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Rahimi H, Allahyari A, Ataei Azimi S, Kamandi M, Mozaheb Z, Zemorshidi F, Khadem-Rezaiyan M, Bary A, Seddigh-Shamsi M, Nodeh MM. Effect of hydroxychloroquine on COVID-19 prevention in cancer patients undergoing treatment: study protocol for a randomized controlled trial. Trials 2021; 22:349. [PMID: 34011413 PMCID: PMC8131879 DOI: 10.1186/s13063-021-05292-8] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/23/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES In this study, we will investigate the effect of hydroxychloroquine on the prevention of novel coronavirus disease (COVID-19) in cancer patients being treated. TRIAL DESIGN This is a two-arm, parallel-group, triple-blind, phase 2-3 randomized controlled trial. PARTICIPANTS All patients over the age of 15 years from 5 types of cancer will be included in the study. Patients with acute lymphoid and myeloid leukemias in the first line treated with curative intent, patients with high-grade non-Hodgkin's lymphoma treated with leukemia regimens, and patients with non-metastatic breast and colon cancer in the first line of treatment will enter the study. INTERVENTION AND COMPARATOR Patients are randomly assigned to two groups: one being given hydroxychloroquine and the other is given placebo. During 2 months of treatment, the two groups will be treated with hydroxychloroquine every other day with a single 200-mg tablet (Amin® Pharmaceutical Company, Isfahan, Iran) or placebo (identical in terms of shape, color, and smell). Patients will be monitored for COVID-19 symptoms during follow-up period. If any COVID-19-related signs or symptoms occur, they will be examined, thoroughly, investigated with a high resolution computerize tomography (CT) scan of the lungs and nasopharyngeal swab assessed by RT-PCR for SARS-CoV-2 virus. This study will be performed in five centers affiliated to Mashhad University of Medical Sciences, Mashhad, Iran. MAIN OUTCOMES The primary end point of this study is to investigate the incidence of COVID-19 in patients being treated for their cancer and receiving prophylactic Hydroxychloroquine. RANDOMIZATION Randomization will be performed using random permuted blocks. By using online website ( www.randomization.com ), the randomization sequence will be produced by quadruple blocks. The allocation ratio in intervention and control groups is 1:1. BLINDING (MASKING) Participants and caregivers do not know whether the patient is in the intervention or the control group. Those assessing the outcomes and data analyzer are also blinded to group assignment. SAMPLE SIZE The calculated total sample size is 60 patients, with 30 patients in each group.
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Affiliation(s)
- H Rahimi
- Division of Hematology and Oncology, Department of Internal Medicine, Faculty of Medicine, MUMS, Mashhad, Iran
| | - A Allahyari
- Division of Hematology and Oncology, Department of Internal Medicine, Faculty of Medicine, MUMS, Mashhad, Iran
| | - S Ataei Azimi
- Department of Internal Medicine, Faculty of Medicine, MUMS, Mashhad, Iran
| | - M Kamandi
- Department of Internal Medicine, Faculty of Medicine, MUMS, Mashhad, Iran
| | - Z Mozaheb
- Division of Hematology and Oncology, Department of Internal Medicine, Faculty of Medicine, MUMS, Mashhad, Iran
| | - F Zemorshidi
- Department of Neurology, Faculty of Medicine, MUMS, Mashhad, Iran
| | - M Khadem-Rezaiyan
- Department of Community Medicine, Faculty of Medicine, MUMS, Mashhad, Iran
| | - A Bary
- Razavi Hospital, Mashhad, Iran
| | - M Seddigh-Shamsi
- Department of Internal Medicine, Faculty of Medicine, MUMS, Mashhad, Iran
| | - M Moeini Nodeh
- Division of Hematology and Oncology, Department of Internal Medicine, Faculty of Medicine, MUMS, Mashhad, Iran.
- Current address: Hematology-Oncology Section, Internal Medicine Department, Ghaem Hospital, Ahmadabad Ave, Shariati Sq, Mashhad, Iran.
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Schubert J, Lindahl B, Melhus H, Renlund H, Leosdottir M, Allahyari A, Ueda P, Jernberg T, Hagstrom E. P5325A possible paradoxical association between LDL-cholesterol in myocardial infarction patients and relation to major adverse outcomes - a 10-year nationwide cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiovascular disease (CVD) risk increases with the level of LDL-cholesterol (LDL-C), and LDL-C lowering treatment improves prognosis. Less is known about LDL-C levels at myocardial infarction (MI) admission and long-term prognosis.
Purpose
To investigate admission LDL-C levels in relation to mortality, recurrent MI and baseline characteristics.
