viktoria Kohlhas
- Department I of Internal Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany.,Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Marie-Christine Albert
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Center for Biochemistry, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
| | - Anna-Maria Hellmann
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany.,Department of Experimental Pediatric Oncology, University Children's Hospital of Cologne, Medical Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
| | - Jakob J Malin
- Department I of Internal Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Sandra Winter
- Department I of Internal Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany.,Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Henning Walczak
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Center for Biochemistry, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany.,Centre for Cell Death, Cancer, and Inflammation (CCCI), UCL Cancer Institute, University College London, London, UK
| | - Phuong-Hien Nguyen
- Department I of Internal Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany.,Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Manuel Koch
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany.,Center for Biochemistry, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany.,Institute for Dental Research and Oral Musculoskeletal Biology,Medical Faculty, University of Cologne, Cologne, Germany
| | - Jan Rybniker
- Department I of Internal Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
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6
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Hirsch C, Park YS, Piechotta V, Chai KL, Estcourt LJ, Monsef I, Salomon S, Wood EM, So-Osman C, McQuilten Z, Spinner CD, Malin JJ, Stegemann M, Skoetz N, Kreuzberger N. SARS-CoV-2-neutralising monoclonal antibodies to prevent COVID-19. Cochrane Database Syst Rev 2022; 6:CD014945. [PMID: 35713300 PMCID: PMC9205158 DOI: 10.1002/14651858.cd014945.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Monoclonal antibodies (mAbs) are laboratory-produced molecules derived from the B cells of an infected host. They are being investigated as potential prophylaxis to prevent coronavirus disease 2019 (COVID-19). OBJECTIVES To assess the effects of SARS-CoV-2-neutralising mAbs, including mAb fragments, to prevent infection with SARS-CoV-2 causing COVID-19; and to maintain the currency of the evidence, using a living systematic review approach. SEARCH METHODS We searched the Cochrane COVID-19 Study Register, MEDLINE, Embase, and three other databases on 27 April 2022. We checked references, searched citations, and contacted study authors to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) that evaluated SARS-CoV-2-neutralising mAbs, including mAb fragments, alone or combined, versus an active comparator, placebo, or no intervention, for pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) of COVID-19. We excluded studies of SARS-CoV-2-neutralising mAbs to treat COVID-19, as these are part of another review. DATA COLLECTION AND ANALYSIS Two review authors independently assessed search results, extracted data, and assessed risk of bias using Cochrane RoB 2. Prioritised outcomes were infection with SARS-CoV-2, development of clinical COVID-19 symptoms, all-cause mortality, admission to hospital, quality of life, adverse events (AEs), and serious adverse events (SAEs). We rated the certainty of evidence using GRADE. MAIN RESULTS We included four RCTs of 9749 participants who were previously uninfected and unvaccinated at baseline. Median age was 42 to 76 years. Around 20% to 77.5% of participants in the PrEP studies and 35% to 100% in the PEP studies had at least one risk factor for severe COVID-19. At baseline, 72.8% to 82.2% were SARS-CoV-2 antibody seronegative. We identified four ongoing studies, and two studies awaiting classification. Pre-exposure prophylaxis Tixagevimab/cilgavimab versus placebo One study evaluated tixagevimab/cilgavimab versus placebo in participants exposed to SARS-CoV-2 wild-type, Alpha, Beta, and Delta variant. About 39.3% of participants were censored for efficacy due to unblinding and 13.8% due to vaccination. Within six months, tixagevimab/cilgavimab probably decreases infection with SARS-CoV-2 (risk ratio (RR) 0.45, 95% confidence interval (CI) 0.29 to 0.70; 4685 participants; moderate-certainty evidence), decreases development of clinical COVID-19 symptoms (RR 0.18, 95% CI 0.09 to 0.35; 5172 participants; high-certainty evidence), and may decrease admission to hospital (RR 0.03, 95% CI 0 to 0.59; 5197 participants; low-certainty evidence). Tixagevimab/cilgavimab may result in little to no difference on mortality within six months, all-grade AEs, and SAEs (low-certainty evidence). Quality of life was not reported. Casirivimab/imdevimab versus placebo One study evaluated casirivimab/imdevimab versus placebo in participants who may have been exposed to SARS-CoV-2 wild-type, Alpha, and Delta variant. About 36.5% of participants opted for SARS-CoV-2 vaccination and had a mean of 66.1 days between last dose of intervention and vaccination. Within six months, casirivimab/imdevimab may decrease infection with SARS-CoV-2 (RR 0.01, 95% CI 0 to 0.14; 825 seronegative participants; low-certainty evidence) and may decrease development of clinical COVID-19 symptoms (RR 0.02, 95% CI 0 to 0.27; 969 participants; low-certainty evidence). We are uncertain whether casirivimab/imdevimab affects mortality regardless of the SARS-CoV-2 antibody serostatus. Casirivimab/imdevimab may increase all-grade AEs slightly (RR 1.14, 95% CI 0.98 to 1.31; 969 participants; low-certainty evidence). The evidence is very uncertain about the effects on grade 3 to 4 AEs and SAEs within six months. Admission to hospital and quality of life were not reported. Postexposure prophylaxis Bamlanivimab versus placebo One study evaluated bamlanivimab versus placebo in participants who may have been exposed to SARS-CoV-2 wild-type. Bamlanivimab probably decreases infection with SARS-CoV-2 versus placebo by day 29 (RR 0.76, 95% CI 0.59 to 0.98; 966 participants; moderate-certainty evidence), may result in little to no difference on all-cause mortality by day 60 (R 0.83, 95% CI 0.25 to 2.70; 966 participants; low-certainty evidence), may increase all-grade AEs by week eight (RR 1.12, 95% CI 0.86 to 1.46; 966 participants; low-certainty evidence), and may increase slightly SAEs (RR 1.46, 95% CI 0.73 to 2.91; 966 participants; low-certainty evidence). Development of clinical COVID-19 symptoms, admission to hospital within 30 days, and quality of life were not reported. Casirivimab/imdevimab versus placebo One study evaluated casirivimab/imdevimab versus placebo in participants who may have been exposed to SARS-CoV-2 wild-type, Alpha, and potentially, but less likely to Delta variant. Within 30 days, casirivimab/imdevimab decreases infection with SARS-CoV-2 (RR 0.34, 95% CI 0.23 to 0.48; 1505 participants; high-certainty evidence), development of clinical COVID-19 symptoms (broad-term definition) (RR 0.19, 95% CI 0.10 to 0.35; 1505 participants; high-certainty evidence), may result in little to no difference on mortality (RR 3.00, 95% CI 0.12 to 73.43; 1505 participants; low-certainty evidence), and may result in little to no difference in admission to hospital. Casirivimab/imdevimab may slightly decrease grade 3 to 4 AEs (RR 0.50, 95% CI 0.24 to 1.02; 2617 participants; low-certainty evidence), decreases all-grade AEs (RR 0.70, 95% CI 0.61 to 0.80; 2617 participants; high-certainty evidence), and may result in little to no difference on SAEs in participants regardless of SARS-CoV-2 antibody serostatus. Quality of life was not reported. AUTHORS' CONCLUSIONS For PrEP, there is a decrease in development of clinical COVID-19 symptoms (high certainty), infection with SARS-CoV-2 (moderate certainty), and admission to hospital (low certainty) with tixagevimab/cilgavimab. There is low certainty of a decrease in infection with SARS-CoV-2, and development of clinical COVID-19 symptoms; and a higher rate for all-grade AEs with casirivimab/imdevimab. For PEP, there is moderate certainty of a decrease in infection with SARS-CoV-2 and low certainty for a higher rate for all-grade AEs with bamlanivimab. There is high certainty of a decrease in infection with SARS-CoV-2, development of clinical COVID-19 symptoms, and a higher rate for all-grade AEs with casirivimab/imdevimab. Although there is high-to-moderate certainty evidence for some outcomes, it is insufficient to draw meaningful conclusions. These findings only apply to people unvaccinated against COVID-19. They are only applicable to the variants prevailing during the study and not other variants (e.g. Omicron). In vitro, tixagevimab/cilgavimab is effective against Omicron, but there are no clinical data. Bamlanivimab and casirivimab/imdevimab are ineffective against Omicron in vitro. Further studies are needed and publication of four ongoing studies may resolve the uncertainties.
