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1.
N Engl J Med ; 2020 Dec 02.
Artículo en Inglés | MEDLINE | ID: mdl-33264556

RESUMEN

BACKGROUND: World Health Organization expert groups recommended mortality trials of four repurposed antiviral drugs - remdesivir, hydroxychloroquine, lopinavir, and interferon beta-1a - in patients hospitalized with coronavirus disease 2019 (Covid-19). METHODS: We randomly assigned inpatients with Covid-19 equally between one of the trial drug regimens that was locally available and open control (up to five options, four active and the local standard of care). The intention-to-treat primary analyses examined in-hospital mortality in the four pairwise comparisons of each trial drug and its control (drug available but patient assigned to the same care without that drug). Rate ratios for death were calculated with stratification according to age and status regarding mechanical ventilation at trial entry. RESULTS: At 405 hospitals in 30 countries, 11,330 adults underwent randomization; 2750 were assigned to receive remdesivir, 954 to hydroxychloroquine, 1411 to lopinavir (without interferon), 2063 to interferon (including 651 to interferon plus lopinavir), and 4088 to no trial drug. Adherence was 94 to 96% midway through treatment, with 2 to 6% crossover. In total, 1253 deaths were reported (median day of death, day 8; interquartile range, 4 to 14). The Kaplan-Meier 28-day mortality was 11.8% (39.0% if the patient was already receiving ventilation at randomization and 9.5% otherwise). Death occurred in 301 of 2743 patients receiving remdesivir and in 303 of 2708 receiving its control (rate ratio, 0.95; 95% confidence interval [CI], 0.81 to 1.11; P = 0.50), in 104 of 947 patients receiving hydroxychloroquine and in 84 of 906 receiving its control (rate ratio, 1.19; 95% CI, 0.89 to 1.59; P = 0.23), in 148 of 1399 patients receiving lopinavir and in 146 of 1372 receiving its control (rate ratio, 1.00; 95% CI, 0.79 to 1.25; P = 0.97), and in 243 of 2050 patients receiving interferon and in 216 of 2050 receiving its control (rate ratio, 1.16; 95% CI, 0.96 to 1.39; P = 0.11). No drug definitely reduced mortality, overall or in any subgroup, or reduced initiation of ventilation or hospitalization duration. CONCLUSIONS: These remdesivir, hydroxychloroquine, lopinavir, and interferon regimens had little or no effect on hospitalized patients with Covid-19, as indicated by overall mortality, initiation of ventilation, and duration of hospital stay. (Funded by the World Health Organization; ISRCTN Registry number, ISRCTN83971151; ClinicalTrials.gov number, NCT04315948.).

3.
Vaccine ; 31 Suppl 3: C114-22, 2013 Jul 02.
Artículo en Inglés | MEDLINE | ID: mdl-23777684

RESUMEN

BACKGROUND: Countries in Latin America were among the first developing countries to introduce new vaccines, particularly rotavirus (RV) and pneumococcal conjugate vaccines (PCVs), into their national immunization schedules. Experiences and lessons learned from these countries are valuable to donors, immunization partners, and policy makers in other countries wishing to make informed decisions on vaccine introduction. OBJECTIVES: In order to enhance knowledge and promote understanding of the process of new vaccine introduction in the Latin American Region, with particular focus on RV and PCV, we conducted a systematic qualitative assessment. We evaluated the decision-making process, documented the structure in place, and reviewed key factors pertaining to new vaccine introduction. These include country morbidity and mortality data available prior to vaccine introduction, funding sources and mechanisms for vaccine introduction, challenges of implementation, and assessment of vaccine impact. METHODS: From March 2010 to April 2011, we evaluated a subset of countries that had introduced RV and/or PCV in the past five years through interviews with key informants at the country level and through a systematic review of published data, gray literature, official technical documents, and country-specific health indicators. Countries evaluated were Bolivia, Brazil, Nicaragua, Peru, and Venezuela. RESULTS: In all countries, the potential of new vaccines to reduce mortality, as established by Millennium Development Goal 4, was an important consideration leading to vaccine introduction. Several factors-the availability of funds, the existence of sufficient evidence for vaccine introduction, and the feasibility of sustainable financing-were identified as crucial components of the decision-making process in the countries evaluated. CONCLUSIONS: The decision making process regarding new vaccine introduction in the countries evaluated does not follow a systematic approach. Nonetheless, existing evidence on efficacy, potential impact, and cost-effectiveness of vaccine introduction, even if not local data, was important in the decision making process for vaccine introduction.


Asunto(s)
Toma de Decisiones en la Organización , Documentación , Programas de Inmunización , Bolivia , Brasil , Costo de Enfermedad , Análisis Costo-Beneficio , Política de Salud , Humanos , Programas de Inmunización/economía , Nicaragua , Organización Panamericana de la Salud , Perú , Vacunas Neumococicas , Vigilancia en Salud Pública , Vacunas contra Rotavirus , Vacunas Conjugadas , Venezuela
12.
Rev Panam Salud Publica ; 25(6): iii-iv, 2009 Jun.
Artículo en Inglés, Español | MEDLINE | ID: mdl-19695140
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