Methods
Patients admitted with an MI in Sweden and recorded in the MI-registry (SWEDEHEART) 2006–2016 were included and followed until 2018. Associations between baseline LDL-C, mortality and MI were assessed with Cox regression analysis, adjusting for risk factors (eg. age, diabetes, prior CV events) and lipid lowering therapy.
Results
Of 126,669 patients (median age: 70) admitted with MI, 26.2% (n=32,883) had ongoing statin therapy, and the median LDL-C was 2.96 (interquartile range 2.23, 3.74) mmol/L. During median follow-up of 4.2 years, 31,024 died and 17,896 had an MI (table). Patients with higher LDL-C were younger, had substantially fewer comorbidities such as diabetes and prior CVD (p<0.001). In this analysis there was an interaction with ongoing statin-use (p=0.0025). When dividing patients by LDL-C into quartiles, statin naive in the highest LDL-C quartile (3.95 mmol/L) had a lower risk of death compared to patients in the lowest quartile (2.62 mmol/L) HR 0.86 (95% CI 0.83–0.90). For patients with ongoing statin, the risk was also lower with higher LDL-C (2.84 mmol/L) compared to lower LDL-C (1.72 mmol/L) HR 0.88 (95% CI 0.81–0.96). No association was observed between LDL-C and recurrent MI.
Table 1. Event rate for mortality and myocardial infarction (MI) by LDL quartile groups Q1 Q2 Q3 Q4 LDL-C (mmol/L) Statin naive <2.62 2.62–3.26 3.26–3.95 >3.95 Ongoing <1.72 1.72–2.21 2.21–2.84 >2.84 Mortality Statin naive 0.074 (6553) 0.049 (4596) 0.037 (3706) 0.030 (2949) Ongoing 0.10 (3297) 0.075 (2769) 0.062 (2462) 0.055 (2157) MI Statin naive 0.034 (2808) 0.026 (2292) 0.024 (2269) 0.023 (2094) Ongoing 0.064 (1796) 0.055 (1792) 0.048 (1694) 0.044 (1557) Event/year (n of events) stratified by statin treatment at index event.
Conclusions
In this real-world population with over 126,000 patients and 10 years of follow-up, higher LDL-C at the time of the MI was associated with a markedly better prognosis in patients with and without prior statin therapy. This paradox may, despite adjustment, be caused by a substantially lower CVD baseline risk in patients with higher LDL-C pertaining to a lower burden of risk factors, younger age, and fewer prior CVD events as well as a highly treatable risk factor.
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Affiliation(s)
- J Schubert
- Uppsala University, Department of Medical Sciences, Uppsala, Sweden
| | - B Lindahl
- Uppsala University, Department of Medical Sciences, Uppsala, Sweden
| | - H Melhus
- Uppsala University, Department of Medical Sciences, Uppsala, Sweden
| | - H Renlund
- Uppsala Clinical Research Center, Uppsala, Sweden
| | - M Leosdottir
- Skane University Hospital, Department of Cardiology, Lund, Sweden
| | - A Allahyari
- Danderyd University Hospital, Department of Clinical Sciences, Stockholm, Sweden
| | - P Ueda
- Karolinska Institute, Clinical Epidemiology Division, Department of Medicine, Stockholm, Sweden
| | - T Jernberg
- Danderyd University Hospital, Department of Clinical Sciences, Stockholm, Sweden
| | - E Hagstrom
- Uppsala University, Department of Medical Sciences, Uppsala, Sweden
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Schubert J, Lindahl B, Melhus H, Renlund H, Leosdottir M, Allahyari A, Ueda P, Jernberg T, Hagstrom E. 5130Association between degree of LDL-cholesterol decrease after a myocardial infarction and mortality - a nationwide cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In clinical trials, patients with myocardial infarction (MI) and elevated LDL-cholesterol (LDL-C) benefit the most from lipid lowering therapy, and more intensive LDL-C lowering therapy is associated with better prognosis.
Purpose
To investigate the association between degree of LDL-C lowering and prognosis in MI patients from a large real-world setting.
Methods
Patients admitted with an MI between 2006 and 2016 and registered in the Swedish MI-registry (SWEDEHEART) were followed until 2018. The difference in LDL-C between the MI hospitalization and a 6–10 week follow-up was measured. In multivariable Cox regression analysis adjusting for clinical risk factors (eg. age, diabetes, prior cardiovascular disease), the association between LDL-C change, mortality and recurrent MI was assessed using restricted cubic splines. Further, the patients were stratified according to quartile decrease in LDL-C from MI hospitalization to the follow-up.