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Affiliation(s)
- Caroline Hirsch
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Yun Soo Park
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Vanessa Piechotta
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Khai Li Chai
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lise J Estcourt
- Haematology/Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
| | - Ina Monsef
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Susanne Salomon
- Laboratory of Experimental Immunology, Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Erica M Wood
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Zoe McQuilten
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Jakob J Malin
- Department I for Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Miriam Stegemann
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nicole Skoetz
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nina Kreuzberger
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Kaduszkiewicz H, Kochen MM, Kluge S, Malin JJ, Weibel S, Skoetz N. Recommendations for the Outpatient Drug Treatment of Patients With COVID-19. Dtsch Arztebl Int 2022; 119:342-349. [PMID: 35506263 PMCID: PMC9468468 DOI: 10.3238/arztebl.m2022.0203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND One of the purposes of outpatient treatment for COVID-19 patients is to prevent severe disease courses and hospitalization. There is a need for evidence-based recommendations to be applied in primary care and specialized outpatient settings. METHODS This guideline was developed on the basis of publications that were retrieved by a systematic search for randomized controlled trials in the Cochrane COVID-19 trial registry. The quality of evidence was assessed with GRADE, and structured consensus generation was carried out with MAGICapp. RESULTS Unvaccinated COVID-19 outpatients with at least one risk factor for a severe disease course may be treated in the early phase of the disease with sotrovimab, remdesivir, or nirmatrelvir/ritonavir. Molnupiravir may also be used for such patients if no other clinically appropriate treatment options are available. Immunosuppressed persons with COVID-19 who are at high risk, and whose response to vaccination is expected to be reduced, ought to be treated with sotrovimab. It should be noted, however, that the clinical efficacy of sotrovimab against infections with the omicron subtype BA.2 is uncertain at the currently used dose, as the drug has displayed reduced activity against this subtype in vitro. COVID-19 patients at risk of a severe course may be offered budesonide inhalation, according to an off-label recommendation of the German College of General Practitioners and Family Physicians (other medical societies do not recommend either for or against this treatment). Thrombo - embolism prophylaxis with low-molecular-weight heparin may be given to elderly patients or those with a pre-existing illness. No recommendation is made concerning fluvoxamine or colchicine. Acetylsalicylic acid, azithromycin, ivermectin, systemic steroids, and vitamin D should not be used for the outpatient treatment of COVID-19. CONCLUSION Drug treatment is now available for outpatients with COVID-19 in the early phase. Nearly all of the relevant trials have been conducted in unvaccinated subjects; this needs to be kept in mind in patient selection.
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Affiliation(s)
- Hanna Kaduszkiewicz
- Institute of General Medicine, Christian Albrechts University of Kiel; Emeritus, University Medical Center Göttingen; Institute of General Medicine, Faculty of Medicine, University Medical Center Freiburg; Department of Intensive Care Medicine, Hamburg-Eppendorf University Hospital; Department I of Internal Medicine, Division of Infectious Diseases, Faculty of Medicine and University Hospital Cologne, University of Cologne; Medical Clinic and Polyclinic for Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, University Hospital of Würzburg; Department I of Internal Medicine, Evidence-Based Oncology, Faculty of Medicine and University Hospital of Cologne, University of Cologne; *See eBox for members of the guideline group and the consensus conference (collaborators)
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8
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Gruell H, Gunst JD, Cohen YZ, Pahus MH, Malin JJ, Platten M, Millard KG, Tolstrup M, Jones RB, Conce Alberto WD, Lorenzi JCC, Oliveira TY, Kümmerle T, Suárez I, Unson-O'Brien C, Nogueira L, Olesen R, Østergaard L, Nielsen H, Lehmann C, Nussenzweig MC, Fätkenheuer G, Klein F, Caskey M, Søgaard OS. Effect of 3BNC117 and romidepsin on the HIV-1 reservoir in people taking suppressive antiretroviral therapy (ROADMAP): a randomised, open-label, phase 2A trial. Lancet Microbe 2022; 3:e203-e214. [PMID: 35544074 DOI: 10.1016/s2666-5247(21)00239-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The administration of broadly neutralising anti-HIV-1 antibodies before latency reversal could facilitate elimination of HIV-1-infected CD4 T cells. We tested this concept by combining the broadly neutralising antibody 3BNC117 in combination with the latency-reversing agent romidepsin in people with HIV-1 who were taking suppressive antiretroviral therapy (ART). METHODS We did a randomised, open-label, phase 2A trial at three university hospital centres in Denmark, Germany, and the USA. Eligible participants were virologically suppressed adults aged 18-65 years who were infected with HIV-1 and on ART for at least 18 months, with plasma HIV-1 RNA concentrations of less than 50 copies per mL for at least 12 months, and a CD4 T-cell count of greater than 500 cells per μL. Participants were randomly assigned (1:1) to receive 3BNC117 plus romidepsin or romidepsin alone in two cycles. All participants received intravenous infusions of romidepsin (5 mg/m2 given over 120 min) at weeks 0, 1, and 2 (treatment cycle 1) and weeks 8, 9, and 10 (treatment cycle 2). Those in the 3BNC117 plus romidepsin group received an intravenous infusion of 3BNC117 (30 mg/kg given over 60 min) 2 days before each treatment cycle. An analytic treatment interruption (ATI) of ART was done at week 24 in both groups. Our primary endpoint was time to viral rebound during analytic treatment interruption, which was assessed in all participants who completed both treatment cycles and ATI. We used a log-rank test to compare time to viral rebound during analytic treatment interruption between the two groups. This trial is registered with ClinicalTrials.gov, NCT02850016. It is closed to new participants, and all follow-up is complete. FINDINGS Between March 20, 2017, and Aug 14, 2018, 22 people were enrolled and randomly assigned, 11 to the 3BNC117 plus romidepsin group and 11 to the romidepsin group. 19 participants completed both treatment cycles and the ATI: 11 in the 3BNC117 plus romidepsin group and 8 in the romidepsin group. The median time to viral rebound during ATI was 18 days (IQR 14-28) in the 3BNC117 plus romidepsin group and 28 days (21-35) in the romidepsin group B (p=0·0016). Although this difference was significant, prolongation of time to viral rebound was not clinically meaningful in either group. All participants in both groups reported adverse events, but overall the combination of 3BNC117 and romidepsin was safe. Two severe adverse events were observed in the romidepsin group during 48 weeks of follow-up, one of which-increased direct bilirubin-was judged to be related to treatment. INTERPRETATION The combination of 3BNC117 and romidepsin was safe but did not delay viral rebound during analytic treatment interruptions in individuals on long-term ART. The results of our trial could serve as a benchmark for further optimisation of HIV-1 curative strategies among people with HIV-1 who are taking suppressive ART. FUNDING amfAR, German Center for Infection Research.
