Clinical antiviral efficacy of favipiravir in early COVID-19 (PLATCOV): an open-label, randomised, controlled, adaptive platform trial

In early symptomatic COVID-19 treatment, high dose oral favipiravir did not accelerate viral clearance.

BACKGROUND

Favipiravir, an anti-influenza drug, has in vitro antiviral activity against SARS-CoV-2. Clinical trial evidence to date is inconclusive. Favipiravir has been recommended for the treatment of COVID-19 in some countries.

METHODS

In a multicentre open-label, randomised, controlled, adaptive platform trial, low-risk adult patients with early symptomatic COVID-19 were randomised to one of ten treatment arms including high dose oral favipiravir (3.6g on day 0 followed by 1.6g daily to complete 7 days treatment) or no study drug. The primary outcome was the rate of viral clearance (derived under a linear mixed-effects model from the daily log10 viral densities in standardised duplicate oropharyngeal swab eluates taken daily over 8 days [18 swabs per patient]), assessed in a modified intention-to-treat population (mITT). The safety population included all patients who received at least one dose of the allocated intervention. This ongoing adaptive platform trial was registered at ClinicalTrials.gov (NCT05041907) on 13/09/2021.

RESULTS

In the final analysis, the mITT population contained data from 114 patients randomised to favipiravir and 126 patients randomised concurrently to no study drug. Under the linear mixed-effects model fitted to all oropharyngeal viral density estimates in the first 8 days from randomisation (4,318 swabs), there was no difference in the rate of viral clearance between patients given favipiravir and patients receiving no study drug; a -1% (95% credible interval: -14 to 14%) difference. High dose favipiravir was well-tolerated.

INTERPRETATION

Favipiravir does not accelerate viral clearance in early symptomatic COVID-19. The viral clearance rate estimated from quantitative measurements of oropharyngeal eluate viral densities assesses the antiviral efficacy of drugs in vivo with comparatively few studied patients.

Clinical Antiviral Efficacy of Remdesivir in Coronavirus Disease 2019: An Open-Label, Randomized Controlled Adaptive Platform Trial (PLATCOV)

BACKGROUND

Uncertainty over the therapeutic benefit of parenteral remdesivir in coronavirus disease 2019 (COVID-19) has resulted in varying treatment guidelines.

METHODS

In a multicenter open-label, controlled, adaptive, pharmacometric platform trial, low-risk adult patients with early symptomatic COVID-19 were randomized to 1 of 8 treatment arms including intravenous remdesivir (200 mg followed by 100 mg daily for 5 days) or no study drug. The primary outcome was the rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) clearance (estimated under a linear model fit to the daily log10 viral densities, days 0-7) in standardized duplicate oropharyngeal swab eluates, in a modified intention-to-treat population. This ongoing adaptive trial is registered at ClinicalTrials.gov (NCT05041907).

RESULTS

The 2 study arms enrolled 131 patients (remdesivir n = 67, no study drug n = 64) and estimated viral clearance rates from a median of 18 swab samples per patient (a total of 2356 quantitative polymerase chain reactions). Under the linear model, compared with the contemporaneous control arm (no study drug), remdesivir accelerated mean estimated viral clearance by 42% (95% credible interval, 18%-73%).

CONCLUSIONS

Parenteral remdesivir accelerates viral clearance in early symptomatic COVID-19. Pharmacometric assessment of therapeutics using the method described can determine in vivo clinical antiviral efficacy rapidly and efficiently.

Acute coronavirus infection triggers a TNF-dependent osteoporotic phenotype in mice

AIMS

Millions of people died during the COVID-19 pandemic, but the vast majority of infected individuals survived. Now, some consequences of the disease, known as long COVID, are been revealed. Although the respiratory system is the target of Sars-CoV-2, COVID-19 can influence other parts of the body, including bone. The aim of this work was to investigate the impact of acute coronavirus infection in bone metabolism.

MAIN METHODS

We evaluated RANKL/OPG levels in serum samples of patients with and without acute COVID-19. In vitro, the effects of coronavirus in osteoclasts and osteoblasts were investigated. In vivo, we evaluated the bone phenotype in a BSL2 mouse model of SARS-like disease induced by murine coronavirus (MHV-3).

KEY FINDINGS

Patients with acute COVID-19 presented decreased OPG and increased RANKL/OPG ratio in the serum versus healthy individuals. In vitro, MHV-3 infected macrophages and osteoclasts, increasing their differentiation and TNF release. Oppositely, osteoblasts were not infected. In vivo, MHV-3 lung infection triggered bone resorption in the femur of mice, increasing the number of osteoclasts at 3dpi and decreasing at 5dpi. Indeed, apoptotic-caspase-3⁺ cells have been detected in the femur after infection as well as viral RNA. RANKL/OPG ratio and TNF levels also increased in the femur after infection. Accordingly, the bone phenotype of TNFRp55^-/- mice infected with MHV-3 showed no signs of bone resorption or increase in the number of osteoclasts.

SIGNIFICANCE

Coronavirus induces an osteoporotic phenotype in mice dependent on TNF and on macrophage/osteoclast infection.

