Effect of High vs Low Doses of Chloroquine Diphosphate as Adjunctive Therapy for Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection DOI Creative Commons
Mayla Gabriela Silva Borba, Fernando Val, Vanderson de Souza Sampaio

et al.

JAMA Network Open, Journal Year: 2020, Volume and Issue: 3(4), P. e208857 - e208857

Published: April 24, 2020

Importance

There is no specific antiviral therapy recommended for coronavirus disease 2019 (COVID-19). In vitro studies indicate that the effect of chloroquine diphosphate (CQ) requires a high concentration drug.

Objective

To evaluate safety and efficacy 2 CQ dosages in patients with severe COVID-19.

Design, Setting, Participants

This parallel, double-masked, randomized, phase IIb clinical trial 81 adult who were hospitalized acute respiratory syndrome (SARS-CoV-2) infection was conducted from March 23 to April 5, 2020, at tertiary care facility Manaus, Brazilian Amazon.

Interventions

Patients allocated receive high-dosage (ie, 600 mg twice daily 10 days) or low-dosage 450 on day 1 once 4 days).

Main Outcomes Measures

Primary outcome reduction lethality by least 50% group compared group. Data presented here refer primarily outcomes during treatment 13. Secondary end points included participant status, laboratory examinations, electrocardiogram results. will be 28. Viral secretion RNA detection performed days 0 4.

Results

Out predefined sample size 440 patients, enrolled (41 [50.6%] 40 [49.4%] group). Enrolled had mean (SD) age 51.1 (13.9) years, most (60 [75.3%]) men. Older (mean [SD] age, 54.7 [13.7] years vs 47.4 [13.3] years) more heart (5 28 [17.9%] 0) seen high-dose detected 31 (77.5%) 41 (75.6%) groups, respectively. Lethality until 13 39.0% (16 41) 15.0% (6 40). The instance QTc interval greater than 500 milliseconds (7 37 [18.9%]) (4 36 [11.1%]). Respiratory negative only 6 27 (22.2%).

Conclusions Relevance

preliminary findings this study suggest higher dosage should not critically ill COVID-19 because its potential hazards, especially when taken concurrently azithromycin oseltamivir. These cannot extrapolated nonsevere

Trial Registration

ClinicalTrials.gov Identifier:NCT04323527

Language: Английский

RETRACTED: Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial DOI Creative Commons
Philippe Gautret, Jean‐Christophe Lagier, Philippe Parola

et al.

International Journal of Antimicrobial Agents, Journal Year: 2020, Volume and Issue: 56(1), P. 105949 - 105949

Published: March 20, 2020

Language: Английский

Citations

4857
The pathogenesis and treatment of the `Cytokine Storm' in COVID-19 DOI Creative Commons

Qing Ye,

Bili Wang, Jianhua Mao

et al.

Journal of Infection, Journal Year: 2020, Volume and Issue: 80(6), P. 607 - 613

Published: April 11, 2020

Cytokine storm is an excessive immune response to external stimuli. The pathogenesis of the cytokine complex. disease progresses rapidly, and mortality high. Certain evidence shows that, during coronavirus 2019 (COVID-19) epidemic, severe deterioration some patients has been closely related in their bodies. This article reviews occurrence mechanism treatment strategies COVID-19 virus-induced inflammatory attempt provide valuable medication guidance for clinical treatment.

Language: Английский

Citations

2703
Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19) DOI Open Access
James M. Sanders, Marguerite L. Monogue,

Tomasz Z. Jodlowski

et al.

JAMA, Journal Year: 2020, Volume and Issue: unknown

Published: April 13, 2020

Importance

The pandemic of coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome 2 (SARS-CoV-2) presents an unprecedented challenge to identify effective drugs for prevention and treatment. Given rapid pace scientific discovery clinical data generated large number people rapidly infected SARS-CoV-2, clinicians need accurate evidence regarding medical treatments this infection.