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Affiliation(s)
- Henning Gruell
- Laboratory of Experimental Immunology, Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; German Center for Infection Research (DZIF) Bonn-Cologne, Cologne, Germany
| | - Jesper D Gunst
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Yehuda Z Cohen
- Laboratory of Molecular Immunology, The Rockefeller University, New York, NY, USA
| | - Marie H Pahus
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Jakob J Malin
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martin Platten
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Wisplinghoff Laboratories, Cologne, Germany
| | - Katrina G Millard
- Laboratory of Molecular Immunology, The Rockefeller University, New York, NY, USA
| | - Martin Tolstrup
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - R Brad Jones
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Winnifer D Conce Alberto
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Julio C C Lorenzi
- Laboratory of Molecular Immunology, The Rockefeller University, New York, NY, USA
| | - Thiago Y Oliveira
- Laboratory of Molecular Immunology, The Rockefeller University, New York, NY, USA
| | - Tim Kümmerle
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Praxis am Ebertplatz, Cologne, Germany
| | - Isabelle Suárez
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; German Center for Infection Research (DZIF) Bonn-Cologne, Cologne, Germany
| | | | - Lilian Nogueira
- Laboratory of Molecular Immunology, The Rockefeller University, New York, NY, USA
| | - Rikke Olesen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Østergaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Clara Lehmann
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; German Center for Infection Research (DZIF) Bonn-Cologne, Cologne, Germany; Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Michel C Nussenzweig
- Laboratory of Molecular Immunology, The Rockefeller University, New York, NY, USA; Howard Hughes Medical Institute, The Rockefeller University, New York, NY, USA
| | - Gerd Fätkenheuer
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; German Center for Infection Research (DZIF) Bonn-Cologne, Cologne, Germany
| | - Florian Klein
- Laboratory of Experimental Immunology, Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; German Center for Infection Research (DZIF) Bonn-Cologne, Cologne, Germany; Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Marina Caskey
- Laboratory of Molecular Immunology, The Rockefeller University, New York, NY, USA
| | - Ole S Søgaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
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Malin JJ, Bunse T, Spinner CD, Protzer U. [Antiviral drugs : Potent agents, promising therapies for COVID‑19 and therapeutic limitations]. Internist (Berl) 2022; 63:118-128. [PMID: 34988607 PMCID: PMC8730307 DOI: 10.1007/s00108-021-01233-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 12/03/2022]
Abstract
Antiviral drugs inhibit viral replication by interaction with specific elements of the viral replication cycle. Directly acting antiviral agents have revolutionized the therapeutic options for chronic infections with human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV). Pharmacological developments constantly improve therapeutic and prophylactic options for diseases caused by herpes viruses, which is of particular relevance for immunocompromised patients. While infections with persistent viruses, such as HIV, HBV or herpes viruses principally so far cannot be cured, complete elimination of viruses that cause acute infections is possible; however, acute infections, such as influenza or coronavirus disease 2019 (COVID-19) offer only a small therapeutic window for antiviral strategies due to their pathophysiological dynamics. The optimal time point for antiviral agents is immediately after exposure to the virus, which frequently limits its application in practice. An effective pre-exposure or postexposure prophylaxis has been established for infections with HIV and influenza A/B and also gains relevance for infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
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Affiliation(s)
- Jakob J Malin
- Klinik I für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland
| | - Till Bunse
- Institut für Virologie, Technische Universität München, München, Deutschland
| | - Christoph D Spinner
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Ulrike Protzer
- Institut für Virologie, Technische Universität München/Helmholtz Zentrum München, Trogerstr. 30, 81675, München, Deutschland.
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Kluge S, Malin JJ, Fichtner F, Müller OJ, Skoetz N, Karagiannidis C. Clinical Practice Guideline: Recommendations on the In-Hospital Treatment of Patients With COVID-19. Dtsch Arztebl Int 2021; 118:865-871. [PMID: 34789365 DOI: 10.3238/arztebl.m2021.0374] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The mortality of COVID-19 patients who are admitted to a hospital because of the disease remains high. The implementation of evidence-based treatments can improve the quality of care. METHODS The new clinical practice guideline is based on publications retrieved by a systematic search in the Medline databases via PubMed and in the Cochrane COVID-19 trial registry, followed by a structured consensus process leading to the adoption of graded recommendations. RESULTS Therapeutic anticoagulation can be considered in patients who do not require intensive care and have an elevated risk of thromboembolism (for example, those with D-dimer levels ≥ 2 mg/L). For patients in intensive care, therapeutic anticoagulation has no benefit. For patients with hypoxemic respiratory insufficiency, prone positioning and an early therapy attempt with CPAP/noninvasive ventilation (CPAP, continuous positive airway pressure) or high-flow oxygen therapy is recommended. Patients with IgG-seronegativity and, at most, low-flow oxygen should be treated with SARS-CoV-2- specific monoclonal antibodies (at present, casirivimab and imdevimab). Patients needing no more than low-flow oxygen should additionally be treated with janus kinase (JAK) inhibitors. All patients who need oxygen (low-flow, high-flow, noninvasive ventilation/CPAP, invasive ventilation) should be given systemic corticosteroids. Tocilizumab should be given to patients with a high oxygen requirement and progressively severe COVID-19 disease, but not in combination with JAK inhibitors. CONCLUSION Noninvasive ventilation, high-flow oxygen therapy, prone positioning, and invasive ventilation are important elements of the treatment of hypoxemic patients with COVID-19. A reduction of mortality has been demonstrated for the administration of monoclonal antibodies, JAK inhibitors, corticosteroids, tocilizumab, and therapeutic anticoagulation to specific groups of patients.
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Malin JJ, Spinner CD, Janssens U, Welte T, Weber-Carstens S, Schälte G, Gastmeier P, Langer F, Wepler M, Westhoff M, Pfeifer M, Rabe KF, Hoffmann F, Böttiger BW, Weinmann-Menke J, Kersten A, Berlit P, Krawczyk M, Nehls W, Fichtner F, Laudi S, Stegemann M, Skoetz N, Nothacker M, Marx G, Karagiannidis C, Kluge S. Correction to: Key summary of German national treatment guidance for hospitalized COVID‑19 patients : Key pharmacologic recommendations from a national German living guideline using an Evidence to Decision Framework (last updated 17.05.2021). Infection 2021; 50:107-108. [PMID: 34414563 PMCID: PMC8375461 DOI: 10.1007/s15010-021-01665-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jakob J Malin
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.