Low pressure ion pair chromatography with amperometric detection for the determination of trigonelline in coffee samples

In this work, the use of ion pair chromatography strategy in low pressure chromatographic flow systems is explored for the first time. The straightforward flow manifold encompassed a peristaltic pump, an injection valve and a 1 cm-length C₁₈ monolithic column. The amperometric detection system relied on a boron-doped diamond electrode, used as working electrode. The determination of trigonelline in coffee samples was the case-study selected. This alkaloid is an important quality marker for this commodity and is usually determined using HPLC-UV methodologies. The proposed methodology, based on ion-pair chromatography with amperometric detection, enabled the quantitative resolution of the studied analyte from the matrix compounds by adding to the mobile phase the ion pair reagent, 1-tetradecanosulfonate sodium. The present work, following the recent developments of the low pressure chromatography approach, demonstrates the potentialities of coupling monolithic columns to traditional flow analysis systems for separation and quantification of ionic or ionisable compounds.

Time domain add-drop multiplexing scheme enhanced using a saw-tooth pulse shaper

We experimentally demonstrate the use of saw-tooth optical pulses, which are shaped using a fiber Bragg grating, to achieve robust and high performance time-domain add-drop multiplexing in a scheme based on cross-phase (XPM) modulation in an optical fiber, with subsequent offset filtering. As compared to the use of more conventional pulse shapes, such as Gaussian pulses of a similar pulse width, the purpose-shaped saw-tooth pulses allow higher extinction ratios for the add and drop windows and significant improvements in the receiver sensitivity for the dropped and added channels.

Simultaneous determination of E-2-nonenal and β-damascenone in beer by reversed-phase liquid chromatography with UV detection

A method for the simultaneous determination of E-2-nonenal and beta-damascenone in beer by reversed-phase liquid chromatography using UV detection is presented. The method consists of beer steam distillation, followed by an extraction/concentration step using Sep-Pak Plus C18 RP cartridges and determination by HPLC at 226 nm UV-absorption maximum. The identity of the compounds was confirmed by GC analysis with MS detection of the isolated fractions. A recovery factor of approximately 80% was obtained for beta-damascenone with a R.S.D. of 3%. E-2-Nonenal and beta-damascenone were monitored in a comparative study of fresh and either naturally and forced aged beer. The results obtained show that both compounds have a similar behaviour through an extended storage of beer and consequently can be used as good analytical markers of beer ageing. Nevertheless, the use of beta-damascenone seems to be more convenient because this compound appears in beer in higher concentrations than E-2-nonenal, thus making it easier to measure.

Determination of E-2-nonenal by high-performance liquid chromatography with UV detection assay for the evaluation of beer ageing

The analysis of E-2-nonenal is of considerable interest for the brewery industry as this compound is claimed to be responsible for a paper/cardboard unpleasant flavour. Usually, the presence of E-2-nonenal can be noticed in aged beers at levels higher than 0.1 microg/l. In this work, an analytical method was developed to determine E-2-nonenal in beer involving steam distillation of beer followed by an extraction/concentration step using solid-phase extraction and determination of E-2-nonenal by HPLC with UV detection. Fastness and simplicity are the main advantages of the proposed method, when compared with other existing methodologies for the determination of E-2-nonenal in beer. Using the developed conditions, the interference of E-2-nonenal formed by degradation of its precursors during steam distillation is almost negligible. The presence of sulphur dioxide at legal levels does not interfere with the assay. The method was used in a comparative study of fresh and either naturally or forced aged beers. A much larger chromatographic peak was found near the peak of E-2-nonenal that correlates well with the peak of E-2-nonenal. Identification of the corresponding compound is currently under investigation, considering its future application on the evaluation of beer ageing.

Endothelium-dependent and endothelium-independent effects of adenosine diphosphate in renovascular hypertension

Norepinephrine-induced responses in isolated perfused mesenteric vascular bed from normotensive and renovascular hypertensive rats were examined in the presence of adenosine diphosphate (ADP, 2 x 10(-6) M). Responses to norepinephrine were significantly greater in vessels from hypertensive rats. Norepinephrine-induced contractions increased after the removal of endothelium. N omega-Nitro-L-arginine (L-NOARG), a potent inhibitor of nitric oxide formation, similarly increased contractions. The greatest responses were obtained, however, after treatment of the vascular segments with methylene blue. The presence of ADP caused significant endothelium-dependent decreases in contractions. Although decreases caused by ADP in vessels with endothelium after treatment with L-NOARG were not statistically significant, a tendency to decreased responses seems to suggest that L-NOARG diminishes but does not completely prevent the effect of ADP in mesenteric vessels. Methylene blue partially reduced the endothelium-dependent ADP-induced relaxant effects in sham-operated nephrectomized rats. A tendency to increased contractions to norepinephrine was observed in the presence of ADP after removal of endothelium. Thus, in the mesenteric resistance arteries of the rat under stimulation by ADP, it appears that nitric oxide released from L-arginine and the activity of soluble guanylate cyclase account only in part for the endothelium-dependent decreased responses to norepinephrine. When nitric oxide formation or soluble guanylate cyclase activity are depressed simultaneously with endothelium damage, ADP released from platelets or red blood cells may be an important factor that acts synergically with vasoconstrictor stimuli.(ABSTRACT TRUNCATED AT 250 WORDS)