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2.
Arch. argent. pediatr ; 119(4): e360-e363, agosto 2021. tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1281901

ABSTRACT

La infección por virus de la hepatitis C en pediatría se produce principalmente por transmisión vertical. La historia natural en niños consiste en alta tasa de eliminación espontánea, infección asintomática o cambios histológicos mínimos. Las complicaciones suelen observarse en la adolescencia o en la edad adulta. El tratamiento clásico con interferón pegilado y ribavirina presenta efectos adversos, es de duración prolongada y logra una respuesta virológica sostenida (RVS) en el 50 % de los pacientes con infección por genotipo 1. Los nuevos antivirales de acción directa se encuentran disponibles para su indicación a partir de los 12 años, con excelente tolerancia y alta tasa de RVS. Se sugiere conducta terapéutica expectante en pacientes asintomáticos hasta acceder a la medicación. Reportamos el caso de un adolescente con hepatitis C crónica sin cirrosis que recibió tratamiento durante 12 semanas con ledipasvir/sofosbuvir y se logró una RVS.


Hepatitis C virus infection in children occurs mainly through vertical transmission. The natural history at this age consists in a high rate of spontaneous clearance, asymptomatic infection, or minimal histological changes. Disease complications are commonly seen in adolescence or adulthood. The classic treatment with pegylated interferon and ribavirin presents adverse effects, prolonged duration and achieves sustained viral response (SVR) in 50 % of patients with genotype 1 infection (the most frequent). New direct-acting antiviral treatments have been available in recent years for their indication from 12 years of age with excellent tolerance and a high SVR rate. Expectant therapeutic behavior is suggested in asymptomatic patients until they can access to them. We report the case of an adolescent with chronic hepatitis C without cirrhosis who received 12 weeks treatment with ledipasvir/sofosbuvir, achieving SVR.


Subject(s)
Humans , Male , Adolescent , Antiviral Agents/therapeutic use , Benzimidazoles/therapeutic use , Hepatitis C, Chronic/drug therapy , Fluorenes/therapeutic use , Sofosbuvir/therapeutic use , Sustained Virologic Response
3.
Brasília; CONITEC; ago. 2021.
Non-conventional in Portuguese | LILACS, BRISA | ID: biblio-1291826

