The efficacy and safety of levilimab in severely ill COVID-19 patients not requiring mechanical ventilation: results of a multicenter randomized double-blind placebo-controlled phase III CORONA clinical study

OBJECTIVE AND DESIGN

The aim of this double-blind, placebo-controlled, phase III CORONA clinical trial was to evaluate the efficacy and safety of IL-6 receptor inhibitor levilimab (LVL) in subjects with severe COVID-19.

SUBJECTS

The study included 217 patients. The eligible were men and non-pregnant women aged 18 years or older, hospitalized for severe COVID-19 pneumonia.

TREATMENT

206 subjects were randomized (1:1) to receive single subcutaneous administration of LVL 324 mg or placebo, both in combination with standard of care (SOC). 204 patients received allocated therapy. After the LVL/placebo administration in case of deterioration of symptoms, the investigator could perform a single open-label LVL 324 mg administration as the rescue therapy.

METHODS

The primary efficacy endpoint was the proportion of patients with sustained clinical improvement on the 7-category ordinal scale on Day 14. All efficacy data obtained after rescue therapy administration were considered missing. For primary efficacy analysis, all subjects with missing data were considered non-responders.

RESULTS

63.1% and 42.7% of patients in the LVL and in the placebo groups, respectively, achieved sustained clinical improvement on Day 14 (P = .0017). The frequency of adverse drug reactions was comparable between the groups.

CONCLUSION

In patients with radiologically confirmed SARS-CoV-2 pneumonia, requiring or not oxygen therapy (but not ventilation) with no signs of other active infection administration of LVL + SOC results in an increase of sustained clinical improvement rate.

TRAIL REGISTRATION

The trial is registered at the US National Institutes of Health (ClinicalTrials.gov; NCT04397562).

AVIFAVIR for Treatment of Patients With Moderate Coronavirus Disease 2019 (COVID-19): Interim Results of a Phase II/III Multicenter Randomized Clinical Trial

In May 2020 the Russian Ministry of Health granted fast-track marketing authorization to RNA polymerase inhibitor AVIFAVIR (favipiravir) for the treatment of COVID-19 patients. In the pilot stage of Phase II/III clinical trial, AVIFAVIR enabled SARS-CoV-2 viral clearance in 62.5% of patients within 4 days, and was safe and well-tolerated.

Clinical Trials Registration. NCT04434248.

The new bedside ROCky score to predict the complications in patients with intermediate-risk pulmonary embolism

OBJECTIVE

Pulmonary embolism (PE) remains one of the leading causes of mortality among cardiovascular diseases. We aimed at investigating risk factors of PE complications in patients with intermediate risk and integrate them into a simple model for its' bedside prediction.

METHODS

Among 173 patients with PE, 136 were classified as high or intermediate risk. Patients were retrospectively divided into groups of complicated (n = 44) or uncomplicated (n = 92) course. Study endpoints: obstructive shock, recurrent PE, needs for resuscitation/thrombolysis/hemodynamic support and death during 30 days.

RESULTS

Predictors of PE complications were: chronic heart failure, diabetes mellitus (DM), atrial fibrillation, permanent risk factor of venous thromboembolism, syncope, positive heart-type fatty acid binding protein (hFABP), positive troponin I, heart rate (HR) ≥ 110 bpm, systolic blood pressure (SBP) ≤ 100 mmHg, creatinine clearance ≤ 70 ml/min. Multivariate logistic regression analysis was used to model a simple predictive score named ROCky (Risk of Complications): HR ≥ 110 bpm (1.5 points), SBP ≤ 100 mmHg (2.5 points), positive hFABP (2 points) and presence of DM (2.5 points). The AUROC of this model was 0.89 to predict any complication, 0.83 for obstructive shock and 0.92 for death from any cause; the optimal cut-off scores for any complication was ≥2.5 points, ≥3.5 for obstructive shock and ≥4.5 points for death within 30 days.

CONCLUSION

hFABP, tachycardia, hypotension and DM were identified as the major independent determinants of complications development in patients with pulmonary embolism and may be used in combination as the bedside simple predictive ROCky score for early risk stratification in intermediate-risk group.

[Relationship of Remodeling of Carotid Arteries and Left Ventricular Geometry in Patients With Chronic Glomerulonephritis]

PURPOSE

to study clinical-functional features of remodeling of carotid arteries and its relation to restructuring of the left ventricle (LV) in patients with chronic glomerulonephritis at pre-dialysis stage.

MATERIALS AND METHODS

We examined 269 patients (189 men, 80 women) with chronic glomerulonephritis (CGN) aged 17-71 years, at pre-dialysis stages of the disease. We analyzed biochemical parameters of peripheral blood with the determination of daily proteinuria and glomerular filtration rate (GFR). For identification of structural changes of carotid arteries (CA) and LV we used Doppler ultrasound and echocardiography.

RESULTS

Atherosclerotic changes of CA were found in 79 patients (29.3 %). Four patients (1.4 %) had history of acute disturbance of cerebral circulation. Concentric type of left ventricular hypertrophy (LVH) was significantly more prevalent among patients with CA remodeling compared with those without (37.84 vs. 18.75 %; p=0.006). Eccentric variant of LVH was significantly more prevalent among patients without atherosclerotic lesions in CA compared with those with CA remodeling (81.25 % vs. 62.16 %; p=0.001). Increased CA intima media thickness positively correlated with body mass index (r=0.273; p=0.014) and negatively - with GFR (r= -0.222; p=0.048). Statistically significant relationships were also found between the presence of carotid atherosclerosis and structural rearrangements of the heart.

