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1.
Genet Test Mol Biomarkers ; 25(2): 85-101, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33596144

RESUMEN

Coronavirus disease 2019 (COVID-19) displays a broad spectrum of clinical presentations ranging from lack of symptoms to severe multiorgan system complications and death. Various laboratory assays have been employed in the diagnosis of COVID-19, including: nucleic acid-based tests; antigen tests; and serum testing for anti-severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) antibodies. The disease can also be diagnosed based on suggestive clinical features and radiological findings. Until now, remdesivir is the only medication approved for the treatment of COVID-19 by the U.S. Food and Drug Administration (FDA); however, it is anticipated that several anti-SARS-CoV-2 monoclonal antibodies will gain soon approval. Other methods of treatment include supportive care directed toward treating the symptoms. Nevertheless, many studies have recently emerged, showing controversial preliminary results with the off-label medication hydroxychloroquine. Given that all results are still preliminary, including those seen by remdesivir, additional evidence and research are required to identify effective medications that are broadly effective and well tolerated. Importantly, two RNA-based vaccines have recently gained approval from Pfizer and Moderna, with many others still in clinical trials. This article reviews various aspects of COVID-19, including its epidemiology; its evolution and mutational spectrum; and its clinical dynamics, symptoms and complications, diagnosis, and treatment.


Asunto(s)
Carga Global de Enfermedades/estadística & datos numéricos , Pandemias/estadística & datos numéricos , /patogenicidad , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/uso terapéutico , Alanina/análogos & derivados , Alanina/uso terapéutico , Antivirales/uso terapéutico , /tratamiento farmacológico , /terapia , /métodos , Ensayos Clínicos como Asunto , Evolución Molecular , Humanos , Hidroxicloroquina/uso terapéutico , Mutación , Uso Fuera de lo Indicado , Pandemias/prevención & control , ARN Viral/genética , ARN Viral/aislamiento & purificación , /inmunología , Índice de Severidad de la Enfermedad
3.
BMJ Case Rep ; 14(1)2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-33452066

RESUMEN

A 53-year-old man with diabetes came to the emergency department with fever and dry cough for 5 days, swelling of the left leg for 2 days, shortness of breath and chest pain for 1 hour. He had raised temperature, tachycardia, tachypnoea, reduced oxygen saturation and swollen tender left leg on examination. The frontal chest radiograph showed bilateral ground-glass opacities; he tested positive for COVID-19 with elevated D-dimer. The colour Doppler examination of the left leg revealed acute deep vein thrombosis (DVT) of the common femoral and the popliteal veins. The chest CT showed bilateral diffuse ground-glass opacities predominantly involving peripheral zones and the lower lobes. The CTPA revealed left pulmonary thromboembolism (PTE), treated with low-molecular-weight heparin. COVID-19 predominantly affects the respiratory system. DVT and PTE are common in COVID-19 but lethal. They should be diagnosed early by clinical and radiological examinations and treated promptly with anticoagulants.


Asunto(s)
/complicaciones , Embolia Pulmonar/etiología , Trombosis de la Vena/etiología , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/uso terapéutico , Alanina/análogos & derivados , Alanina/uso terapéutico , Antibacterianos/uso terapéutico , Anticoagulantes/uso terapéutico , Antiparasitarios/uso terapéutico , Antivirales/uso terapéutico , /diagnóstico , /terapia , Angiografía por Tomografía Computarizada , Diabetes Mellitus Tipo 2/complicaciones , Doxiciclina/uso terapéutico , Vena Femoral , Productos de Degradación de Fibrina-Fibrinógeno , Glucocorticoides/uso terapéutico , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Ivermectina/uso terapéutico , Masculino , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Terapia por Inhalación de Oxígeno , Vena Poplítea , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/terapia , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler en Color , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/terapia
4.
Rev Med Suisse ; 17(720-1): 80-84, 2021 Jan 13.
Artículo en Francés | MEDLINE | ID: mdl-33443836

RESUMEN

The main pharmacovigilance updates in 2020 are reviewed. Remdesivir in COVID-19: relatively safe but turns out to be less effective than expected. Hydroxychloroquine in COVID-19 : lack of efficacy and risk of arrhythmias. Cytokines storm in COVID-19: may impact pharmacokinetics. VEGF inhibitors: risk of aneurysm and artery dissection. Tofacitinib: dose-dependant risk of venous thromboembolic events. Ondansetron in the first trimester of pregnancy : a highly debated risk of orofacial cleft defects. Fingolimod : contraindicated during pregnancy due to suspected risk of congenital malformations. Ranitidine: global market withdrawal due to contamination with nitrosamines. Ulipristal for uterine fibroids : market withdrawal due to risk of severe liver injury. Ingenol mebutate : market withdrawal due to paradoxical risk of skin cancers.