ABSTRACT

INTRODUÇÃO: No dia 12 de março de 2021 a ANVISA concedeu o registro para comercialização de rendesivir no Brasil como primeiro e único medicamento com indicação aprovada em bula, para tratamento de pacientes com COVID-19 com pneumonia e necessidade de suplementação de oxigênio (baixo ou alto fluxo e ventilação mecânica não invasiva). A autorização fornecida pela ANVISA para uso do medicamento no Brasil, diverge da recomendação da OMS que desaconselha o uso do rendesivir para tratamento de pacientes hospitalizados por COVID-19, independente de sua gravidade usando como base os resultados interinos do estudo Solidarity (14). Este estudo revelou que o uso do rendesivir, assim como outros antivirais analisados, não foi capaz de reduzir de forma significativa a mortalidade geral ou de nenhum subgrupo estudado, nem retardar o início da ventilação mecânica ou reduzir o tempo de hospitalização. A redução do tempo de internação para a ANVISA foi um critério importante para o contexto brasileiro devido a constante falta de leitos disponíveis para o tratamento dos pacientes acometidos pela COVID-19. DEMANDANTE: Gilead Sciences Farmacêutica Brasil Ltda. PERGUNTA: O uso do rendesivir é eficaz e seguro para tratamento de pacientes hospitalizados com COVID-19 e que necessitam de suplementação de oxigênio (de baixo ou alto fluxo e ventilação mecânica não invasiva)? EVIDÊNCIAS CLÍNICAS: As evidências avaliadas baseiam-se em quatro ensaios clínicos randomizados, onde dois compararam rendesivir com placebo e outros dois comparando rendesivir com cuidado padrão. Foram obtidos resultados favoráveis ao rendesivir com maior probabilidade de recuperação no 29º dia (Hazard Ratio [HR] 1,29, 95%IC 1,12-1,49, p<0,001) em um dos estudos. Para o desfecho mortalidade no 29º dia, os resultados do mesmo ensaio foram significativos apenas para o subgrupo de pacientes que necessitavam de suplementação de oxigênio de baixo ou alto fluxo (HR = 0,30, 95%IC 0,14- 0,64). Ao sumarizar os dados dos quatro estudos observou-se que em pacientes hospitalizados com COVID-19, o uso do rendesivir comparado com o grupo controle não resultou em diferenças estatisticamente significativas tanto quanto os desfechos de mortalidade (Risco Relativo [RR]: 0,98, 95%IC 0,84-1,14); necessidade de ventilação mecânica (RR: 0,77, 95%IC 0,48-1,22) e recuperação (RR: 1,09, 95%IC 1,03-1,15), segundo três estudos. O rendesivir comparado com placebo e cuidado padrão pode reduzir em 25% o risco da ocorrência de eventos adversos sérios (RR: 0,75, 95%IC 0,63-0,90). AVALIAÇÃO ECONÔMICA: Os resultados do modelo econômico apresentado pelo demandante têm limitações que tornam incertos os resultados do modelo econômico apresentado, de forma que a sua utilização para tomada de decisão sobre a tecnologia é duvidosa. ANÁLISE DE IMPACTO ORÇAMENTÁRIO: O impacto orçamentário incremental após a proposta de redução de preço pelo demandante foi estimado em aproximadamente 28 bilhões de reais, como melhor cenário. MONITORAMENTO DO HORIZONTE TECNOLÓGICO: Foram identificadas oito tecnologias potenciais para a indicação clínica. O opaganib consiste no primeiro agente de uma nova classe farmacológica, a dos inibidores de esfingosina-quinases. Outro potencial medicamento para a indicação a ser administrado por via oral e em combinação ao cuidado padrão (não especificado no protocolo do estudo), é o fostamatinib. O reparixin é um análogo do ibuprofeno e sua eficácia para o tratamento de pacientes com pneumonia grave acometidos por COVID-19 está sendo avaliada. O BDB-001 e o ravulizumab têm como alvo farmacológico o fator C5a do sistema complemento. Os anticorpos monoclonais canaquinumab, mavrilimumab e tocilizumabe também estão em desenvolvimento. Além disso, foram identificados três depósitos de patentes relacionados ao rendesivir no Instituto Nacional da Propriedade Intelectual. CONSIDERAÇÕES FINAIS: O balanço entre os aspectos positivos e negativos do rendesivir foi desfavorável ao seu uso no tratamento de pacientes com COVID-19. Apesar do baixo risco de eventos adversos, houve uma baixa confiança na eficácia do medicamento, uma vez que os resultados dos estudos são discrepantes e baseados em uma análise de subgrupo de apenas um estudo. O impacto orçamentário estimado foi considerado elevado. RECOMENDAÇÃO PRELIMINAR DA CONITEC: Diante do exposto, a Conitec, em sua 98ª Reunião Ordinária, realizada no dia 10 de junho de 2021, deliberou que a matéria fosse disponibilizada em consulta pública com recomendação preliminar desfavorável à incorporação no SUS do rendesivir para o tratamento da doença causada pelo coronavírus 2019 (COVID19), em pacientes adultos com pneumonia que requerem suplementação de oxigênio de baixo ou alto fluxo. Foi discutido, emplenária, que a evidência disponívelsobre a tecnologia emavaliação foi baseada emestudos adaptativos heterogêneos, com importantes limitações metodológicas, que podem se traduzir em resultados devidos apenas ao acaso. Além disso, o perfil de segurança do rendesivir, quando comparado aos medicamentos de cuidado padrão, mostrou que o medicamento está associado a um risco aumentado de bradicardia em pacientes diagnosticados com COVID-19. CONSULTA PÚBLICA: Foram recebidas 90 contribuições, sendo 34 contribuições técnico-científicas e 56 de experiência e opinião. Diante das argumentações apresentadas, o plenário da Conitec entendeu que não houve argumentação suficiente para mudança de entendimento acerca de sua recomendação preliminar, com base nas evidências científicas apresentadas, tampouco na redução de preço proposta pelo fabricante. Desse modo, a Comissão, diante das incertezas quanto à eficácia do medicamento, manteve a posição desfavorável à incorporação do rendesivir para o tratamento dos pacientes hospitalizados com pneumonia provocada pelo COVID-19 com necessidade de suplementação de oxigênio. DELIBERAÇÃO FINAL: O Plenário da Conitec, em sua 100ª Reunião Ordinária, no dia 05 de agosto de 2021, deliberou por unanimidade recomendar a não incorporação do rendesivir para o tratamento de pacientes com COVID-19 com necessidade de suplementação de oxigênio (baixo ou alto fluxo, ventilação não invasiva) no âmbito do SUS, com base nas incertezas quanto à eficácia do medicamento. Foi assinado o Registro de Deliberaçã nº 651/2021. DECISÃO: Não incorporar o rendesivir para tratamento de pacientes com Covid-19 hospitalizados com pneumonia e necessidade de suplementação de oxigênio, no âmbito do Sistema Único de Saúde ­ SUS, conforme a Portaria nº 60, publicada no Diário Oficial da União nº 171, seção 1, página 77, em 9 de setembro de 2021.


Subject(s)
Humans , Antiviral Agents/therapeutic use , Respiration, Artificial , SARS-CoV-2/drug effects , COVID-19/drug therapy , Unified Health System , Brazil , Cost-Benefit Analysis
4.
Arch. argent. pediatr ; 119(3): 208-212, Junio 2021. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1223006

ABSTRACT

La infección crónica con el virus C de la hepatitis constituye un problema de salud a nivel mundial, tanto en niños como en adultos. Su eliminación espontánea puede ocurrir durante la infancia temprana, y luego es infrecuente. Aunque la mayoría de los casos son asintomáticos en la infancia y adolescencia, al llegar a la edad adulta, los pacientes pueden evolucionar a la cirrosis y presentar complicaciones, que incluyen el carcinoma hepatocelular. Un tratamiento eficaz debe tener como meta la eliminación del virus, lo que significaría la curación de la enfermedad. Recientemente, el advenimiento de varios agentes antivirales de acción directa ha posibilitado una alta resolución de la infección, del 97-100 % de los casos. Para lograr este objetivo costo-efectivo, es fundamental la concientización de los pediatras en la detección de los pacientes infectados y su derivación al especialista hepatólogo pediatra para la implementación del tratamiento adecuado.


Chronic hepatitis C virus infection is a health problem worldwide, both in children and adults. Its spontaneous resolution may occur during early childhood, and then it becomes uncommon. Although most cases are asymptomatic during childhood and adolescence, as adults, patients may progress to cirrhosis and develop complications, including hepatocellular carcinoma. The goal of an effective treatment should be virus elimination, i.e., disease cure. Recently, the emergence of several direct-acting antivirals has enabled a high rate of infection resolution in 97-100 % of cases. To achieve this cost-effective objective, it is critical to raise awareness among pediatricians so that they can detect infected patients and refer them to a pediatric liver specialist for an adequate management.