Observations

No proven therapies virus currently exist. expanding knowledge SARS-CoV-2 virology provides a significant potential drug targets. most promising therapy is remdesivir. Remdesivir has potent in vitro activity against but it not US Food Drug Administration approved being tested ongoing randomized trials. Oseltamivir been shown have efficacy, corticosteroids are recommended. Current does support stopping angiotensin-converting enzyme inhibitors or angiotensin receptor blockers patients with COVID-19.

Conclusions Relevance

COVID-19 represents greatest global public health crisis generation and, potentially, since influenza outbreak 1918. speed volume trials launched investigate highlight both capability produce high-quality even middle pandemic. date.

Language: Английский

Citations

2399
Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19) DOI Creative Commons
Waleed Alhazzani, Morten Hylander Møller, Yaseen M. Arabi

et al.

Intensive Care Medicine, Journal Year: 2020, Volume and Issue: 46(5), P. 854 - 887

Published: March 28, 2020

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, Coronavirus Disease 2019 (COVID-19), affecting thousands people around world. Urgent guidance for clinicians caring sickest these patients needed. We formed panel 36 experts from 12 countries. All members completed World Health Organization conflict interest disclosure form. proposed 53 questions that are relevant to management COVID-19 in ICU. searched literature direct and indirect evidence on critically ill identified recent systematic reviews most relating supportive care. assessed certainty using Grading Recommendations, Assessment, Development Evaluation (GRADE) approach, then generated recommendations based balance between benefit harm, resource cost implications, equity, feasibility. Recommendations were either strong or weak, form best practice recommendations. Surviving Sepsis Campaign issued 54 statements, which 4 9 recommendations, 35 weak No recommendation was provided 6 questions. topics were: (1) infection control, (2) laboratory diagnosis specimens, (3) hemodynamic support, (4) ventilatory (5) therapy. several help support healthcare workers ICU with COVID-19. When available, we will provide new further releases guidelines.

Language: Английский

Citations

2009
Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic DOI Creative Commons
Elissa Driggin, Mahesh V. Madhavan, Behnood Bikdeli

et al.

Journal of the American College of Cardiology, Journal Year: 2020, Volume and Issue: 75(18), P. 2352 - 2371

Published: March 19, 2020

Language: Английский

Citations

1992
Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19) DOI Open Access
Riccardo M. Inciardi, L Lupi,

G Zaccone

et al.

JAMA Cardiology, Journal Year: 2020, Volume and Issue: 5(7), P. 819 - 819

Published: March 27, 2020

Virus infection has been widely described as one of the most common causes myocarditis. However, less is known about cardiac involvement a complication severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.To describe presentation myocardial inflammation in patient with disease 2019 (COVID-19) who recovered from influenzalike and developed fatigue signs symptoms heart failure week after upper tract symptoms.This case report describes an otherwise healthy 53-year-old woman tested positive for COVID-19 was admitted to care unit March 2020 myopericarditis systolic dysfunction, confirmed on magnetic resonance imaging, onset fever dry cough due COVID-19. The did not show any during clinical course.Cardiac COVID-19.Detection increase levels N-terminal pro-brain natriuretic peptide (NT-proBNP) high-sensitivity troponin T, echocardiography changes, diffuse biventricular edema late gadolinium enhancement imaging.An white presented emergency department fatigue. She before. afebrile but hypotensive; electrocardiography showed ST elevation, elevated T NT-proBNP were detected. Findings chest radiography normal. There no evidence obstructive coronary angiography. Based outbreak, nasopharyngeal swab performed, result SARS-CoV-2 real-time reverse transcriptase-polymerase chain reaction assay. Cardiac imaging increased wall thickness hypokinesis, especially apical segments, left ventricular dysfunction (left ejection fraction 35%). Short tau inversion recovery T2-mapping sequences marked interstitial edema, there also involving entire wall. circumferential pericardial effusion that notable around right chambers. These findings all consistent myopericarditis. treated dobutamine, antiviral drugs (lopinavir/ritonavir), steroids, chloroquine, medical treatment failure, progressive instrumental stabilization.This highlights associated COVID-19, even without pneumonia.