CONCLUSION

We demonstrated a clear relationship between GFR, restructuring of CA and concentric type of change of LV geometry, regardless of the presence of traditional risk factors.

[Randomized Comparison of Two Approaches to Initial Warfarin Dosing: Time in Therapeutic Range of International Normalized Ratio During Hospitalization]

AIM

To perform a randomized, open-label comparison of average time in therapeutic range (TTR) of international normalized ratio (INR) using two approaches to initial warfarin dosing during hospitalization: the standard method and the one using individual patient characteristics (clinical algorithm - the studied approach).

MATERIALS AND METHODS

We randomly assigned 60 patients with different indications for vitamin K antagonist therapy to the studied approach (n=31, intervention group) or to the standard method (n=29, control group). А target INR range for all patients was 2.0 to 3.0.

RESULTS

The average TTR and portions of INR values within target range during the whole time of drug dosing turned out to be small. TTR was 22.4% with standard method and 21.4% with clinical algorithm, which was well below desired 60%.

CONCLUSION

The opportunities for achieving target INR in inpatient settings, regardless of warfarin dosing regimen, are limited.

[Comparative Analysis of the Efficacy and Safety of Rosuvastatin and Original Rosuvastatin]

The study is one of the priority points of the Russian Scientific Medical Society of Internal Medicine, initiated due to known high average level of LDL cholesterol in Russian population and necessity for its optimized control by better access to treatment.

AIM

To conduct comparative analysis of efficacy and safety of the rosuvastatin compound akorta and original rosuvastatin crestor.

MATERIAL AND METHODS

To randomized crossover study (PARITET) 60 patients were included with the diagnosis dyslipidemia. Total duration of treatment phase was 14 weeks - two times by 7 weeks, when the drugs were crossed, separated by 4 weeks washout. Main endpoints were the rate of low density lipoprotein cholesterol (LDL-C) decrease comparing to baseline, and reach of LDL-C guidelines-based target level.

RESULTS

After the first 7-week treatment the rate of decrease in akorta group was 49.0+/-15.6%, in crestor 52.6+/-17.4% (p=0.606). After the second period, in respective groups prescription of crestor led to LDL-C decrease by 43.4+/-17.9%, akorta - by 47.2+/-16.3% (p=0.724). After the first period of treatment the value of target levels reach did not differ significantly (akorta - 70.0%, crestor - 83.3%; p>0.05). After the second period in the group crestor-akorta the value was significantly better than in akorta-crestor group (60.0% and 83.3%; p<0.05). Secondary efficacy endpoints were comparable in both groups. Safety parameters were comparable in both groups.

CONCLUSION

The study has shown equivalence of the original rosuvastatin compound crestor and generic compound acorta within the aim of dyslipidemia correction.

[The role of renal anemia and cardiovascular disease in the progression of chronic glomerulonephritis]

AIM

To study the rate of chronic glomerulonephritis progression when added by anemia and cardiovascular disease (CVD).

SUBJECTS AND METHODS

231 patients (133 men and 98 women) with predialysis chronic glomerulonephritis (CGN) were examined. The patients' mean age of was 35.8±11.8 years; the disease duration was 1 to 17 years. The disease onset was the date when urinalysis showed evidence of persistent proteinuria and (or) hematuria. Besides, the time when anemia developed and the clinical and instrumental signs of CVD appeared was taken as the initial reference point; the time when end-stage renal failure was diagnosed was taken to be the endpoint. Red blood cell counts with the inclusion of its indices, hemoglobin concentration, hematocrit values, daily proteinuria values, and glomerular filtration rate were analyzed. The biochemical parameters included the concentrations of electrolytes, creatinine, fibrinogen, iron, cholesterol, total protein and C-reactive protein (CRP). Electrocardiography and echocardiography, bicycle ergometry and 24-hour ECG monitoring were used to detect CVD.

RESULTS

The presence of anemia and CVD in patients with predialysis CGN versus those without anemia and CVD was associated with an increase in the concentrations of CRP [36.2 and 12.6%; respectively; (p<0.05)], creatinine [123.0 (83.2-217.0) and 86.5 (72.0-128.5) µmol/L; (p<0.05)] and a decrease in GFR [65.4 (30.8-95.5) and 92.7 (64.5-122.3) ml/min; (p<0.05)]. The 8-year survival of patients with CGN concurrent with CVD was noted to be 58% whereas the renal survival in patients with CGN + CVD + anemia was shorter and the 6-year survival in this case was as high as 52%.

CONCLUSION

Anemia and CVD in patients with CGN serve as additional independent factors for the progression of the underlying disease. The concurrence of CGN, anemia, and CVD substantially reduces the predialysis period.

[Derangements of contractility of left ventricular myocardium in patients subjected to coronary bypass surgery. Methods of their correction]

Coronary bypass grafting with the use of cardiopulmonary bypass was performed in 119 patients (age 41-75 years) with stable angina. In addition to standard therapy in pre and post operative periods patients of group 1 (n=40) received mildronate (750 mg/day for 3 days then 750 mg twice weekly), patients of group 2 (n=41) received trimetazidine (70 mg/day). Patients of group 3 (n=38) received no "metabolic" drugs. The use of cardioprotectors mildronate and trimetazidine facilitated improvement of total and local myocardial contractility both before and after surgery, and caused limitation of development of myocardial stunning, associated with derangement of local contractility in post operative period.