Subject(s)
Humans , Male , Female , Pregnancy , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Hepatitis C/therapy , Hepatitis C/transmission , Antiviral Agents/therapeutic use , Hepatitis C/etiology , Infectious Disease Transmission, Vertical
5.
Buenos Aires; Comisión Nacional de Evaluación de Tecnologías de Salud; 19 Abril 2021. 17 p. (Informe de Evaluación de Tecnologías Sanitarias COVID N°01, 1).
Monography in Spanish | LILACS, BRISA, BINACIS, ARGMSAL | ID: biblio-1178400

ABSTRACT

INTRODUCCIÓN: El presente informe es producto del trabajo colaborativo de la Comisión Nacional de Evaluación de Tecnologías de Salud (CONETEC), dependiente del Ministerio de Salud de la Nación y creada por RM N° 623/2018. La CONETEC realiza evaluaciones y emite recomendaciones a la autoridad sanitaria sobre la incorporación, forma de uso, financiamiento y políticas de cobertura de las tecnologías sanitarias desde una perspectiva global del sistema de salud argentino. En sus evaluaciones y recomendaciones, la CONETEC tiene en cuenta criterios de calidad, seguridad, efectividad, eficiencia y equidad, evaluados bajo dimensiones éticas, médicas, económicas y sociales. Sus resultados son consensuados mediante discusiones públicas y ponderados a través de un marco de valor explícito, con la participación de todos los actores involucrados en el proceso de toma de decisiones en salud. Los informes y recomendaciones de esta comisión surgen de este proceso público, transparente y colaborativo, siendo de libre consulta y acceso para toda la sociedad. El objetivo del presente informe es evaluar parámetros de eficacia, seguridad y conveniencia de Remdesivir para el tratamiento de pacientes con COVID-19. OBJETIVO: El objetivo del presente informe es evaluar parámetros de eficacia, seguridad y conveniencia de Remdesivir para el tratamiento de pacientes con COVID-19. METODOLOGIA: Se realizó una evaluación de tecnología sanitaria, basada en evidencia proveniente de revisiones sistemáticas vivas y guías de práctica clínica de alta calidad metodológica para brindar parámetros actualizados y balanceados que sean de utilidad para la toma de decisiones en los diferentes niveles de gestión. RESULTADOS: Efectos en la Salud: Se identificaron tres revisiones sistemáticas que cumplen con los criterios de inclusión del presente informe. Las revisiones sistemáticas identificadas incluyeron 6 estudios aleatorizados para remdesivir en COVID-19 que aleatorizaron un total de 7797 pacientes. La mayoría de los estudios analizados incluyeron pacientes con enfermedad severa a crítica ya que la mortalidad promedio varió entre 8,3% y 12,6%. Uno de los estudios incluyó pacientes leves con una mortalidad del 2%. En relación con el desenlace mortalidad se postuló un posible efecto de subgrupo en el que remdesivir reduciría la mortalidad en pacientes con enfermedad menos severa mientras que no afectaría la mortalidad en pacientes con enfermedad más severa. Sin embargo, el análisis de credibilidad del efecto de subgrupo resultó moderado por lo que continúa siendo incierto si existe o no un efecto diferencial de remdesivir según la severidad de la enfermedad. CONCLUSIONES: El cuerpo de evidencia disponible hasta el momento muestra que remdesivir podría asociarse a beneficios modestos sin eventos adversos severos. La certeza en los efectos de remdesivir sobre la salud de pacientes con COVID-19 es baja. Remdesivir no se encuentra disponible en Argentina. La dificultad para su adquisición en el país y el elevado costo comparativo de esta intervención podría afectar la distribución equitativa de la misma y su disponibilidad en un contexto de alta demanda. Las guías de práctica clínica identificadas entregan recomendaciones condicionales pero discordantes en cuanto a su dirección.


Subject(s)
Humans , Antiviral Agents/therapeutic use , Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , COVID-19/drug therapy , Severity of Illness Index , Cost-Benefit Analysis , Therapeutic Index
7.
Electron. j. biotechnol ; 50: 16-22, Mar. 2021. ilus, tab
Article in English | LILACS | ID: biblio-1292419

ABSTRACT

BACKGROUND: Cecropin P1, acting as an antimicrobial, has a broad-spectrum antibacterial activity with some antiviral and antifungal properties. It is a promising natural alternative to antibiotics which is originally isolated from the pig intestinal parasitic nematode Ascaris suum. Many studies have shown that Cecropin P1 is helpful for the prevention or treatment of clinical diseases. Therefore, it is very necessary to establish a safe, nontoxic, and efficient expression method of Cecropin P1. RESULTS: The results indicated that the recombinant protein was about 5.5 kDa showed by Tricine­SDS­ PAGE and Western blot. And Cecropin P1 was efficiently secreted and expressed after 12 h of induction, with an increasing yield over the course of the induction. Its maximum concentration was 7.83 mg/L after concentration and purification. In addition, in vitro experiments demonstrated that Cecropin P1 not only exerted a strong inhibitory effect on Escherichia coli, Salmonella sp., Shigella sp., and Pasteurella sp., but also displayed an antiviral activity against PRRSV NADC30-Like strain. CONCLUSIONS: Collectively, the strategy of expressing Cecropin P1 in Saccharomyces cerevisiae is harmless, efficient, and safe for cells. In addition, the expressed Cecropin P1 has antiviral and antibacterial properties concurrently.