Asunto(s)
Farmacovigilancia , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/uso terapéutico , Alanina/análogos & derivados , Alanina/uso terapéutico , Labio Leporino/prevención & control , Contraindicaciones de los Medicamentos , Síndrome de Liberación de Citoquinas/virología , Femenino , Clorhidrato de Fingolimod/efectos adversos , Humanos , Hidroxicloroquina/efectos adversos , Leiomioma/tratamiento farmacológico , Norpregnadienos/uso terapéutico , Farmacocinética , Embarazo , Ranitidina/efectos adversos , Retirada de Medicamento por Seguridad , Neoplasias Cutáneas/inducido químicamente
5.
Eur Rev Med Pharmacol Sci ; 25(1): 541-548, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33506946

RESUMEN

OBJECTIVE: List the clinical data of the role of remdesivir in COVID-19, and try to make an objective evaluation and analyze its feasibility. MATERIALS AND METHODS: The keywords of "remdesivir", "COVID-19" and "SARS-CoV-2" were systematically searched in PubMed and Web of Science. After removing the repetitions, we summarize articles, letters, and comments on remdesivir in the treatment of COVID-19. RESULTS: In this review, we summarize clinical case of using remdesivir in the treatment of COVID-19, analyzed the final treatment results, and judged whether the drug was effective for the treatment of COVID-19. Also, attention was paid to the side effects of the drug. CONCLUSIONS: According to the clinical results, it was found that remdesivir was effective in the treatment of COVID-19. The drug has side effects, but the symptoms were mild and disappeared immediately after discontinuation of medication.


Asunto(s)
Adenosina Monofosfato/análogos & derivados , Alanina/análogos & derivados , Antivirales/uso terapéutico , /tratamiento farmacológico , Adenosina Monofosfato/administración & dosificación , Adenosina Monofosfato/efectos adversos , Adenosina Monofosfato/uso terapéutico , Alanina/administración & dosificación , Alanina/efectos adversos , Alanina/uso terapéutico , Antivirales/administración & dosificación , Antivirales/efectos adversos , Humanos , Resultado del Tratamiento
6.
Ann Palliat Med ; 10(1): 707-720, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33440983

RESUMEN

The whole world is battling through coronavirus disease 2019 (COVID-19) which is a fatal pandemic. In the early 2020, the World Health Organization (WHO) declared it as a global health emergency without definitive treatments and preventive approaches. In the absence of definitive therapeutic agents, this thorough review summarizes and outlines the potency and safety of all molecules and therapeutics which may have potential antiviral effects. A number of molecules and therapeutics licensed or being tested for some other conditions were found effective in different in vitro studies as well as in many small sample-sized clinical trials and independent case studies. However, in those clinical trials, there were some limitations which need to be overcome to find the most promising antiviral against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In conclusion, many of above-mentioned antivirals seems to have some therapeutic effects but none of them have been shown to have a strong evidence for their proper recommendation and approval in the treatment of COVID-19. Constantly evolving new evidences, exclusive adult data, language barrier, and type of study (observational, retrospective, small-sized clinical trials, or independent case series) resulted to the several limitations of this review. The need for multicentered, large sample-sized, randomized, placebo-controlled trials on COVID-19 patients to reach a proper conclusion on the most promising antiviral agent is warranted.