| | - Christoph D Spinner
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, University Hospital Rechts Der Isar, Munich, Germany
| | - Uwe Janssens
- Medical Clinic and Medical Intensive Care Medicine, St Antonius Hospital, Eschweiler, Germany
| | - Tobias Welte
- Department of Respiratory Medicine and German Centre of Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Gereon Schälte
- Department of Anaesthesiology, Medical Faculty Aachen, Rhenish Westphalian Technical University (RWTH), Aachen, Germany
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité-University Medicine, Berlin, Germany
| | - Florian Langer
- Department of Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Wepler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ulm, Ulm, Germany
| | - Michael Westhoff
- Department of Pneumology, Intensive Care and Sleep Medicine, Hemer Lung Clinic Centre of Pneumology and Thoracic Surgery, 58675, Hemer, Germany
| | - Michael Pfeifer
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
- Department of Pneumology, Donaustauf Hospital, Donaustauf, Germany
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Airway Research Centre North, German Centre for Lung Research, Grosshansdorf, Germany
| | - Florian Hoffmann
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Bernd W Böttiger
- Department of Anesthesiology and Intensive Care Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Weinmann-Menke
- Division of Nephrology, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Alexander Kersten
- Department of Cardiology, Angiology and Intensive Care, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Peter Berlit
- Germany German Society of Neurology, Berlin, Germany
| | - Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Wiebke Nehls
- Department of Palliative Care and Geriatric Medicine, Helios Clinic Emil Von Behring, Berlin, Germany
| | - Falk Fichtner
- Department of Anesthesiology and Intensive Care, University Hospital of Leipzig, Leipzig, Germany
| | - Sven Laudi
- Department of Anesthesiology and Intensive Care, University Hospital of Leipzig, Leipzig, Germany
| | - Miriam Stegemann
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nicole Skoetz
- Evidence-Based Oncology, Department I of Internal Medicine and Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Monika Nothacker
- Institute for Medical Knowledge Management, Association of the Scientific Medical Societies (AWMF), Universität Marburg, Marburg, Germany
| | - Gernot Marx
- Department of Intensive Care Medicine and Intermediate Care, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany
| | - Christian Karagiannidis
- Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken Der Stadt Köln, Witten/Herdecke University Hospital, Cologne, Germany
| | - Stefan Kluge
- Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Theobald SJ, Simonis A, Georgomanolis T, Kreer C, Zehner M, Eisfeld HS, Albert M, Chhen J, Motameny S, Erger F, Fischer J, Malin JJ, Gräb J, Winter S, Pouikli A, David F, Böll B, Koehler P, Vanshylla K, Gruell H, Suárez I, Hallek M, Fätkenheuer G, Jung N, Cornely OA, Lehmann C, Tessarz P, Altmüller J, Nürnberg P, Kashkar H, Klein F, Koch M, Rybniker J. Long-lived macrophage reprogramming drives spike protein-mediated inflammasome activation in COVID-19. EMBO Mol Med 2021; 13:e14150. [PMID: 34133077 PMCID: PMC8350892 DOI: 10.15252/emmm.202114150] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 01/12/2023] Open
Abstract
Innate immunity triggers responsible for viral control or hyperinflammation in COVID-19 are largely unknown. Here we show that the SARS-CoV-2 spike protein (S-protein) primes inflammasome formation and release of mature interleukin-1β (IL-1β) in macrophages derived from COVID-19 patients but not in macrophages from healthy SARS-CoV-2 naïve individuals. Furthermore, longitudinal analyses reveal robust S-protein-driven inflammasome activation in macrophages isolated from convalescent COVID-19 patients, which correlates with distinct epigenetic and gene expression signatures suggesting innate immune memory after recovery from COVID-19. Importantly, we show that S-protein-driven IL-1β secretion from patient-derived macrophages requires non-specific monocyte pre-activation in vivo to trigger NLRP3-inflammasome signaling. Our findings reveal that SARS-CoV-2 infection causes profound and long-lived reprogramming of macrophages resulting in augmented immunogenicity of the SARS-CoV-2 S-protein, a major vaccine antigen and potent driver of adaptive and innate immune signaling.
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Affiliation(s)
- Sebastian J Theobald
- Department I of Internal MedicineFaculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
- Faculty of Medicine and University Hospital of CologneCenter for Molecular Medicine Cologne (CMMC)University of CologneCologneGermany
| | - Alexander Simonis
- Department I of Internal MedicineFaculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
- Faculty of Medicine and University Hospital of CologneCenter for Molecular Medicine Cologne (CMMC)University of CologneCologneGermany
| | - Theodoros Georgomanolis
- Faculty of Medicine and University Hospital of CologneCologne Center for Genomics (CCG)University of CologneCologneGermany
| | - Christoph Kreer
- Laboratory of Experimental ImmunologyInstitute of VirologyFaculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
| | - Matthias Zehner
- Laboratory of Experimental ImmunologyInstitute of VirologyFaculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
| | - Hannah S Eisfeld
- Department I of Internal MedicineFaculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
- Faculty of Medicine and University Hospital of CologneCenter for Molecular Medicine Cologne (CMMC)University of CologneCologneGermany
| | - Marie‐Christine Albert
- Excellence Cluster on Cellular Stress Responses in Aging‐Associated Diseases (CECAD)University of CologneCologneGermany
- Institute for Medical Microbiology, Immunology and Hygiene (IMMIH)University of CologneCologneGermany
| | - Jason Chhen
- Department I of Internal MedicineFaculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
- Faculty of Medicine and University Hospital of CologneCenter for Molecular Medicine Cologne (CMMC)University of CologneCologneGermany
| | - Susanne Motameny
- Faculty of Medicine and University Hospital of CologneCologne Center for Genomics (CCG)University of CologneCologneGermany
| | - Florian Erger
- Faculty of Medicine and University Hospital of CologneCologne Center for Genomics (CCG)University of CologneCologneGermany
- Faculty of MedicineInstitute of Human GeneticsUniversity Hospital CologneCologneGermany
| | - Julia Fischer
- Department I of Internal MedicineFaculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
- Faculty of Medicine and University Hospital of CologneCenter for Molecular Medicine Cologne (CMMC)University of CologneCologneGermany
- German Center for Infection Research (DZIF), Partner Site Bonn‐CologneCologneGermany
| | - Jakob J Malin
- Department I of Internal MedicineFaculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
- Faculty of Medicine and University Hospital of CologneCenter for Molecular Medicine Cologne (CMMC)University of CologneCologneGermany
| | - Jessica Gräb
- Department I of Internal MedicineFaculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
- Faculty of Medicine and University Hospital of CologneCenter for Molecular Medicine Cologne (CMMC)University of CologneCologneGermany
| | - Sandra Winter
- Department I of Internal MedicineFaculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
- Faculty of Medicine and University Hospital of CologneCenter for Molecular Medicine Cologne (CMMC)University of CologneCologneGermany
| | - Andromachi Pouikli
- Max Planck Research Group “Chromatin and Ageing”Max Planck Institute for Biology of AgeingCologneGermany
| | - Friederike David
- Faculty of Medicine and University Hospital of CologneCologne Center for Genomics (CCG)University of CologneCologneGermany
| | - Boris Böll
- Department I of Internal MedicineFaculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
| | - Philipp Koehler
- Department I of Internal MedicineFaculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
- Faculty of Medicine and University Hospital of CologneCenter for Molecular Medicine Cologne (CMMC)University of CologneCologneGermany
- Excellence Cluster on Cellular Stress Responses in Aging‐Associated Diseases (CECAD)University of CologneCologneGermany
| | - Kanika Vanshylla
- Laboratory of Experimental ImmunologyInstitute of VirologyFaculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
| | - Henning Gruell
- Laboratory of Experimental ImmunologyInstitute of VirologyFaculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
| | - Isabelle Suárez
- Department I of Internal MedicineFaculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
- German Center for Infection Research (DZIF), Partner Site Bonn‐CologneCologneGermany
| | - Michael Hallek
- Department I of Internal MedicineFaculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
| | - Gerd Fätkenheuer
- Department I of Internal MedicineFaculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
