Effect of Therapeutic Agents on Outcome of Different level of Progression of COVID-19 Infection in Pakistani Population



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Submitted Mar 23, 2021
Published Jun 28, 2021
10.24018/clinicmed.2021.2.3.41

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Background: Cytopathic effects of virus and cytokine release syndrome complicate acute respiratory distress syndrome and ultimately leads to multi-organ failure which can eventually culminate to mortality in COVID-19 patients. Many therapeutic agents have been tried from different aspects in desperation to control the unrestricted spread of virus, although the evidence of benefit was sparse.

Material and method: It is a retrospective cohort study of the treatment given to the patients admitted at Indus hospital Karachi from March 2020 to September 2020. In this study, we aim to evaluate therapeutic response of the treatment recommended in COVID-19 patients which included Methylprednisolone, Remdesivir, Tocilizumab and Hydroxychloroquine. We categorized the patients according to the CALL score (Comorbid, Age, Lymphocyte count, LDH) in to mild, moderate and at severe risk of progression of disease.

Results: Overall, out of 704 patients, 238(33.8%) patients died while 466(66.2%) survived. Least deaths were observed in low-risk group 30(12.6%) as compared to intermediate group 98(41.2%) and high risk patients 110(46.2%). In low, intermediate, and high risk groups, patients who didn’t receive treatment showed better recovery [61(95.3%) vs 90(76.9%)], [59(75.6%) vs 137(63.4)] and [31(63.3%) vs 88(48.9%)] respectively. Similarly, in Remdesivir group, the patients who did not receive the treatment showed good outcome [(132 (86.6%) vs15 (62.5%)], [164 (69.8%) vs 32 (54.2%)] and [103 (56.3%) vs 16 (34.8%)]. In the same way Tocilizumab [136 (86.6%) vs 15(62.5%)], [166 (72.5%) vs 30 (46.2%)] and [103 (57.9%) vs 16 (31.4%)]. Lastly, Hydroxychloroquine [133 (86.4%) vs 18 (66.7%)], [169 (67.3%) vs27 (62.8%)] and [102 (52%) vs17 (51.5%)]. Over none of the treatment showed any beneficial effect on hospital stay and mortality.

Conclusion: Therapeutic option for treatment is limited and that these drugs as currently used should no longer be considered viable treatment options for COVID-19. There is need of research in developing new therapeutic options.

Keywords: COVID-19, Methylprednisolone, Remdesivir, tocilizumab, Hydroxychloroquine, COVID-19 treatment, Pakistan