Subject(s)
Peptides/pharmacology , Saccharomyces cerevisiae/drug effects , Anti-Bacterial Agents/pharmacology , Antiviral Agents/pharmacology , Peptides/chemistry , In Vitro Techniques , Recombinant Proteins , Microbial Sensitivity Tests , Blotting, Western
8.
Rev. bras. cancerol ; 67(2): e-121220, 2021.
Article in Portuguese | LILACS | ID: biblio-1254344

ABSTRACT

Introdução: A hepatite C está associada ao desenvolvimento do carcinoma hepatocelular (CHC). O regime terapêutico baseado em interferon vem sendo substituído pelos antivirais de ação direta (AAD) para tratamento da infecção pelo vírus da hepatite C (HCV). Contudo, estudos recentes evidenciaram um aumento inesperado da recorrência do CHC em pacientes tratados com AAD para resolução da hepatite C. Objetivo: Avaliar o risco de recorrência de hepatocarcinoma após uso de AAD em pacientes com infecção por HCV. Método: Realizou-se um levantamento nas bases de dados PubMed, MEDLINE e LILACS de acordo com os descritores DeCS/MeSH ((hepatocellular carcinoma) AND recurrence) AND Direct-acting antiviral. A revisão obedeceu ao protocolo PRISMA e está cadastrada na plataforma PROSPERO. A análise estatística dos dados foi realizada no software RStudio. Resultados: Sete artigos foram selecionados resultando em 847 pacientes. Entre os tratados com AAD, a taxa de recorrência variou entre 11,1% e 42,1% e, no grupo controle, ocorreu em 5% a 65,6% dos pacientes. O risco relativo (RR) de recorrência do CHC no grupo de pacientes que recebeu AAD foi menor do que o risco evidenciado no grupo controle, apesar de não haver significância estatística (RR 0,71 95% IC [0,55;0,93] I²=38%, p=0,14). O tempo até o diagnóstico da recorrência teve uma média de 9,35 meses no grupo exposto à terapia e 13,42 meses no grupo controle. Conclusão: Sugere-se que a terapia com AAD não aumenta o risco de recorrência do CHC em comparação com grupos controle. Nos pacientes que desenvolveram recorrência, ocorreu com maior frequência dentro do primeiro ano após introdução dos AAD.


Introduction: Hepatitis C is associated with the development of hepatocellular carcinoma (HCC). The interferon-based therapeutic regimen has been replaced by direct-acting antivirals (AAD) to treat HCV virus infection. However, recent studies have shown an unexpected increase in HCC recurrence in patients treated with AAD to resolve hepatitis C. Objective: To assess the risk of hepatocarcinoma recurrence after using AAD in patients with HCV infection. Method: A survey was carried out in PubMed, MEDLINE, and LILACS databases according to the descriptors DeCS/MeSH ((hepatocellular carcinoma) AND recurrence) AND Direct-acting antiviral. The review followed the PRISMA protocol and is registered on the PROSPERO platform. The data statistical analysis was performed through RStudio software. Results: Seven articles were selected resulting in 847 patients. Among those treated with AAD, the recurrence rate varied between 11.1% to 42.1% and, in the control group, it occurred in 5% to 65.6% of the patients. The relative risk (RR) of recurrence of HCC in the group of patients who received AAD was less than the risk evidenced in the control group, although there is no statistical significance (RR 0.71 95% CI [0.55; 0.93] I²=38%, p=0.14). The mean time until the diagnosis of recurrence was 9.35 months in the group exposed to therapy and 13.42 months in the control group. Conclusion: It is suggested that therapy with AAD does not increase the risk of HCC recurrence compared to control groups. In patients who developed recurrence, it occurred more frequently within the first year after the introduction of AAD.


Introducción: La hepatitis C está asociada con el desarrollo de carcinoma hepatocelular (CHC). El régimen terapéutico basado en interferón ha sido reemplazado por antivirales de acción directa (AAD) para tratar la infección por VHC. Sin embargo, estudios recientes han mostrado un incremento inesperado en la recurrencia del CHC en pacientes tratados con AAD para resolución de la hepatitis C. Objetivo: Evaluar el riesgo de recurrencia del hepatocarcinoma después de usar AAD en pacientes con infección por VHC. Método: Se realizó una pesquisa en las bases de datos PubMed, MEDLINE y LILACS según los descriptores DeCS/MeSH ((carcinoma hepatocelular) AND recurrencia) AND antiviral de acción directa. La revisión siguió el protocolo PRISMA y está registrada en la plataforma PROSPERO. El análisis estadístico de los datos se realizó mediante el software RStudio. Resultados: Fueron seleccionados 7 artículos resultando en 847 pacientes. Entre los tratados con AAD, la tasa de recurrencia varió entre el 11,1% y el 42,1% y, en el grupo de control, ocurrió entre el 5% y el 65,6% de los pacientes. El riesgo relativo (RR) de recurrencia del CHC en el grupo de pacientes que recibieron AAD fue inferior que el riesgo evidenciado en el grupo control, aunque no hay significación estadística (RR 0,71; IC del 95% [0,55; 0,93] I²=38%, p=0,14). El tiempo hasta el diagnóstico de recidiva fue de 9,35 meses en el grupo expuesto a terapia y de 13,42 meses en el grupo control. Conclusión: Se sugiere que la terapia con AAD no aumenta el riesgo de recurrencia del CHC en comparación con los grupos control. En los pacientes que desarrollaron recurrencia, esta ocurrió con mayor frecuencia durante el primer año después de la introducción de los AAD.