- German Center for Infection Research (DZIF), Partner Site Bonn‐CologneCologneGermany
| | - Norma Jung
- Department I of Internal MedicineFaculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
- German Center for Infection Research (DZIF), Partner Site Bonn‐CologneCologneGermany
| | - Oliver A Cornely
- Department I of Internal MedicineFaculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
- Faculty of Medicine and University Hospital of CologneCenter for Molecular Medicine Cologne (CMMC)University of CologneCologneGermany
- Excellence Cluster on Cellular Stress Responses in Aging‐Associated Diseases (CECAD)University of CologneCologneGermany
- German Center for Infection Research (DZIF), Partner Site Bonn‐CologneCologneGermany
| | - Clara Lehmann
- Department I of Internal MedicineFaculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
- Faculty of Medicine and University Hospital of CologneCenter for Molecular Medicine Cologne (CMMC)University of CologneCologneGermany
- German Center for Infection Research (DZIF), Partner Site Bonn‐CologneCologneGermany
| | - Peter Tessarz
- Excellence Cluster on Cellular Stress Responses in Aging‐Associated Diseases (CECAD)University of CologneCologneGermany
- Max Planck Research Group “Chromatin and Ageing”Max Planck Institute for Biology of AgeingCologneGermany
| | - Janine Altmüller
- Faculty of Medicine and University Hospital of CologneCologne Center for Genomics (CCG)University of CologneCologneGermany
| | - Peter Nürnberg
- Faculty of Medicine and University Hospital of CologneCenter for Molecular Medicine Cologne (CMMC)University of CologneCologneGermany
- Faculty of Medicine and University Hospital of CologneCologne Center for Genomics (CCG)University of CologneCologneGermany
| | - Hamid Kashkar
- Excellence Cluster on Cellular Stress Responses in Aging‐Associated Diseases (CECAD)University of CologneCologneGermany
- Institute for Medical Microbiology, Immunology and Hygiene (IMMIH)University of CologneCologneGermany
| | - Florian Klein
- Laboratory of Experimental ImmunologyInstitute of VirologyFaculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
- German Center for Infection Research (DZIF), Partner Site Bonn‐CologneCologneGermany
| | - Manuel Koch
- Medical FacultyInstitute for Dental Research and Oral Musculoskeletal BiologyUniversity of CologneCologneGermany
- Medical FacultyCenter for BiochemistryUniversity of CologneCologneGermany
| | - Jan Rybniker
- Department I of Internal MedicineFaculty of Medicine and University Hospital of CologneUniversity of CologneCologneGermany
- Faculty of Medicine and University Hospital of CologneCenter for Molecular Medicine Cologne (CMMC)University of CologneCologneGermany
- German Center for Infection Research (DZIF), Partner Site Bonn‐CologneCologneGermany
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13
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Paul G, Meißner A, Neuneier J, Neuschmelting V, Grau S, Yagdiran A, Scheyerer MJ, Malin JJ, Suárez I, Lehmann C, Exner M, Wiesmüller GA, Higgins PG, Seifert H, Fätkenheuer G, Zweigner J, Jung N. Outbreak of Pseudomonas aeruginosa infections after CT-guided spinal injections. J Hosp Infect 2021; 116:1-9. [PMID: 34298033 DOI: 10.1016/j.jhin.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Meningitis and spinal infections with Gram-negative bacteria after local injections for treatment of chronic back pain are rare. This study investigated an outbreak of Pseudomonas aeruginosa infections following computed tomography (CT)-guided spinal injections (SI). METHODS A case was defined as a spinal infection or meningitis with P. aeruginosa after SI between 10th January and 1st March 2019 in the same outpatient clinic. Patients without microbiological evidence of P. aeruginosa but with a favourable response to antimicrobial therapy active against P. aeruginosa were defined as probable cases. FINDINGS Twenty-eight of 297 patients receiving CT-guided SI during the study period developed meningitis or spinal infections. Medical records were available for 19 patients. In 15 patients, there was microbiological evidence of P. aeruginosa, and four patients were defined as probable cases. Two of 19 patients developed meningitis, while the remaining 17 patients developed spinal infections. The median time from SI to hospital admission was 8 days (interquartile range 2-23 days). Patients mainly presented with back pain (N=18; 95%), and rarely developed fever (N=3; 16%). Most patients required surgery (N=16; 84%). Seven patients (37%) relapsed and one patient died. Although the source of infection was not identified microbiologically, documented failures in asepsis when performing SI probably contributed to these infections. CONCLUSIONS SI is generally considered safe, but non-adherence to asepsis can lead to deleterious effects. Spinal infections caused by P. aeruginosa are difficult to treat and have a high relapse rate.
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Affiliation(s)
- G Paul
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Department of Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany.
| | - A Meißner
- Department of Hospital Hygiene and Infection Control, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - J Neuneier
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - V Neuschmelting
- Centre for Neurosurgery, Department of General Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - S Grau
- Centre for Neurosurgery, Department of General Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - A Yagdiran
- Department of Orthopaedics and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - M J Scheyerer
- Department of Orthopaedics and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - J J Malin
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - I Suárez
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - C Lehmann
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - M Exner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | - G A Wiesmüller
- Abteilung Infektions- and Umwelthygiene, Gesundheitsamt der Stadt Köln, Germany
| | - P G Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - H Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - G Fätkenheuer
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - J Zweigner
- Department of Hospital Hygiene and Infection Control, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - N Jung
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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14
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Malin JJ, Spinner CD, Janssens U, Welte T, Weber-Carstens S, Schälte G, Gastmeier P, Langer F, Wepler M, Westhoff M, Pfeifer M, Rabe KF, Hoffmann F, Böttiger BW, Weinmann-Menke J, Kersten A, Berlit P, Krawczyk M, Nehls W, Fichtner F, Laudi S, Stegemann M, Skoetz N, Nothacker M, Marx G, Karagiannidis C, Kluge S. Key summary of German national treatment guidance for hospitalized COVID-19 patients Key pharmacologic recommendations from a national German living guideline using an Evidence to Decision Framework (last updated 17.05.2021). Infection 2021; 50:93-106. [PMID: 34228347 PMCID: PMC8259552 DOI: 10.1007/s15010-021-01645-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/19/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE This executive summary of a national living guideline aims to provide rapid evidence based recommendations on the role of drug interventions in the treatment of hospitalized patients with COVID-19. METHODS The guideline makes use of a systematic assessment and decision process using an evidence to decision framework (GRADE) as recommended standard WHO (2021). Recommendations are consented by an interdisciplinary panel. Evidence analysis and interpretation is supported by the CEOsys project providing extensive literature searches and living (meta-) analyses. For this executive summary, selected key recommendations on drug therapy are presented including the quality of the evidence and rationale for the level of recommendation. RESULTS The guideline contains 11 key recommendations for COVID-19 drug therapy, eight of which are based on systematic review and/or meta-analysis, while three recommendations represent consensus expert opinion. Based on current evidence, the panel makes strong recommendations for corticosteroids (WHO scale 5-9) and prophylactic anticoagulation (all hospitalized patients with COVID-19) as standard of care. Intensified anticoagulation may be considered for patients with additional risk factors for venous thromboembolisms (VTE) and a low bleeding risk. The IL-6 antagonist tocilizumab may be added in case of high supplemental oxygen requirement and progressive disease (WHO scale 5-6). Treatment with nMABs may be considered for selected inpatients with an early SARS-CoV-2 infection that are not hospitalized for COVID-19. Convalescent plasma, azithromycin, ivermectin or vitamin D3 should not be used in COVID-19 routine care. CONCLUSION For COVID-19 drug therapy, there are several options that are sufficiently supported by evidence. The living guidance will be updated as new evidence emerges.
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Affiliation(s)
- Jakob J Malin
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.