References

  1. Liuzzo G, Patrono C. Re-purposed antiviral drugs without a purpose in COVID-19: a valuable lesson for clinicians. European Heart Journal. 2021 Feb 11.
     Google Scholar
  2. Huang E, Jordan SC. Tocilizumab for Covid-19—The Ongoing Search for Effective Therapies. n engl j med2020. 383;24 :2387-2388.
     Google Scholar
  3. Chen PL, Lee NY, Cia CT, Ko WC, Hsueh PR. A Review of Treatment of Coronavirus Disease 2019 (COVID-19): Therapeutic Repurposing and Unmet Clinical Needs. Frontiers in pharmacology. 2020;11.
     Google Scholar
  4. WHO Solidarity Trial Consortium. Repurposed antiviral drugs for Covid-19 — interim WHO Solidarity trial results. N Engl J Med 2021;384:497-511.
     Google Scholar
  5. Gautret P, Lagier JC, Parola P, Meddeb L, Mailhe M, Doudier B, Courjon J, Giordanengo V, Vieira VE, Dupont HT, Honoré S. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. International journal of antimicrobial agents. 2020 Jul 1;56(1):105949.
     Google Scholar
  6. Chidambaram V, Tun NL, Haque WZ, Majella MG, Sivakumar RK, Kumar A, Hsu AT, Ishak IA, Nur AA, Ayeh SK, Salia EL. Factors associated with disease severity and mortality among patients with COVID-19: A systematic review and meta-analysis. PloS one. 2020 Nov 18;15(11):e0241541.
     Google Scholar
  7. Ji D, Zhang D, Xu J, Chen Z, Yang T, Zhao P, Chen G, Cheng G, Wang Y, Bi J, Tan L. Prediction for progression risk in patients with COVID-19 pneumonia: the CALL score. Clinical Infectious Diseases. 2020 Sep 15;71(6):1393-9.
     Google Scholar
  8. Arabi YM, Mandourah Y, Al-Hameed F, et al; Saudi Critical Care Trial Group. Corticosteroid Therapy for critically ill patients with Middle East respiratory syndrome. Am J Respir Crit Care Med. 2018;197(6):757-767. doi:10.1164/rccm.201706- 1172OC.
     Google Scholar
  9. Lee N, Allen Chan KC, Hui DS, et al. Effects of early corticosteroid treatment on plasma SARS-associated Coronavirus RNA concentrations in adult patients.J Clin Virol. 2004;31(4):304-309. doi:10.1016/j.jcv.2004.07.006.
     Google Scholar
  10. Villar J, Ferrando C, Martínez D, et al; Dexamethasone in ARDS Network. Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial. Lancet Respir Med. 2020;8(3):267-276. doi:10. 1016/S2213-2600(19)30417-5.
     Google Scholar
  11. Steinberg KP, Hudson LD, Goodman RB, et al; National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med. 2006;354(16): 1671-1684. doi:10.1056/NEJMoa051693.
     Google Scholar
  12. Tomazini BM et al. Effect of dexamethasone on days alive and ventilator-free in patients with moderate or severe acute respiratory distress syndrome and COVID-19: The CoDEX randomized clinical trial. JAMA 2020 Sep 2; [e-pub].
     Google Scholar
  13. Dequin PF, Heming N, Meziani F, Plantefève G, Voiriot G, Badié J, François B, Aubron C, Ricard JD, Ehrmann S, Jouan Y. CAPE COVID Trial Group and the CRICS-TriGGERSep Network. Effect of hydrocortisone on 21-day mortality or respiratory support among critically ill patients with COVID-19: a randomized clinical trial. JAMA. 2020 Oct 6;324(13):1-9.
     Google Scholar
  14. US Food and Drug Administration. Coronavirus (COVID-19) update: FDA issues emergency use authorization for potential COVID-19 treatment. Published May 1, 2020. Accessed August 10, 2020.
     Google Scholar
  15. European Medicines Agency. First COVID-19 treatment recommended for EU authorization. PublishedJune25, 2020. Accessed August 10, 2020.
     Google Scholar
  16. Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, Hohmann E, Chu HY, Luetkemeyer A, Kline S, de Castilla DL. Remdesivir for the treatment of Covid-19—preliminary report. The New England journal of medicine. 2020 May 22.
     Google Scholar
  17. Goldman JD, Lye DCB, Hui DS, et al; GS-US-540-5773 Investigators. Remdesivir for 5 or 10 days in patients with severe Covid-19. N Engl J Med. Published online May 27, 2020. doi:10.1056/ NEJMoa2015301.
     Google Scholar
  18. Gupta S, Wang W, Hayek SS, Chan L, Mathews KS, Melamed ML, Brenner SK, Leonberg-Yoo A, Schenck EJ, Radbel J, Reiser J. Association between early treatment with tocilizumab and mortality among critically ill patients with COVID-19. JAMA internal medicine. 2021 Jan 1;181(1):41-51.
     Google Scholar
  19. Jordan SC, Zakowski P, Tran HP, Smith EA, Gaultier C, Marks G, Zabner R, Lowenstein H, Oft J, Bluen B, Le C. Compassionate use of tocilizumab for treatment of SARS-CoV-2 pneumonia. Clinical Infectious Diseases. 2020 Jun 23.
     Google Scholar
  20. Hermine O, Mariette X, Tharaux PL, Resche-Rigon M, Porcher R, Ravaud P, Bureau S, Dougados M, Tibi A, Azoulay E, Cadranel J. Effect of tocilizumab vs usual care in adults hospitalized with COVID-19 and moderate or severe pneumonia: a randomized clinical trial. JAMA internal medicine. 2021 Jan 1;181(1):32-40.
     Google Scholar
  21. Salvarani C, Dolci G, Massari M, Merlo DF, Cavuto S, Savoldi L, Bruzzi P, Boni F, Braglia L, Turrà C, Ballerini PF. Effect of tocilizumab vs standard care on clinical worsening in patients hospitalized with COVID-19 pneumonia: a randomized clinical trial. JAMA internal medicine. 2021 Jan 1;181(1):24-31.
     Google Scholar
  22. Stone JH, Frigault MJ, Serling-Boyd NJ, Fernandes AD, Harvey L, Foulkes AS, Horick NK, Healy BC, Shah R, Bensaci AM, Woolley AE. Efficacy of tocilizumab in patients hospitalized with Covid-19. New England Journal of Medicine. 2020 Dec 10;383(24):2333-44.
     Google Scholar
  23. Atif M, Malik I. Why is Pakistan vulnerable to COVID‐19 associated morbidity and mortality? A scoping review. The International journal of health planning and management. 2020 Sep;35(5):1041-54.
     Google Scholar
  24. Harrington DP, Baden LR, Hogan JW. A Large, Simple Trial Leading to Complex Questions. 2021 n engl j med 384;6:576-577.
     Google Scholar