Results
A total of 44,148 patients (median age: 64) had an LDL-C measured during the MI hospitalization and at follow-up. Of these, 9,905 (22.4%) had ongoing statin treatment prior to admission. The median LDL-C at the MI hospitalization was 2.96 (interquartile range 2.23, 3.74) mmol/L and the median decrease in LDL-C was 1.17 (0.37, 1.86) mmol/L. During a median follow-up of 3.9 years, 3,342 patients died and 3,210 had an MI. Patients with the highest quartile of LDL-C decrease (1.86 mmol/L) from index event to follow-up, had a lower risk of mortality, hazard ratio (HR) 0.59 (95% confidence interval [CI] 0.44–0.80) compared to those with the lowest quartile of LDL-C decrease (0.37 mmol/L) (figure). For MI, the corresponding HR was 0.83 (95% CI 0.68–1.02). Ongoing statin-use prior to admission did not alter the effect of LDL-C decrease and outcome in the analysis.
Conclusions
In this large nationwide cohort of MI patients, a gradually lower risk of death was observed in patients with larger decrease in LDL-C from index event to follow-up, regardless of statin use prior to admission. The same trend was observed for recurrent MI, although not reaching statistical significance. This confirms previous findings that efforts should be made to lower LDL-C after MI.
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Affiliation(s)
- J Schubert
- Uppsala University, Department of Medical Sciences, Uppsala, Sweden
| | - B Lindahl
- Uppsala University, Department of Medical Sciences, Uppsala, Sweden
| | - H Melhus
- Uppsala University, Department of Medical Sciences, Uppsala, Sweden
| | - H Renlund
- Uppsala Clinical Research Center, Uppsala, Sweden
| | - M Leosdottir
- Skane University Hospital, Department of Cardiology, Lund, Sweden
| | - A Allahyari
- Danderyd University Hospital, Department of Clinical Sciences, Stockholm, Sweden
| | - P Ueda
- Karolinska Institute, Clinical Epidemiology Division, Department of Medicine, Stockholm, Sweden
| | - T Jernberg
- Danderyd University Hospital, Department of Clinical Sciences, Stockholm, Sweden
| | - E Hagstrom
- Uppsala University, Department of Medical Sciences, Uppsala, Sweden
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Allahyari A, Jernberg T, Lautsch D, Lundman P, Hagstrom E, Schubert J, Boggs R, Salomonsson S, Ueda P. P828Low-density lipoprotein cholesterol lowering therapy and target level attainment after a recent myocardial infarction - nationwide cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Lowering low-density lipoprotein cholesterol (LDL-C) reduces the risk of cardiovascular disease after a myocardial infarction (MI). The European Society of Cardiology (ESC) guidelines recommend lipid lowering therapy to reach LDL-C treatment targets after an MI.
Purpose
To assess LDL-C target level attainment according to the ESC guidelines among patients with a recent MI in Sweden.
Methods
We used data from nationwide registers in Sweden and included patients aged 18–74 years admitted to a hospital with MI (1 January 2013–1 October 2016). Among patients who were alive and had LDL-C data available, we assessed LDL-C target achievement at 6–10 weeks (n=21,505) and 12–14 months (n=17,957) after the MI by category of lipid lowering therapy (no statin; low/moderate-intensity statins; high-intensity statins; any statin plus ezetimibe). The target was defined as an LDL-C of <1.8 mmol/L and a ≥50% reduction from the baseline if LDL-C was 1.8–3.5 mmol/L and the patient was not already receiving statins.
Results
Most patients were treated with high-intensity statin monotherapy (84.2% and 72.0%) or any statin with ezetimibe (2.1% and 10.4%) at 6–10 weeks and 12–14 months after the MI, respectively. In total, 37.7% (6–10 weeks) and 38.3% (12–14 months) had attained their LDL-C target. The proportion of patients attaining their LDL-C target at 6–10 weeks was 12% (no statin), 30% (low/moderate-intensity statins), 39% (high-intensity statins), and 49% (any statin plus ezetimibe). The corresponding numbers at 12–14 months were 16% (no statin), 29% (low/moderate-intensity statins), 39% (high-intensity statins), and 58% (any statin plus ezetimibe). A total of 11.8% at 6–10 weeks and 12.3% at 12–14 months reached an LDL-C level of <1.8 mmol/L, but did not reach their LDL-C target level due to the ≥50% reduction criteria. (Figure 1)
Figure 1
Conclusions
In this large population-based study using nationwide data, more than half of patients with a recent MI did not achieve the ESC guidelines LDL-C target levels, despite a large proportion with high-intensity statin therapy. In patients treated with statins and ezetimibe, four out of ten did not reach the ESC LDL-C target level. Our findings indicate that there may be a need for additional LDL-C lowering therapy if the target level is to be attained in all patients.