| | - Christoph D Spinner
- Department of Internal Medicine II, School of Medicine, Technical University of Munich, University Hospital Rechts Der Isar, Munich, Germany
| | - Uwe Janssens
- Medical Clinic and Medical Intensive Care Medicine, St Antonius Hospital, Eschweiler, Germany
| | - Tobias Welte
- Department of Respiratory Medicine and German Centre of Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Gereon Schälte
- Department of Anaesthesiology, Medical Faculty Aachen, Rhenish Westphalian Technical University (RWTH), Aachen, Germany
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité-University Medicine, Berlin, Germany
| | - Florian Langer
- Department of Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Wepler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ulm, Ulm, Germany
| | - Michael Westhoff
- Department of Pneumology, Intensive Care and Sleep Medicine, Hemer Lung Clinic Centre of Pneumology and Thoracic Surgery, 58675, Hemer, Germany
| | - Michael Pfeifer
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.,Department of Pneumology, Donaustauf Hospital, Donaustauf, Germany
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Airway Research Centre North, German Centre for Lung Research, Grosshansdorf, Germany
| | - Florian Hoffmann
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Bernd W Böttiger
- Department of Anesthesiology and Intensive Care Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Weinmann-Menke
- Division of Nephrology, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Alexander Kersten
- Department of Cardiology, Angiology and Intensive Care, Medical Faculty RWTH Aachen, Aachen, Germany
| | - Peter Berlit
- Germany German Society of Neurology, Berlin, Germany
| | - Marcin Krawczyk
- Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany
| | - Wiebke Nehls
- Department of Palliative Care and Geriatric Medicine, Helios Clinic Emil Von Behring, Berlin, Germany
| | - Falk Fichtner
- Department of Anesthesiology and Intensive Care, University Hospital of Leipzig, Leipzig, Germany
| | - Sven Laudi
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Miriam Stegemann
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nicole Skoetz
- Evidence-Based Oncology, Department I of Internal Medicine and Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Monika Nothacker
- Institute for Medical Knowledge Management, Association of the Scientific Medical Societies (AWMF), Universität Marburg, Marburg, Germany
| | - Gernot Marx
- Department of Intensive Care Medicine and Intermediate Care, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany
| | - Christian Karagiannidis
- Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken Der Stadt Köln, Witten/Herdecke University Hospital, Cologne, Germany
| | - Stefan Kluge
- Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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15
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Sörgel F, Malin JJ, Hagmann H, Kinzig M, Bilal M, Eichenauer DA, Scherf-Clavel O, Simonis A, El Tabei L, Fuhr U, Rybniker J. Pharmacokinetics of remdesivir in a COVID-19 patient with end-stage renal disease on intermittent haemodialysis. J Antimicrob Chemother 2021; 76:825-827. [PMID: 33251541 PMCID: PMC7799013 DOI: 10.1093/jac/dkaa500] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 11/09/2020] [Indexed: 12/21/2022] Open
Affiliation(s)
- Fritz Sörgel
- IBMP – Institute for Biomedical and Pharmaceutical Research, Paul-Ehrlich-Straße 19, D-90562, Nürnberg-Heroldsberg, Germany
- Institute of Pharmacology, West German Heart and Vascular Centre, University of Duisburg-Essen, Essen, Germany
| | - Jakob J Malin
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Cologne, Germany
- Faculty of Medicine, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Henning Hagmann
- Faculty of Medicine, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
- Department II of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Martina Kinzig
- IBMP – Institute for Biomedical and Pharmaceutical Research, Paul-Ehrlich-Straße 19, D-90562, Nürnberg-Heroldsberg, Germany
| | - Muhammad Bilal
- Faculty of Medicine and University Hospital Cologne, Center for Pharmacology, Department I of Pharmacology, University of Cologne, Cologne, Germany
| | - Dennis A Eichenauer
- University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Intensive Care Program, Cologne, Germany
| | - Oliver Scherf-Clavel
- IBMP – Institute for Biomedical and Pharmaceutical Research, Paul-Ehrlich-Straße 19, D-90562, Nürnberg-Heroldsberg, Germany
- University of Wuerzburg, Institute for Pharmacy and Food Chemistry, Wuerzburg, Germany
| | - Alexander Simonis
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Cologne, Germany
- Faculty of Medicine, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Lobna El Tabei
- Faculty of Medicine and University Hospital Cologne, Center for Pharmacology, Department I of Pharmacology, University of Cologne, Cologne, Germany
| | - Uwe Fuhr
- Faculty of Medicine and University Hospital Cologne, Center for Pharmacology, Department I of Pharmacology, University of Cologne, Cologne, Germany
| | - Jan Rybniker
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Cologne, Germany
- Faculty of Medicine, Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
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16
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Kluge S, Janssens U, Welte T, Weber-Carstens S, Schälte G, Spinner CD, Malin JJ, Gastmeier P, Langer F, Wepler M, Westhoff M, Pfeifer M, Rabe KF, Hoffmann F, Böttiger BW, Weinmann-Menke J, Kersten A, Berlit P, Haase R, Marx G, Karagiannidis C. [S2k Guideline - Recommendations for Inpatient Therapy of Patients with COVID-19]. Pneumologie 2021; 75:88-112. [PMID: 33450783 DOI: 10.1055/a-1334-1925] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Since December 2019, the novel coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome - Corona Virus-2) has been spreading rapidly in the sense of a global pandemic. This poses significant challenges for clinicians and hospitals and is placing unprecedented strain on the healthcare systems of many countries. The majority of patients with Coronavirus Disease 2019 (COVID-19) present with only mild symptoms such as cough and fever. However, about 6 % require hospitalization. Early clarification of whether inpatient and, if necessary, intensive care treatment is medically appropriate and desired by the patient is of particular importance in the pandemic. Acute hypoxemic respiratory insufficiency with dyspnea and high respiratory rate (> 30/min) usually leads to admission to the intensive care unit. Often, bilateral pulmonary infiltrates/consolidations or even pulmonary emboli are already found on imaging. As the disease progresses, some of these patients develop acute respiratory distress syndrome (ARDS). Mortality reduction of available drug therapy in severe COVID-19 disease has only been demonstrated for dexamethasone in randomized controlled trials. The main goal of supportive therapy is to ensure adequate oxygenation. In this regard, invasive ventilation and repeated prone positioning are important elements in the treatment of severely hypoxemic COVID-19 patients. Strict adherence to basic hygiene, including hand hygiene, and the correct wearing of adequate personal protective equipment are essential when handling patients. Medically necessary actions on patients that could result in aerosol formation should be performed with extreme care and preparation.
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Affiliation(s)
- S Kluge
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN); Berlin.,Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin.,Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin.,ARDS Netzwerk Deutschland, Berlin
| | - U Janssens
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN); Berlin.,Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin.,ARDS Netzwerk Deutschland, Berlin
| | - T Welte
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN); Berlin.,Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin.,ARDS Netzwerk Deutschland, Berlin
| | - S Weber-Carstens
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin.,Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg.,ARDS Netzwerk Deutschland, Berlin
| | - G Schälte
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg
| | - C D Spinner
- Deutsche Gesellschaft für Infektiologie (DGI), Berlin
| | - J J Malin
- Deutsche Gesellschaft für Infektiologie (DGI), Berlin
| | - P Gastmeier
- Deutsche Gesellschaft für Hygiene und Mikrobiologie (DGHM), Münster
| | - F Langer
- Gesellschaft für Thrombose und Hämostaseforschung (GTH), Köln
| | - M Wepler
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg
| | - M Westhoff
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin
| | - M Pfeifer
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin
| | - K F Rabe
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin
| | - F Hoffmann
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin.,Deutsche Gesellschaft für Kinder- und Jugendmedizin (DGKJ), Berlin
| | - B W Böttiger
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin.,Deutscher Rat für Wiederbelebung (German Resuscitation Council; GRC), Ulm
| | | | - A Kersten
- Deutsche Gesellschaft für Kardiologie (DGK)
| | - P Berlit
- Deutsche Gesellschaft für Neurologie (DGN)
| | - R Haase
- Patientenvertretung (individueller Betroffener)
| | - G Marx
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin.,Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg.,ARDS Netzwerk Deutschland, Berlin
| | - C Karagiannidis
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN); Berlin.,Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin.,Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin.,ARDS Netzwerk Deutschland, Berlin
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17
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Simonis A, Theobald SJ, Fätkenheuer G, Rybniker J, Malin JJ. A comparative analysis of remdesivir and other repurposed antivirals against SARS-CoV-2. EMBO Mol Med 2021; 13:e13105. [PMID: 33015938 PMCID: PMC7646058 DOI: 10.15252/emmm.202013105] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023] Open
Abstract
The ongoing SARS-CoV-2 pandemic stresses the need for effective antiviral drugs that can quickly be applied in order to reduce morbidity, mortality, and ideally viral transmission. By repurposing of broadly active antiviral drugs and compounds that are known to inhibit viral replication of related viruses, several advances could be made in the development of treatment strategies against COVID-19. The nucleoside analog remdesivir, which is known for its potent in vitro activity against Ebolavirus and other RNA viruses, was recently shown to reduce the time to recovery in patients with severe COVID-19. It is to date the only approved antiviral for treating COVID-19. Here, we provide a mechanism and evidence-based comparative review of remdesivir and other repurposed drugs with proven in vitro activity against SARS-CoV-2.