Language: Английский

Citations

1830
Coronavirus Disease 2019–COVID-19 DOI
Kuldeep Dhama, Khan Sharun, Ruchi Tiwari

et al.

Clinical Microbiology Reviews, Journal Year: 2020, Volume and Issue: 33(4)

Published: June 23, 2020

In recent decades, several new diseases have emerged in different geographical areas, with pathogens including Ebola virus, Zika Nipah and coronaviruses (CoVs). Recently, a type of viral infection Wuhan City, China, initial genomic sequencing data this virus do not match previously sequenced CoVs, suggesting novel CoV strain (2019-nCoV), which has now been termed severe acute respiratory syndrome CoV-2 (SARS-CoV-2). Although coronavirus disease 2019 (COVID-19) is suspected to originate from an animal host (zoonotic origin) followed by human-to-human transmission, the possibility other routes should be ruled out.

Language: Английский

Citations

1795
Potential Effects of Coronaviruses on the Cardiovascular System DOI Open Access
Mohammad Madjid,

Payam Safavi‐Naeini,

Scott D. Solomon

et al.

JAMA Cardiology, Journal Year: 2020, Volume and Issue: 5(7), P. 831 - 831

Published: March 27, 2020

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes disease 2019 (COVID-19) has reached a pandemic level. Coronaviruses are known to affect the cardiovascular system. We review basics of coronaviruses, with focus on COVID-19, along their effects system.Coronavirus can cause viral pneumonia additional extrapulmonary manifestations and complications. A large proportion patients have underlying and/or cardiac risk factors. Factors associated mortality include male sex, advanced age, presence comorbidities including hypertension, diabetes mellitus, diseases, cerebrovascular diseases. Acute injury determined by elevated high-sensitivity troponin levels is commonly observed in severe cases strongly mortality. distress also mortality.Coronavirus high inflammatory burden that induce vascular inflammation, myocarditis, arrhythmias. Extensive efforts underway find specific vaccines antivirals against SARS-CoV-2. Meanwhile, factors conditions should be judiciously controlled per evidence-based guidelines.

Language: Английский

Citations

1722
COVID-19 and Cardiovascular Disease DOI Creative Commons
Kevin J. Clerkin, J. Fried, J. Raikhelkar

et al.

Circulation, Journal Year: 2020, Volume and Issue: 141(20), P. 1648 - 1655

Published: March 21, 2020

Coronavirus disease 2019 (COVID-19) is a global pandemic affecting 185 countries and >3 000 patients worldwide as of April 28, 2020. COVID-19 caused by severe acute respiratory syndrome coronavirus 2, which invades cells through the angiotensin-converting enzyme 2 receptor. Among with COVID-19, there high prevalence cardiovascular disease, >7% experience myocardial injury from infection (22% critically ill patients). Although serves portal for infection, role inhibitors or angiotensin receptor blockers requires further investigation. poses challenge heart transplantation, donor selection, immunosuppression, posttransplant management. There are number promising therapies under active investigation to treat prevent COVID-19.

Language: Английский

Citations

1715
Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations DOI Creative Commons
Jason Phua, Li Weng, Lowell Ling

et al.

The Lancet Respiratory Medicine, Journal Year: 2020, Volume and Issue: 8(5), P. 506 - 517

Published: April 6, 2020

As coronavirus disease 2019 (COVID-19) spreads across the world, intensive care unit (ICU) community must prepare for challenges associated with this pandemic. Streamlining of workflows rapid diagnosis and isolation, clinical management, infection prevention will matter not only to patients COVID-19, but also health-care workers other who are at risk from nosocomial transmission. Management acute respiratory failure haemodynamics is key. ICU practitioners, hospital administrators, governments, policy makers a substantial increase in critical bed capacity, focus just on infrastructure supplies, staff management. Critical triage allow rationing scarce resources might be needed. Researchers address unanswered questions, including role repurposed experimental therapies. Collaboration local, regional, national, international level offers best chance survival critically ill.

Language: Английский

Citations

1499