Acknowledgement/Funding
This project was supported by funding from Merck Sharp & Dohme.
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Affiliation(s)
- A Allahyari
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - T Jernberg
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - D Lautsch
- Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | - P Lundman
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - E Hagstrom
- Uppsala University, Department of Medical Sciences, Cardiology, Uppsala, Sweden
| | - J Schubert
- Uppsala University, Department of Medical Sciences, Cardiology, Uppsala, Sweden
| | - R Boggs
- Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | | | - P Ueda
- Karolinska Institute, Division of Clinical Epidemiology, Department of Medicine, Solna, Stockholm, Sweden
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Kagiyama N, Okura H, Kume T, Neishi Y, Hayashida A, Hirohata A, Yamamoto K, Yoshida K, Yang LT, Tsai W, Tsai S, Tsai Y, Liao I, Hsu C, Poorzand H, Mohamadzadeh Shabestari M, Vakilian F, Abasi Teshnizi M, Allahyari A, Narayanan SR, Jafar NS, Al Shamkhany WS, Rajappan AK, Janardhanan R, Patel K, Mizyed A, Thompson J, Rodrigues A, Afonso J, Cordovil A, Monaco C, Piveta R, Cordovil R, Fischer C, Vieira M, Lira E, Morhy S. Case-Based Session: Cases from Outside Europe: Friday 5 December 2014, 15:30-16:30 * Location: Agora. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ghavamzadeh A, Allahyari A, Alimoghaddam K, Karimi A, Shamshiri A, Abolhasani R, Manookian A, Asadi M, Khatami F. Outpatient versus inpatient autologous stem cell transplantation for malignant hematologic disorders. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.7042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7042 Background: High-dose chemotherapy with autologous stem cell support is utilized for the treatment of a variety of malignancies including Hodgkin/non-Hodgkins lymphoma and acute leukemias. The aim of this study was to compare the time of engraftment and mortality rate and cost of neutropenic treatment in outpatient versus inpatient autologous stem cell transplantation (SCT). Methods: 9 outpatients (5 HL, 2 NHL, and 2 AML) were compared with 32 inpatients (15 HL, 8 NHL, and 9 AML; for whom the outpatient facilities were not ready) from May 2008 to December 2008. All patients were below 45 yrs; median age for outpatients and inpatients were 26 and 30 years respectively. Also all the patients were in complete remission and without significant organ failure. They received conditioning regimen (CEAM for NHL and HL, busulfan and etoposide for AML) and stem cell infusion in hospital. The day after SCT, outpatient group were discharged and followed by outpatient SCT team, and to be re-hospitalized in case of febrile neutropenia, after sepsis workup and performing chest x-ray, they were received the first dose of antibiotic in hospital and treatment continued in home. Results: For outpatients and inpatients, median time to WBC engraftment was 11 and 12 days (p = 0.03), time to PLT engraftment was 15 and 25 days (p = 0.20), number of transfused single donor PLT was 3 and 4.5 units (p = 0.21), duration of neutropenic fever was 6 and 9 days (p = 0.001), duration of hospitalization (after SCT) 0 and 16 (p < 0.001), respectively. All outpatients are alive and 3 patients from other group died between days +35 and +100 after SCT due to transplantation complications. For inpatient group the cost of drugs, just for neutropenic fever antibiotic therapy was six times than outpatient group. Conclusions: Results show that out-patient autologous SCT in malignant hematologic disorders is feasible and comparable with inpatient protocol. We are waiting for more patients and longer follow-up for future conclusions. No significant financial relationships to disclose.
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Affiliation(s)
- A. Ghavamzadeh
- Hematology Oncology Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran; Hematology-Oncology and SCT Research Center
| | - A. Allahyari
- Hematology Oncology Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran; Hematology-Oncology and SCT Research Center
| | - K. Alimoghaddam
- Hematology Oncology Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran; Hematology-Oncology and SCT Research Center
| | - A. Karimi
- Hematology Oncology Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran; Hematology-Oncology and SCT Research Center
| | - A. Shamshiri
- Hematology Oncology Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran; Hematology-Oncology and SCT Research Center
| | - R. Abolhasani
- Hematology Oncology Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran; Hematology-Oncology and SCT Research Center
| | - A. Manookian
- Hematology Oncology Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran; Hematology-Oncology and SCT Research Center
| | - M. Asadi
- Hematology Oncology Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran; Hematology-Oncology and SCT Research Center
| | - F. Khatami
- Hematology Oncology Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran; Hematology-Oncology and SCT Research Center
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