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Affiliation(s)
- Alexander Simonis
- Department I of Internal MedicineDivision of Infectious DiseasesUniversity of CologneCologneGermany
- Faculty of MedicineCenter for Molecular Medicine Cologne (CMMC)University of CologneCologneGermany
| | - Sebastian J Theobald
- Department I of Internal MedicineDivision of Infectious DiseasesUniversity of CologneCologneGermany
- Faculty of MedicineCenter for Molecular Medicine Cologne (CMMC)University of CologneCologneGermany
| | - Gerd Fätkenheuer
- Department I of Internal MedicineDivision of Infectious DiseasesUniversity of CologneCologneGermany
| | - Jan Rybniker
- Department I of Internal MedicineDivision of Infectious DiseasesUniversity of CologneCologneGermany
- Faculty of MedicineCenter for Molecular Medicine Cologne (CMMC)University of CologneCologneGermany
- German Center for Infection Research (DZIF)Partner Site Bonn‐CologneCologneGermany
| | - Jakob J Malin
- Department I of Internal MedicineDivision of Infectious DiseasesUniversity of CologneCologneGermany
- Faculty of MedicineCenter for Molecular Medicine Cologne (CMMC)University of CologneCologneGermany
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18
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Suárez I, Rohr S, Stecher M, Lehmann C, Winter S, Jung N, Priesner V, Berger M, Wyen C, Augustin M, Malin JJ, Fischer J, Horn C, Neuhann F, Püsken M, Plum G, Fätkenheuer G, Rybniker J. Plasma interferon-γ-inducible protein 10 (IP-10) levels correlate with disease severity and paradoxical reactions in extrapulmonary tuberculosis. Infection 2020; 49:437-445. [PMID: 33140838 PMCID: PMC7605464 DOI: 10.1007/s15010-020-01541-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 09/11/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND With 1.5 million deaths worldwide in 2018, tuberculosis (TB) remains a major global public health problem. While pulmonary TB (PTB) is the most common manifestation, the proportion of extrapulmonary TB (EPTB) is increasing in low-burden countries. EPTB is a heterogeneous disease entity posing diagnostic and management challenges due to the lack of reliable biomarkers. In this study, we prospectively evaluated clinical data and treatment response which were correlated with different biomarkers. METHODS The study was conducted at the University Hospital of Cologne. 20 patients with EPTB were enrolled. We analyzed plasma interferon-γ-inducible protein 10 (IP-10) levels in plasma by ELISA for up to 12 months of treatment. In addition, the QuantiFERON®-TB Gold Plus (QFT® Plus) test was performed during the course of treatment. Clinical data were assessed prospectively and correlated with QFT® Plus and IP-10 levels. RESULTS Plasma IP-10 levels were found to be significantly increased (p < 0.001) in patients with extensive disease compared to patients with limited disease (cervical lymph node TB) or healthy controls. In patients with clinically confirmed paradoxical reaction (PR), a further increase of IP-10 was noted. IFN-γ measured by the QFT® Plus test did not decrease significantly during the course of treatment. Of note, in four EPTB patients (20%) without radiographic pulmonary involvement, sputum culture was positive for Mycobacterium tuberculosis. CONCLUSION Our data demonstrate that IP-10 may be a valuable biomarker for estimation of disease severity in EPTB and monitoring of the disease course in extensive forms. However, IP-10 may be less suitable for diagnosis and monitoring of EPTB patients with limited disease. The QFT® Plus test does not appear to be a suitable marker for therapy monitoring. Sputum should be examined in EPTB patients even in case of normal diagnostic imaging of the chest.
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Affiliation(s)
- Isabelle Suárez
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Samuel Rohr
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Melanie Stecher
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Clara Lehmann
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Sandra Winter
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Norma Jung
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Vanessa Priesner
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Melanie Berger
- Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, Kliniken Der Stadt Köln GmbH, Witten/Herdecke University Hospital, Ostmerheimer Strasse 200, 51109, Cologne, Germany
| | - Christoph Wyen
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,Praxis Am Ebertplatz, Cologne, Germany
| | - Max Augustin
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Jakob J Malin
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Julia Fischer
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Carola Horn
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Florian Neuhann
- Levy Mwanawasa Medical University (LMMU), Lusaka, Zambia.,Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany.,Municipal Health Authority Cologne, Cologne, Germany
| | - Michael Püsken
- Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany
| | - Georg Plum
- Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany
| | - Gerd Fätkenheuer
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Jan Rybniker
- Division of Infectious Diseases, Department I of Internal Medicine, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. .,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany. .,Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany.
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19
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Paul G, Wesselmann J, Adzic D, Malin JJ, Suarez I, Priesner V, Kümmerle T, Wyen C, Jung N, van Bremen K, Schlabe S, Wasmuth JC, Boesecke C, Fätkenheuer G, Rockstroh J, Schwarze-Zander C, Lehmann C. Predictors of serofast state after treatment for early syphilis in HIV-infected patients. HIV Med 2020; 22:165-171. [PMID: 33128333 DOI: 10.1111/hiv.12985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/25/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Non-treponemal serological tests are used to monitor treatment response during syphilis infection. Syphilis- and HIV-coinfected patients may experience incomplete resolution in non-treponemal titres, which is referred to as the serofast state. The goal of this study was to evaluate risk factors for serofast state in HIV-infected patients. METHODS From November 2015 to June 2018, 1530 HIV-positive patients were tested for syphilis using a Treponema pallidum particle agglutination (TPPA) assay. Among TPPA-positive patients, medical records were reviewed for early syphilis infection. Serofast state was defined as a less than four-fold decrease in non-treponemal antibody titres during a 6-month follow-up period in the absence of symptoms of syphilis. Baseline characteristics were tested as predictive factors of serological response. RESULTS In all, 515 patients (33.7%) tested positive in TPPA assays, and in 163 patients at least one previous syphilis infection was documented. A total of 61 out of 163 patients (37.4%) were in a serofast state. A history of previous syphilis infection (61 vs. 43%; P = 0.04) was more common in serofast patients than in patients with serological cure after 6 months. Non-treponemal titres ≥ 1:32 before therapy (47 vs. 25%; P = 0.005) and adjunctive corticosteroids to prevent the Jarisch-Herxheimer reaction (35% vs 15%; P = 0.006) were associated with serological cure after 6 months, but corticosteroid therapy had no influence at 12 months. The intensity of syphilis treatment did not affect serological cure. CONCLUSION Corticosteroids for prevention of the Jarisch-Herxheimer reaction were associated with earlier serological cure. Although serological response is the accredited surrogate method to monitor syphilis treatment, the biological significance of the serofast state remains unclear.
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Affiliation(s)
- G Paul
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.,Department of Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
| | - J Wesselmann
- Department of Medicine I, Bonn University Hospital, Bonn, Germany
| | - D Adzic
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - J J Malin
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - I Suarez
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - V Priesner
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - T Kümmerle
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - C Wyen
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - N Jung
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - K van Bremen
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - S Schlabe
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - J-C Wasmuth
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - C Boesecke
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - G Fätkenheuer
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - J Rockstroh
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - C Schwarze-Zander
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - C Lehmann
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Bonn-Cologne, Germany
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20
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Augustin M, Schommers P, Suárez I, Koehler P, Gruell H, Klein F, Maurer C, Langerbeins P, Priesner V, Schmidt-Hellerau K, Malin JJ, Stecher M, Jung N, Wiesmüller G, Meissner A, Zweigner J, Langebartels G, Kolibay F, Suárez V, Burst V, Valentin P, Schedler D, Cornely OA, Hallek M, Fätkenheuer G, Rybniker J, Lehmann C. Rapid response infrastructure for pandemic preparedness in a tertiary care hospital: lessons learned from the COVID-19 outbreak in Cologne, Germany, February to March 2020. ACTA ACUST UNITED AC 2020; 25. [PMID: 32489176 PMCID: PMC7268272 DOI: 10.2807/1560-7917.es.2020.25.21.2000531] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Indexed: 12/21/2022]
Abstract
The coronavirus disease (COVID-19) pandemic has caused tremendous pressure on hospital infrastructures such as emergency rooms (ER) and outpatient departments. To avoid malfunctioning of critical services because of large numbers of potentially infected patients seeking consultation, we established a COVID-19 rapid response infrastructure (CRRI), which instantly restored ER functionality. The CRRI was also used for testing of hospital personnel, provided epidemiological data and was a highly effective response to increasing numbers of suspected COVID-19 cases.