Subject(s)
Humans , Liver Neoplasms/etiology , Antiviral Agents/therapeutic use , Hepatitis C/complications , Carcinoma, Hepatocellular/etiology , Neoplasm Recurrence, Local
9.
Rev. bras. cancerol ; 67(2): e-121220, 2021.
Article in Portuguese | LILACS | ID: biblio-1254542

ABSTRACT

Introdução: A hepatite C está associada ao desenvolvimento do carcinoma hepatocelular (CHC). O regime terapêutico baseado em interferon vem sendo substituído pelos antivirais de ação direta (AAD) para tratamento da infecção pelo vírus da hepatite C (HCV). Contudo, estudos recentes evidenciaram um aumento inesperado da recorrência do CHC em pacientes tratados com AAD para resolução da hepatite C. Objetivo: Avaliar o risco de recorrência de hepatocarcinoma após uso de AAD em pacientes com infecção por HCV. Método: Realizou-se um levantamento nas bases de dados PubMed, MEDLINE e LILACS de acordo com os descritores DeCS/MeSH ((hepatocellular carcinoma) AND recurrence) AND Direct-acting antiviral. A revisão obedeceu ao protocolo PRISMA e está cadastrada na plataforma PROSPERO. A análise estatística dos dados foi realizada no software RStudio. Resultados: Sete artigos foram selecionados resultando em 847 pacientes. Entre os tratados com AAD, a taxa de recorrência variou entre 11,1% e 42,1% e, no grupo controle, ocorreu em 5% a 65,6% dos pacientes. O risco relativo (RR) de recorrência do CHC no grupo de pacientes que recebeu AAD foi menor do que o risco evidenciado no grupo controle, apesar de não haver significância estatística (RR 0,71 95% IC [0,55;0,93] I²=38%, p=0,14). O tempo até o diagnóstico da recorrência teve uma média de 9,35 meses no grupo exposto à terapia e 13,42 meses no grupo controle. Conclusão: Sugere-se que a terapia com AAD não aumenta o risco de recorrência do CHC em comparação com grupos controle. Nos pacientes que desenvolveram recorrência, ocorreu com maior frequência dentro do primeiro ano após introdução dos AAD.


Introduction: Hepatitis C is associated with the development of hepatocellular carcinoma (HCC). The interferon-based therapeutic regimen has been replaced by direct-acting antivirals (AAD) to treat HCV virus infection. However, recent studies have shown an unexpected increase in HCC recurrence in patients treated with AAD to resolve hepatitis C. Objective: To assess the risk of hepatocarcinoma recurrence after using AAD in patients with HCV infection. Method: A survey was carried out in PubMed, MEDLINE, and LILACS databases according to the descriptors DeCS/MeSH ((hepatocellular carcinoma) AND recurrence) AND Direct-acting antiviral. The review followed the PRISMA protocol and is registered on the PROSPERO platform. The data statistical analysis was performed through RStudio software. Results: Seven articles were selected resulting in 847 patients. Among those treated with AAD, the recurrence rate varied between 11.1% to 42.1% and, in the control group, it occurred in 5% to 65.6% of the patients. The relative risk (RR) of recurrence of HCC in the group of patients who received AAD was less than the risk evidenced in the control group, although there is no statistical significance (RR 0.71 95% CI [0.55; 0.93] I²=38%, p=0.14). The mean time until the diagnosis of recurrence was 9.35 months in the group exposed to therapy and 13.42 months in the control group. Conclusion: It is suggested that therapy with AAD does not increase the risk of HCC recurrence compared to control groups. In patients who developed recurrence, it occurred more frequently within the first year after the introduction of AAD.


Introducción: La hepatitis C está asociada con el desarrollo de carcinoma hepatocelular (CHC). El régimen terapéutico basado en interferón ha sido reemplazado por antivirales de acción directa (AAD) para tratar la infección por VHC. Sin embargo, estudios recientes han mostrado un incremento inesperado en la recurrencia del CHC en pacientes tratados con AAD para resolución de la hepatitis C. Objetivo: Evaluar el riesgo de recurrencia del hepatocarcinoma después de usar AAD en pacientes con infección por VHC. Método: Se realizó una pesquisa en las bases de datos PubMed, MEDLINE y LILACS según los descriptores DeCS/MeSH ((carcinoma hepatocelular) AND recurrencia) AND antiviral de acción directa. La revisión siguió el protocolo PRISMA y está registrada en la plataforma PROSPERO. El análisis estadístico de los datos se realizó mediante el software RStudio. Resultados: Fueron seleccionados 7 artículos resultando en 847 pacientes. Entre los tratados con AAD, la tasa de recurrencia varió entre el 11,1% y el 42,1% y, en el grupo de control, ocurrió entre el 5% y el 65,6% de los pacientes. El riesgo relativo (RR) de recurrencia del CHC en el grupo de pacientes que recibieron AAD fue inferior que el riesgo evidenciado en el grupo control, aunque no hay significación estadística (RR 0,71; IC del 95% [0,55; 0,93] I²=38%, p=0,14). El tiempo hasta el diagnóstico de recidiva fue de 9,35 meses en el grupo expuesto a terapia y de 13,42 meses en el grupo control. Conclusión: Se sugiere que la terapia con AAD no aumenta el riesgo de recurrencia del CHC en comparación con los grupos control. En los pacientes que desarrollaron recurrencia, esta ocurrió con mayor frecuencia durante el primer año después de la introducción de los AAD.