Asunto(s)
Antivirales/uso terapéutico , /terapia , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/farmacología , Adenosina Monofosfato/uso terapéutico , Alanina/análogos & derivados , Alanina/farmacología , Alanina/uso terapéutico , Amidas/farmacología , Amidas/uso terapéutico , Anticuerpos Monoclonales Humanizados/farmacología , Anticuerpos Monoclonales Humanizados/uso terapéutico , Azetidinas/farmacología , Azetidinas/uso terapéutico , Cloroquina/farmacología , Cloroquina/uso terapéutico , Combinación de Medicamentos , Humanos , Hidroxicloroquina/farmacología , Hidroxicloroquina/uso terapéutico , Inmunización Pasiva , Indoles/farmacología , Indoles/uso terapéutico , Interferones/farmacología , Interferones/uso terapéutico , Ivermectina/farmacología , Ivermectina/uso terapéutico , Lopinavir/farmacología , Lopinavir/uso terapéutico , Oseltamivir/farmacología , Oseltamivir/uso terapéutico , Purinas/farmacología , Purinas/uso terapéutico , Pirazinas/farmacología , Pirazinas/uso terapéutico , Pirazoles/farmacología , Pirazoles/uso terapéutico , Ribavirina/farmacología , Ribavirina/uso terapéutico , Ritonavir/farmacología , Ritonavir/uso terapéutico , Sulfonamidas/farmacología , Sulfonamidas/uso terapéutico , Tiazoles/farmacología , Tiazoles/uso terapéutico
7.
Theranostics ; 11(3): 1207-1231, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33391531

RESUMEN

Rationale: Coronavirus disease 2019 (COVID-19) has spread worldwide and poses a threat to humanity. However, no specific therapy has been established for this disease yet. We conducted a systematic review to highlight therapeutic agents that might be effective in treating COVID-19. Methods: We searched Medline, Medrxiv.org, and reference lists of relevant publications to identify articles of in vitro, in vivo, and clinical studies on treatments for severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and COVID-19 published in English until the last update on October 11, 2020. Results: We included 36 studies on SARS, 30 studies on MERS, and 10 meta-analyses on SARS and MERS in this study. Through 12,200 title and 830 full-text screenings for COVID-19, eight in vitro studies, 46 randomized controlled trials (RCTs) on 6,886 patients, and 29 meta-analyses were obtained and investigated. There was no therapeutic agent that consistently resulted in positive outcomes across SARS, MERS, and COVID-19. Remdesivir showed a therapeutic effect for COVID-19 in two RCTs involving the largest number of total participants (n = 1,461). Other therapies that showed an effect in at least two RCTs for COVID-19 were sofosbuvir/daclatasvir (n = 114), colchicine (n = 140), IFN-ß1b (n = 193), and convalescent plasma therapy (n = 126). Conclusions: This review provides information to help establish treatment and research directions for COVID-19 based on currently available evidence. Further RCTs are required.


Asunto(s)
Antivirales/uso terapéutico , Infecciones por Coronavirus/terapia , Síndrome Respiratorio Agudo Grave/terapia , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/uso terapéutico , Alanina/análogos & derivados , Alanina/uso terapéutico , Animales , Carbamatos/uso terapéutico , Infecciones por Coronavirus/mortalidad , Modelos Animales de Enfermedad , Combinación de Medicamentos , Evaluación Preclínica de Medicamentos , Quimioterapia Combinada/métodos , Humanos , Imidazoles/uso terapéutico , Inmunización Pasiva/métodos , Pirrolidinas/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Síndrome Respiratorio Agudo Grave/mortalidad , Sofosbuvir/uso terapéutico , Resultado del Tratamiento , Valina/análogos & derivados , Valina/uso terapéutico
10.
Farm Hosp ; 45(1): 28-31, 2021 01 13.
Artículo en Inglés | MEDLINE | ID: mdl-33443475

RESUMEN

OBJECTIVE: Remdesivir has not shown survival benefit for patients with severe COVID-19. However, subgroup analysis of ACTT-1 Study Group showed an apparent reduction in mortality for patients who required non­high-flow oxygen. Presentation of SOLIDARITY study results were associated by a meta-analysis combining mortality results by subsets rom randomized clinical trials. The aim is a methodological assessment of reliability and clinical applicability about findings by subgroups on the effect of remdesivir on mortality in patients with COVID-19. METHOD: A validated tool was used to evaluate the findings of subgroup analyses in randomized clinical trials, including meta-analysis atached to SOLIDARITY study. It is structured in preliminary questions to  reject subset analyses without relevant minimum conditions, and a specific checklist. The latter considers certain criteria: statistical association, which encompassed p of interaction, prespecification of subgroups, sample size,  number of factors analyzed, and overall study result; biological plausibility of observed differences; and consistency between results of  similar studies. A score was assigned to each criterion and the tool related  global summation to a recommendation on the applicability of subset  results in clinical decision making. RESULTS: Preliminary questions had positive answers, so checklist was applied. Statistical association obtained "null" assessment (-3 points), including a "doubtful" p of interaction (p = 0.0650) among  subgroups and mortality reached no statistical significance for global  population. These findings reduced the reliability of subset analysis.  Biological plausibility was considered "probable" (+3 points) because  antiviral could have a greater effect before the inflammatory process and  clinical worsening. Consistency between results of similar studies was  evaluated as "possible" (+2 points) analysis for compatibility of ACTT-1  and SOLIDARITY study results. The recommendation about application of  subset analysis results according to the risk of patients was "null". CONCLUSIONS: This structured interpretation of subgroup analysis  suggested too much uncertainty in hypothesis about remdesivir could  reduce mortality in patients with severe COVID-19 who required non-high- flow oxygen. It was probably a random finding. Therefore, a randomized  clinical trial about effect of remdesivir in mortality in patients with  COVID­19 and non-high-flow oxygen is essential.