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Affiliation(s)
- Max Augustin
- These authors contributed equally to this article.,University of Cologne, Center for Molecular Medicine Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | - Philipp Schommers
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,These authors contributed equally to this article.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | - Isabelle Suárez
- These authors contributed equally to this article.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | - Philipp Koehler
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Department I of Internal Medicine, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.,University of Cologne, Center for Molecular Medicine Cologne, Cologne, Germany.,University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | - Henning Gruell
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Florian Klein
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,University of Cologne, Center for Molecular Medicine Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Christian Maurer
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Köln, Düsseldorf, University of Cologne, Cologne, Germany
| | - Petra Langerbeins
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Köln, Düsseldorf, University of Cologne, Cologne, Germany
| | - Vanessa Priesner
- University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | - Kirsten Schmidt-Hellerau
- University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | - Jakob J Malin
- University of Cologne, Center for Molecular Medicine Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | - Melanie Stecher
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | - Norma Jung
- University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | | | - Arne Meissner
- Department of Hospital Hygiene and Infection Control, University Hospital Cologne, Cologne, Germany
| | - Janine Zweigner
- Department of Hospital Hygiene and Infection Control, University Hospital Cologne, Cologne, Germany
| | | | - Felix Kolibay
- Department for Clinical Affairs, University of Cologne, Germany
| | - Victor Suárez
- Department II of Internal Medicine (Nephrology, Rheumatology, Diabetes, and General Internal Medicine) and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Volker Burst
- Department II of Internal Medicine (Nephrology, Rheumatology, Diabetes, and General Internal Medicine) and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Philippe Valentin
- Department II of Internal Medicine (Nephrology, Rheumatology, Diabetes, and General Internal Medicine) and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Dirk Schedler
- University of Cologne, Medical Faculty and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Cologne, Germany
| | - Oliver A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Department I of Internal Medicine, Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.,University of Cologne, Center for Molecular Medicine Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine and Center of Integrated Oncology Aachen, Bonn, Köln, Düsseldorf, University of Cologne, Cologne, Germany.,University of Cologne, Center for Molecular Medicine Cologne, Cologne, Germany
| | - Gerd Fätkenheuer
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | - Jan Rybniker
- These authors contributed equally to this article.,University of Cologne, Center for Molecular Medicine Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
| | - Clara Lehmann
- These authors contributed equally to this article.,University of Cologne, Center for Molecular Medicine Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.,University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany
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21
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Abstract
Resistance against commonly used antibiotics has emerged in all bacterial pathogens. In fact, there is no antibiotic currently in clinical use against which resistance has not been reported. In particular, rapidly increasing urbanization in developing nations are sites of major concern. Additionally, the widespread practice by physicians to prescribe antibiotics in cases of viral infections puts selective pressure on antibiotics that still remain effective and it will only be a matter of time before resistance develops on a large scale. The biosynthesis pathway of the bacterial cell wall is well studied and a validated target for the development of antibacterial agents. Cell wall biosynthesis involves two major processes; 1) the biosynthesis of cell wall teichoic acids and 2) the biosynthesis of peptidoglycan. Key molecules in these pathways, including enzymes and precursor molecules are attractive targets for the development of novel antibacterial agents. In this review, we will focus on the major class of natural antibacterial compounds that target the peptidoglycan precursor molecule Lipid II; namely the glycopeptides, including the novel generation of lipoglycopeptides. We will discuss their mechanism-of-action and clinical applications. Further, we will briefly discuss additional peptides that target Lipid II such as the lantibiotic nisin and defensins. We will highlight recent developments and future perspectives.
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Affiliation(s)
- Jakob J Malin
- University of Cologne, Department I of Internal Medicine, Division of Infectious Diseases, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Erik de Leeuw
- Institute of Human Virology and Department of Molecular Biology & Biochemistry of the University of Maryland, Baltimore School of Medicine, Baltimore, MD 21201, USA
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22
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Malin JJ, Boesecke C, Schwarze-Zander C, Wasmuth JC, Schlabe S, Trebicka J, Spengler U, Llibre JM, Jou T, Vasylyev M, Clotet B, Rockstroh JK. Liver stiffness regression after successful Hepatitis C treatment is independent of HIV coinfection. HIV Med 2019; 20:230-236. [PMID: 30687989 DOI: 10.1111/hiv.12705] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The aim of the study was to assess the regression of liver stiffness after successful direct-acting antiviral (DAA) treatment in patients with hepatitis C virus (HCV) monoinfection and HCV/-HIV coinfection. In addition, we aimed to identify factors associated with liver stiffness regression. METHODS We studied patients treated with interferon-free DAA regimens with a sustained virological response at week 12 (SVR12 ) or 24 (SVR24 ) post-treatment. Liver stiffness was assessed by transient elastography (TE) before the initiation and after the end of treatment (median 12 weeks). RESULTS Of 214 enrolled patients, 85 (40%) were HCV monoinfected and 129 (60%) HCV/HIV coinfected. Baseline median TE values were 7.8 kPa [interquartile range (IQR) 5.9-12.0 kPa] in mono-infected patients and 10.7 kPa (IQR 7.8-17.0 kPa) in coinfected patients. Overall, the median TE value decreased from 10.1 to 6.8 kPa (n = 214; P < 0.0001). There was no difference between mono- and coinfected patients (-2.2 versus -3.3 kPa, respectively; P = 0.88), which was verified by an analysis of covariance (ANCOVA) adjusting for baseline TE values. Significant (≥ 30%) regression of liver stiffness was achieved by 45% of patients (54% with baseline TE ≥ 7.1 kPa). In multivariate analysis, a prior HCV treatment was a negative predictor of liver stiffness regression [odds ratio (OR) 0.31; P = 0.001]. A higher baseline TE value was positively associated with achieving a significant regression (OR 1.06; P = 0.02). HIV coinfection status, HCV genotype, age, sex, treatment duration, controlled attenuation parameter value, bilirubin concentration, platelet count and aspartate aminotransferase concentration were not associated with liver stiffness regression. CONCLUSIONS Regression of liver stiffness after successful DAA treatment did not differ in patients with HCV monoinfection and those with HCV/HIV coinfection. Half of all patients achieved a significant (≥ 30%) regression. Prior treatment for HCV was a negative predictor for this endpoint, while a higher baseline TE value was positively associated with regression.
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Affiliation(s)
- J J Malin
- Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany
| | - C Boesecke
- Department of Medicine I, Bonn University Hospital, Bonn, Germany
| | | | - J C Wasmuth
- Department of Medicine I, Bonn University Hospital, Bonn, Germany
| | - S Schlabe
- Department of Medicine I, Bonn University Hospital, Bonn, Germany
| | - J Trebicka
- Department of Medicine I, Bonn University Hospital, Bonn, Germany.,European Foundation for Study of Chronic Liver Failure, Barcelona, Spain.,Medical Department I, Goethe University Clinic Frankfurt, Frankfurt, Germany
| | - U Spengler
- Department of Medicine I, Bonn University Hospital, Bonn, Germany
| | - J M Llibre
- Department of Infectious Diseases, University Hospital "Germans Trias i Pujol", Badalona, Spain
| | - T Jou
- Department of Infectious Diseases, University Hospital "Germans Trias i Pujol", Badalona, Spain
| | - M Vasylyev
- HIV Unit Lviv Regional Public Health Center, Lviv, Ukraine
| | - B Clotet
- Irsicaixa Foundation, University Hospital "Germans Trias i Pujol", Badalona, Spain
| | - J K Rockstroh
- Department of Medicine I, Bonn University Hospital, Bonn, Germany
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