Subject(s)
Antiviral Agents/therapeutic use , Hepatitis C/complications , Carcinoma, Hepatocellular/etiology , Liver Neoplasms/etiology , Neoplasm Recurrence, Local
10.
Article in Chinese | WPRIM | ID: wpr-879810

ABSTRACT

OBJECTIVE@#To study the medication in children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Wuhan, China, and to provide a reference for rational drug use in clinical practice.@*METHODS@#A retrospective analysis was performed on the medical data of the children who were diagnosed with SARS-CoV-2 infection from January 26 to March 5, 2020. The children were divided into an asymptomatic group with 41 children and a symptomatic group with 73 children. A subgroup analysis was performed to investigate the effect of different antiviral regimens (monotherapy, double therapy, or triple therapy) and whether interferon α-1b was used in combination with azithromycin on the length of hospital stay and the clearance time of SARS-CoV-2 nucleic acid.@*RESULTS@#A total of 114 children with SARS-CoV-2 infection (72 boys and 42 girls) were enrolled. The median age of the children was 7.1 years. The median length of hospital stay was 10 days and the clearance time of SARS-CoV-2 nucleic acid was 6 days. In either group, the subgroup analysis showed no significance differences in the length of hospital stay and the clearance time of SARS-CoV-2 nucleic acid between the subgroups treated with different combinations of antiviral drugs and the subgroups treated with interferon α-1b alone or in combination with azithromycin (@*CONCLUSIONS@#It is not recommended to use the routine combinations of antiviral drugs for children with SARS-COV-2 infection or combine with azithromycin for the purpose of antiviral therapy.


Subject(s)
Antiviral Agents/therapeutic use , COVID-19 , Child , China , Female , Humans , Male , Retrospective Studies , SARS-CoV-2
11.
Braz. j. med. biol. res ; 54(2): e9542, 2021. tab
Article in English | LILACS, ColecionaSUS | ID: biblio-1142580

ABSTRACT

Influenza viruses exacerbate chronic obstructive pulmonary disease (COPD) with considerable morbidity and mortality. Zanamivir and oseltamivir are effective in treating influenza. However, their efficacy in relieving influenza symptoms in COPD patients remains unknown, with the lack of controlled trials in this subject. Therefore, we conducted this randomized controlled trial to investigate the clinical efficacy of both interventions in this population. Patients were allocated to two groups (80 patients each): oseltamivir (OSELTA) and zanamivir (ZANA) groups. Oseltamivir (75 mg) was orally administered twice daily for 5 days, while zanamivir (10 mg) was inhaled twice daily for 5 days. Clinical parameters including body temperature, influenza symptoms (i.e., sore throat, cough, etc.), and serial blood tests were recorded on days 1, 3, and 7. We analyzed primary (changes in body temperature) and secondary outcomes (changes in non-specific symptoms) using the pre-protocol and intention-to-treat analyses. Differences between groups were assessed using t-test. Oseltamivir and zanamivir significantly reduced body temperature on the 3rd day after treatment; however, the number of patients who reported clinical improvement in influenza-like symptoms was significantly higher in the OSELTA group compared to the ZANA group on days 3 (85 vs 68.8%, P=0.015) and 7 (97.5 vs 83.8%, P=0.003). However, no significant changes in hematological (white blood cells and its subtypes) and inflammatory (C-reactive protein) parameters were noted (P>0.05). Our results suggested that oseltamivir and zanamivir are effective in reducing body temperature, while oseltamivir led to better clinical improvement regarding influenza-like symptoms in patients with COPD.


Subject(s)
Humans , Male , Female , Middle Aged , Antiviral Agents/therapeutic use , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/drug therapy , Influenza, Human/drug therapy , Oseltamivir/therapeutic use , Zanamivir/therapeutic use , Enzyme Inhibitors/therapeutic use , Neuraminidase
12.
Chinese Journal of Hepatology ; (12): 319-325, 2021.
Article in Chinese | WPRIM | ID: wpr-879638

ABSTRACT

Viral hepatitis C is one of the important causes of liver cirrhosis and hepatocellular carcinoma. There are approximately 10 million cases of chronic hepatitis C virus (HCV) infection in China. However, over 70% of HCV infections of China have not yet been detected. According to the goal of "eliminating viral hepatitis as a public health threat by 2030" of the World Health Organization Viral Hepatitis Strategy, and the fact that medical institutions remain the main places for detecting HCV infections or patients in China at present, we established the " In-hospital process for viral hepatitis C screening and management in China (Draft)", with intention to promote the multidisciplinary collaboration and cooperation among the departments of clinic, laboratory, infection control, management, and etc. in medical institutions, and strengthen consultation and referral of patients with detected HCV antibodies and advance the diagnosis and antiviral treatment of patients with chronic hepatitis C.


Subject(s)
Antiviral Agents/therapeutic use , China/epidemiology , Hepacivirus/genetics , Hepatitis C/epidemiology , Hepatitis C, Chronic/epidemiology , Hospitals , Humans , Liver Neoplasms/drug therapy
13.
Chinese Journal of Hepatology ; (12): 313-318, 2021.
Article in Chinese | WPRIM | ID: wpr-879637

ABSTRACT

The World Health Organization (WHO) has set the goal of eliminating viral hepatitis as a threat to public health by 2030. Blocking mother-to-child transmission (MTCT) of hepatitis B virus (HBV) is the key step for eliminating viral hepatitis, at the same time, it is the hotspot in the field of hepatitis B prevention and control as well. The China Foundation of Hepatitis Prevention and Control (CFHPC) organized a team of specialists to develop an algorithm for preventing MTCT of HBV, based on the most recent hepatitis B guidelines and the latest evidence. The algorithm covers 10 continuous steps from pregnant management to follow-up postpartum. Among the 10 steps, screening, antiviral therapy during pregnancy, and infant's immunization are the core components in the algorithm.