Asunto(s)
Adenosina Monofosfato/análogos & derivados , Alanina/análogos & derivados , Antivirales/uso terapéutico , /mortalidad , Adenosina Monofosfato/uso terapéutico , Alanina/uso terapéutico , Humanos , Metaanálisis como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto
12.
Am J Nurs ; 121(1): 22-24, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-33350691

RESUMEN

Remdesivir (Veklury) is the first antiviral drug approved to treat patients ages 12 and older who are hospitalized with COVID-19.The drug is administered via slow IV infusion.Elevated liver enzymes are common with treatment. Hypersensitivity reactions, including anaphylaxis, are possible.


Asunto(s)
Adenosina Monofosfato/análogos & derivados , Alanina/análogos & derivados , Antivirales/uso terapéutico , /tratamiento farmacológico , Adenosina Monofosfato/uso terapéutico , Alanina/uso terapéutico , Ensayos Clínicos como Asunto , Aprobación de Drogas , Humanos , Estados Unidos , United States Food and Drug Administration
13.
Am J Nurs ; 121(1): 55, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-33350698

RESUMEN

According to this study: The antiviral remdesivir is superior to placebo in the treatment of patients hospitalized with COVID-19.A variety of therapeutic approaches are needed to continue to improve outcomes in COVID-19 patients.


Asunto(s)
Adenosina Monofosfato/análogos & derivados , Alanina/análogos & derivados , Antivirales/uso terapéutico , /tratamiento farmacológico , Adenosina Monofosfato/uso terapéutico , Alanina/uso terapéutico , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad
14.
Mod Rheumatol Case Rep ; 5(1): 101-107, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33019894

RESUMEN

Anti-melanoma differentiation-associated gene 5 juvenile dermatomyositis (anti-MDA5 JDM) is associated with high risk of developing rapidly progressive interstitial lung disease (RP-ILD). Here we report an 11-year-old girl with anti-MDA5 JDM and RP-ILD which led to a fatal outcome, further aggravated by SARS-CoV-2 infection. She was referred to our hospital after being diagnosed with anti-MDA5 JDM and respiratory failure due to RP-ILD. On admission, fibrobronchoscopy with bronchoalveolar lavage (BAL) revealed Pneumocystis jirovecii infection so treatment with intravenous trimethoprim-sulfamethoxazole was initiated. Due to RP-ILD worsening, immunosuppressive therapy was intensified using methylprednisolone pulses, cyclophosphamide, tofacitinib and intravenous immunoglobulin without response. She developed severe hypoxemic respiratory failure, pneumomediastinum and pneumothorax, further complicated with severe RP-ILD and cervical subcutaneous emphysema. Three real-time RT-PCR for SARS-CoV-2 were made with a negative result. In addition, she was complicated with a secondary hemophagocytic lymphohistiocytosis and a fourth real-time PCR for SARS-CoV-2 performed in BAS sample was positive. Despite aggressive treatment of RP-ILD due to anti-MDA5 JDM, there was no improvement of respiratory failure in the following days and patient developed refractory septic shock and died. Anti-MDA5 JDM patients with RP-ILD have a poor prognosis with a high mortality rate. For this reason, intensive immunosuppressive therapy is essential including the use of promising drugs such as tofacitinib. COVID-19 in children with underlying health conditions like anti-MDA5 JDM may still be at risk for disease and severe complications.


Asunto(s)
/complicaciones , Dermatomiositis/complicaciones , Inmunosupresores/uso terapéutico , Enfermedades Pulmonares Intersticiales/complicaciones , Linfohistiocitosis Hemofagocítica/etiología , Neumonía por Pneumocystis/complicaciones , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/uso terapéutico , Alanina/análogos & derivados , Alanina/uso terapéutico , Antibacterianos/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antivirales/uso terapéutico , Autoanticuerpos/inmunología , Broncoscopía , Niño , Ciclofosfamida/uso terapéutico , Dermatomiositis/tratamiento farmacológico , Dermatomiositis/inmunología , Progresión de la Enfermedad , Resultado Fatal , Femenino , Humanos , Hidroxicloroquina/uso terapéutico , Huésped Inmunocomprometido , Inmunoglobulinas Intravenosas/uso terapéutico , Factores Inmunológicos/uso terapéutico , Helicasa Inducida por Interferón IFIH1/inmunología , Pulmón/diagnóstico por imagen , Enfermedades Pulmonares Intersticiales/diagnóstico por imagen , Enfermedades Pulmonares Intersticiales/inmunología , Enfermedades Pulmonares Intersticiales/terapia , Linfohistiocitosis Hemofagocítica/inmunología , Enfisema Mediastínico/etiología , Metilprednisolona/uso terapéutico , Piperidinas/uso terapéutico , Neumonía por Pneumocystis/inmunología , Neumotórax/etiología , Pirimidinas/uso terapéutico , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Choque Séptico/etiología , Enfisema Subcutáneo/etiología , Tomografía Computarizada por Rayos X , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico
15.
Acta Pharm ; 71(2): 163-174, 2021 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-33151166

RESUMEN

The current outbreak of novel coronavirus (COVID-19) infections urges the need to identify potential therapeutic agents. Therefore, the repurposing of FDA-approved drugs against today's diseases involves the use of de-risked compounds with potentially lower costs and shorter development timelines. In this study, the recently resolved X-ray crystallographic structure of COVID-19 main protease (Mpro) was used to generate a pharmacophore model and to conduct a docking study to capture antiviral drugs as new promising COVID-19 main protease inhibitors. The developed pharmacophore successfully captured five FDA-approved antiviral drugs (lopinavir, remdesivir, ritonavir, saquinavir and raltegravir). The five drugs were successfully docked into the binding site of COVID-19 Mpro and showed several specific binding interactions that were comparable to those tying the co-crystallized inhibitor X77 inside the binding site of COVID-19 Mpro. Three of the captured drugs namely, remdesivir, lopinavir and ritonavir, were reported to have promising results in COVID-19 treatment and therefore increases the confidence in our results. Our findings suggest an additional possible mechanism of action for remdesivir as an antiviral drug inhibiting COVID-19 Mpro. Additionally, a combination of structure-based pharmacophore modeling with a docking study is expected to facilitate the discovery of novel COVID-19 Mpro inhibitors.


Asunto(s)
Infecciones por Coronavirus/enzimología , Neumonía Viral/enzimología , Inhibidores de Proteasas/farmacología , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/química , Adenosina Monofosfato/farmacología , Adenosina Monofosfato/uso terapéutico , Alanina/análogos & derivados , Alanina/química , Alanina/farmacología , Alanina/uso terapéutico , Antivirales/química , Antivirales/farmacología , Infecciones por Coronavirus/tratamiento farmacológico , Cristalografía por Rayos X , Descubrimiento de Drogas/métodos , Reposicionamiento de Medicamentos , Humanos , Modelos Químicos , Simulación del Acoplamiento Molecular , Estructura Molecular , Pandemias , Neumonía Viral/tratamiento farmacológico , Inhibidores de Proteasas/química , Relación Estructura-Actividad
16.
Mol Ther ; 29(2): 873-885, 2021 02 03.
Artículo en Inglés | MEDLINE | ID: mdl-33333292

RESUMEN

Antiviral drug development for coronavirus disease 2019 (COVID-19) is occurring at an unprecedented pace, yet there are still limited therapeutic options for treating this disease. We hypothesized that combining drugs with independent mechanisms of action could result in synergy against SARS-CoV-2, thus generating better antiviral efficacy. Using in silico approaches, we prioritized 73 combinations of 32 drugs with potential activity against SARS-CoV-2 and then tested them in vitro. Sixteen synergistic and eight antagonistic combinations were identified; among 16 synergistic cases, combinations of the US Food and Drug Administration (FDA)-approved drug nitazoxanide with remdesivir, amodiaquine, or umifenovir were most notable, all exhibiting significant synergy against SARS-CoV-2 in a cell model. However, the combination of remdesivir and lysosomotropic drugs, such as hydroxychloroquine, demonstrated strong antagonism. Overall, these results highlight the utility of drug repurposing and preclinical testing of drug combinations for discovering potential therapies to treat COVID-19.