Subject(s)
Algorithms , Antiviral Agents/therapeutic use , Child , China , Female , Hepatitis B/prevention & control , Hepatitis B Surface Antigens , Hepatitis B e Antigens , Hepatitis B virus , Humans , Infant , Infectious Disease Transmission, Vertical/prevention & control , Pregnancy , Pregnancy Complications, Infectious/prevention & control
14.
Article in Chinese | WPRIM | ID: wpr-879191

ABSTRACT

Antiviral Oral Liquid is modified on the basis of Baihu Decoction in Treatise on Febrility Diseases by ZHANG Zhongjing and Qingwen Baidu Yin in Qing Dynasty, with effects in clearing toxic heat, repelling dampness and cooling blood. It is widely used in clinical treatment of common colds, influenza and upper respiratory tract infection, mumps, viral conjunctivitis and hand-foot-mouth disease, with a good clinical efficacy and safety. Based on a questionnaire survey of clinicians and a systematic review of study literatures on Antiviral Oral Liquid, the international clinical practice guidelines development method was adopted to analyze the optimal available evidences and expert experiences in the "evidence-based, consensus-based and experience-based" principles. The consensus was jointly reached by more than 30 multidisciplinary experts nationwide, including clinical experts of traditional Chinese and Western medicine in the field of respiratory diseases and infectious diseases, and methodological experts. In the study, literatures were retrieved based on clinical problems in the clinical survey as well as PICO clinical problems. The GRADE system was used for the classification and evaluation of evidence, and fully combined with clinical expert experience, so as to reach expert consensus by the nominal grouping method. This expert consensus recommended or suggested indications, usage and dosage, course of treatment, intervention time for treatment, and the safety and precautions of Antiviral Oral Liquid for treatment of influenza, and can provide reference for the rational use of this drug in clinical practice.


Subject(s)
Antiviral Agents/therapeutic use , Consensus , Hand, Foot and Mouth Disease , Humans , Influenza, Human/drug therapy , Medicine, Chinese Traditional
15.
Article in Chinese | WPRIM | ID: wpr-879126

ABSTRACT

Isatidis Radix is the dried root of the Isatis indigotica, with pharmacological effects such as heat-clearing and detoxification, cooling blood and pharyngeal relief, antibacterial and anti-inflammatory effects. It is often used clinically to prevent and treat influenza and other diseases. In this paper, relevant domestic and foreign literatures in recent years were summarized, and it was found that Isatidis Radix lignans, indole alkaloids, polysaccharides, etc. were the main active components against influenza virus. Then its pharmacological effects and the mechanism of action were reviewed, providing a basis for in-depth research on the antiviral effect of Isatidis Radix.


Subject(s)
Antiviral Agents/pharmacology , Drugs, Chinese Herbal , Isatis , Orthomyxoviridae , Plant Roots , Polysaccharides
16.
Article in Chinese | WPRIM | ID: wpr-878989

ABSTRACT

In this paper, Asarum polysaccharides(AP) were extracted, and its composition was analyzed to study the activity against H1 N1 influenza virus in vitro and its intervention effect on mice with kidney Yang deficiency syndrome. AP was prepared by the strategy of water extraction and alcohol precipitation, the content was determined, and its monosaccharide composition was analyzed. The cell Real-time monitoring system and Reed-Muench model were adopted to evaluate the antiviral activity of AP in vitro. And the mouse model of kidney Yang deficiency syndrome was established in vivo to compare the efficacy of Mahuang Xixin Fuzi Decoction(MXF) and AP. MXF group and AP group were treated with clinical equivalent doses of 1.8 g·kg~(-1)·d~(-1) and 0.077 g·kg~(-1)·d~(-1) respectively, once a day for 6 consecutive days. Real-time PCR was used to detect the relative expression of M gene of H1 N1 influenza virus and cytokines in lung tissue. The content of AP in Asarum was 25.22%, and the protein content was 0.8%. And the monosaccharide composition was identified as L-rhamnose, D-arabinose, D-xylose, D-glucose, D-galactose and D-mannose. TI values of Tamiflu, MXF and AP were 30.00, 8.06 and 10.33, respectively. Three different doses of AP could significantly reduce the concentration of virus in supernatant. Compared with the model mice, lung indexes of MXF group and AP group decreased significantly(P<0.05), and the relative expression of M gene decreased significantly(P<0.05). The relative expressions of IL-10 and IFN-γ were up-regulated to varying degrees, while the relative gene expressions of IL-1β, IL-6 and MCP-1 were down-regulated to different degrees. In addition, AP could significantly enhance the expression of TNF-α(P<0.01). AP had a good anti-influenza virus activity in vitro, and could protect mice with kidney Yang deficiency syndrome by reducing the viral load in lung tissue, decreasing inflammation damage in lung tissue, and regulating the expression of inflammatory cytokines. Compared with the prescription of MXF, AP had a better antiviral activity.


Subject(s)
Animals , Antiviral Agents/therapeutic use , Asarum , Cytokines/genetics , Drugs, Chinese Herbal , Influenza A Virus, H1N1 Subtype , Influenza, Human/genetics , Lung , Mice , Polysaccharides
17.
Chinese Journal of Biotechnology ; (12): 1237-1248, 2021.
Article in Chinese | WPRIM | ID: wpr-878627

ABSTRACT

RNA interference (RNAi) is one of the important mechanisms to regulate gene expression in eukaryotes. One of the original functions of RNAi is to facilitate the antiviral strategy of host. Early studies reveal that invertebrates can use RNAi to resist viruses. However, if this mechanism exists in mammals is still controversial. The latest studies confirm that mammals do have the RNAi-based immunity, and researchers believe that RNAi-based antiviral immunity is a brand-new immunological mechanism that was neglected in the past. It is worthy to note that virus can also use RNAi to enhance its infectivity and immune escape in host cells. This review introduces the research history of RNAi-based antiviral immunity in animals and summarizes the main findings in this field. Last but not least, we indicate a series of unresolved questions about RNAi-based antiviral immunity, and explore the relationship between RNAi-based antiviral immunity and other innate immunological pathways. The virus-mediated RNAi pathway in animal is not only an interesting basic biology question, but also has important guiding roles in the development of antiviral drugs.