Asunto(s)
Antivirales/uso terapéutico , /efectos de los fármacos , Adenosina Monofosfato/análogos & derivados , Adenosina Monofosfato/uso terapéutico , Alanina/análogos & derivados , Alanina/uso terapéutico , Combinación de Medicamentos , Sinergismo Farmacológico , Humanos , Hidroxicloroquina/uso terapéutico
19.
Medwave ; 20(11): e8080, 2020 Dec 09.
Artículo en Inglés | MEDLINE | ID: mdl-33361753

RESUMEN

Objective: Provide a timely, rigorous and continuously updated summary of the evidence on the role of remdesivir in the treatment of patients with COVID-19. Methods: Eligible studies were randomized trials evaluating the effect of remdesivir versus placebo or no treatment. We conducted searches in the special L·OVE (Living OVerview of Evidence) platform for COVID-19, a system that performs regular searches in databases, trial registries, preprint servers and websites relevant to COVID-19. All the searches covered the period until 25 August 2020. No date or language restrictions were applied. Two reviewers independently evaluated potentially eligible studies according to predefined selection criteria, and extracted data on study characteristics, methods, outcomes, and risk of bias, using a predesigned, standardized form. We performed meta-analyses using random-effect models and assessed overall certainty in evidence using the GRADE approach. A living, web-based version of this review will be openly available during the COVID-19 pandemic. Results: Our search strategy yielded 574 references. Finally, we included three randomized trials evaluating remdesivir in addition to standard care versus standard care alone. The evidence is very uncertain about the effect of remdesivir on mortality (RR 0.7, 95% CI 0.46 to 1.05; very low certainty evidence) and the need for invasive mechanical ventilation (RR 0.69, 95% CI 0.39 to 1.24; very low certainty evidence). On the other hand, remdesivir likely results in a large increase in the incidence of adverse effects in patients with COVID-19 (RR 1.29, 95% CI 0.58 to 2.84; moderate certainty evidence). Conclusions: The evidence is insufficient for the outcomes critical for making decisions on the role of remdesivir in the treatment of patients with COVID-19, so it is impossible to balance potential benefits, if there are any, with the adverse effects and costs. PROSPERO registration number: CRD42020183384.


Asunto(s)
Adenosina Monofosfato/análogos & derivados , Alanina/análogos & derivados , Antivirales/uso terapéutico , /tratamiento farmacológico , Adenosina Monofosfato/efectos adversos , Adenosina Monofosfato/uso terapéutico , Alanina/efectos adversos , Alanina/uso terapéutico , Antivirales/efectos adversos , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Respiración Artificial/estadística & datos numéricos , Resultado del Tratamiento
20.
Ned Tijdschr Geneeskd ; 1642020 11 12.
Artículo en Holandés | MEDLINE | ID: mdl-33331727

RESUMEN

Much has changed in the medical treatment of COVID-19 after the first patient with an infection with SARS-CoV-2 in the Netherlands was diagnosed in February 2020. On the basis of limited data, at first only off-label use of (hydroxy)chloroquine seemed to be a treatment option. However, now based on the findings of several randomized studies, other medicines have been included in the Dutch guidelines about the treatment of COVID-19. In this article, we will briefly discuss the current state of affairs with regard to the drugs (hydroxy) chloroquine, remdesivir and corticosteroids. Again, it appears that only well-executed randomized clinical trials can determine the status of various supposedly effective drugs.


Asunto(s)
Adenosina Monofosfato/análogos & derivados , Alanina/análogos & derivados , Reposicionamiento de Medicamentos , Glucocorticoides , Hidroxicloroquina , /efectos de los fármacos , Adenosina Monofosfato/farmacología , Adenosina Monofosfato/uso terapéutico , Alanina/farmacología , Alanina/uso terapéutico , Antiinflamatorios/farmacología , Antiinflamatorios/uso terapéutico , Antivirales/farmacología , Antivirales/uso terapéutico , /epidemiología , Reposicionamiento de Medicamentos/métodos , Reposicionamiento de Medicamentos/normas , Glucocorticoides/farmacología , Glucocorticoides/uso terapéutico , Humanos , Hidroxicloroquina/farmacología , Hidroxicloroquina/uso terapéutico , Países Bajos/epidemiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
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