Subject(s)
Animals , Antiviral Agents , Immunity, Innate/genetics , Mammals , RNA Interference , RNA, Small Interfering/genetics , RNA, Viral
18.
Article in English | WPRIM | ID: wpr-881088

ABSTRACT

Huashi Baidu prescription (HSBDF), recommended in the Guideline for the Diagnosis and Treatment of Novel Coronavirus (2019-nCoV) Pneumonia (On Trials, the Seventh Edition), was clinically used to treat severe corona virus disease 2019 (COVID-19) with cough, blood-stained sputum, inhibited defecation, red tongue etc. symptoms. This study was aimed to elucidate and profile the knowledge on its chemical constituents and the potential anti-inflammatory effect in vitro. In the study, the chemical constituents in extract of HSBDF were characterized by UPLC-Q-TOF/MS in both negative and positive modes, and the pro-inflammatory cytokines were measured by enzyme-linked immunosorbent assays (ELISA) to determine the effects of HSBDF in lipopolysaccharide (LPS)-stimulated RAW264.7 cells. The results showed that a total of 217 chemical constituents were tentativedly characterized in HSBDF. Moreover, HSBDF could alleviate the expression levels of IL-6 and TNF-α in the cell models, indicating that the antiviral effects of HSBDF might be associated with regulation of the inflammatory cytokines production in RAW264.7 cells. We hope that the results could be served as the basic data for further study of HSBDF on anti-COVID-19 effect.


Subject(s)
Anti-Inflammatory Agents/therapeutic use , Antiviral Agents/therapeutic use , COVID-19/drug therapy , Drugs, Chinese Herbal/therapeutic use , Humans , Plant Extracts/therapeutic use , SARS-CoV-2/drug effects
19.
Article in English | WPRIM | ID: wpr-880988

ABSTRACT

OBJECTIVE@#Traditional Chinese medicine plays a significant role in the treatment of the pandemic of coronavirus disease 2019 (COVID-19). Tanreqing Capsule (TRQC) was used in the treatment of COVID-19 patients in the Shanghai Public Health Clinical Center. This study aimed to investigate the clinical efficacy of TRQC in the treatment of COVID-19.@*METHODS@#A retrospective cohort study was conducted on 82 patients who had laboratory-confirmed mild and moderate COVID-19; patients were treated with TRQC in one designated hospital. The treatment and control groups consisted of 25 and 57 cases, respectively. The treatment group was given TRQC orally three times a day, three pills each time, in addition to conventional Western medicine treatments which were also administered to the control group. The clinical efficacy indicators, such as the negative conversion time of pharyngeal swab nucleic acid, the negative conversion time of fecal nucleic acid, the duration of negative conversion of pharyngeal-fecal nucleic acid, and the improvement in the level of immune indicators such as T-cell subsets (CD3, CD4 and CD45) were monitored.@*RESULTS@#COVID-19 patients in the treatment group, compared to the control group, had a shorter negative conversion time of fecal nucleic acid (4 vs. 9 days, P = 0.047) and a shorter interval of negative conversion of pharyngeal-fecal nucleic acid (0 vs. 2 days, P = 0.042). The level of CD3@*CONCLUSION@#Significant reductions in the negative conversion time of fecal nucleic acid and the duration of negative conversion of pharyngeal-fecal nucleic acid were identified in the treatment group as compared to the control group, illustrating the potential therapeutic benefits of using TRQC as a complement to conventional medicine in patients with mild and moderate COVID-19. The underlying mechanism may be related to the improved levels of the immune indicator CD3


Subject(s)
Adult , Antiviral Agents/therapeutic use , COVID-19/pathology , Capsules , DNA, Viral/analysis , Drugs, Chinese Herbal/therapeutic use , Feces/virology , Female , Humans , Length of Stay , Lymphocyte Count , Male , Medicine, Chinese Traditional/methods , Middle Aged , Retrospective Studies , SARS-CoV-2/genetics , Severity of Illness Index , Treatment Outcome , Young Adult
20.
Article in English | WPRIM | ID: wpr-880560

ABSTRACT

Covid-19 pandemic has caused hundreds of thousands deaths and millions of infections and continued spreading violently. Although researchers are racing to find or develop effective drugs or vaccines, no drugs from modern medical system have been proven effective and the high mutant rates of the virus may lead it resistant to whatever drugs or vaccines developed following modern drug development procedure. Current evidence has demonstrated impressive healing effects of several Chinese medicines (CMs) for Covid-19, which urges us to reflect on the role of CM in the era of modern medicine. Undoubtedly, CM could be promising resources for developing drug candidates for the treatment of Covid-19 in a way similar to the development of artemisinin. But the theory that builds CM, like the emphasis of driving away exogenous pathogen (virus, etc.) by restoring self-healing capacity rather than killing the pathogen directly from the inside and the 'black-box' mode of diagnosing and treating patients, is as important, yet often ignored, an treasure as CM herbs and should be incorporated into modern medicine for future advancement and innovation of medical science.


Subject(s)
Antiviral Agents/therapeutic use , COVID-19/therapy , Disease Outbreaks , Drug Development/standards , Drug Resistance, Viral/genetics , Drug Therapy, Combination , Drugs, Chinese Herbal/therapeutic use , Humans , Medicine, Chinese Traditional/trends , Mutation Rate , Pandemics , Phytotherapy/methods , SARS-CoV-2/physiology
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