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ObjectivesAn IFN-2b and IFN-{gamma} combination has demonstrated favorable pharmacodynamics for genes underlying antiviral activity which might be involved in the defense of a host from a SARS-CoV-2 infection. Considering this synergy, we conducted a randomized controlled clinical trial for efficacy and safety evaluation of subcutaneous IFN - 2b and IFN-{gamma} administration in patients positive for SARS-CoV-2. MethodsWe enrolled 19-82 years-old inpatients at the Military Central Hospital Luis Diaz Soto, Havana, Cuba. They were hospitalized after confirmed diagnosis for SARS-CoV-2 RNA by real-time reverse transcription polymerase chain reaction. Patients were randomly assigned in a 1:1 ratio to receive either, subcutaneous treatment with a co-lyophilized combination of 3.0 MIU IFN-2b and 0.5 MIU IFN-{gamma} (HeberFERON, CIGB, Havana, Cuba), twice a week for two weeks, or thrice a week intramuscular injection of 3.0 MIU IFN-2b (Heberon(R) Alpha R, CIGB, Havana, Cuba). Additionally, all patients received lopinavir-ritonavir (200/50 mg every 12 h) and chloroquine (250 mg every 12 h, i.e.standard of care). The primary endpoints were, from the start of treatment, the time to elimination of viral RNA and the time to progression to severe COVID-19. The protocol was approved by the Ethics Committee on Clinical Investigation from the Hospital and the Center for the State Control of Medicines, Equipment and Medical Devices in Cuba. Informed consent was obtained from each participant (INSTITUTION PROTOCOL IG/IAG/CV/2001). ResultsA total of 79 patients with laboratory-confirmed SARS-CoV-2 infection, including symptomatic or asymptomatic conditions, fulfilled the inclusion criteria and underwent randomization. Thirty-three subjects were assigned to the HeberFERON group, and 33 to the Heberon Alpha R group. Sixty-three patients were analyzed for viral elimination, of these 78.6% in the HeberFERON group eliminated the virus after 4 days of treatment versus 40.6% of patients in the Heberon Alpha R groups (p=0.004). Time to reach the elimination of SARS-CoV-2, as measured by RT-PCR was 3.0 and 5.0 days for the HeberFERON and Heberon Alpha R groups, respectively. A significant improvement in the reduction of time for virus elimination was attributable to HeberFERON (p=0.0027, Log-rank test) with a Hazard Ratio of 3.2 and 95% CI of 1.529 to 6.948, as compared to the Heberon Alpha R treated group. Worsening of respiratory symptoms was detected in two (6.6%) and one (3.3%) patients in HeberFERON and IFN-2b groups, respectively. However, none of the subjects transited to severe COVID-19 during the study or during the following clinical evaluation (21 more days). RT-PCR on day 14 after the start of the treatment was negative to SARS-CoV-2 in 100% and 91% of patients of the combination of IFNs and IFN-2b, respectively. Elimination in HeberFERON treated patients was related to a significant increase in lymphocytes counts and also a significant reduction in CRP as early as 7 days after commencing the therapeutic schedule. All the patients in both cohorts recovered and had their laboratory parameters return to normal values by day 14 after treatment initiation. Adverse events were identified in 31.5% of patients, 28.5% in the control group, and 34.4% in the HeberFERON group, with the most frequent adverse event being headaches (17.4%). ConclusionsIn a cohort of 63 hospitalized patients between 19 to 82 years-old with positive SARS-CoV-2, HeberFERON significantly eliminated the virus on day 4 of treatment when compared to treatment with IFN-2b alone. However, Heberon Alpha R alone also showed efficacy for the treatment of the viral infection. Both treatments were safe and positively impacted on the resolution of the symptoms. None of the patients developed severe COVID-19.
RESUMO
Objetivo: Estimar el tiempo promedio de desarrollo de Lutzomyia evansi. Materiales y métodos: Se inició una colonia de Lutzomyia evansi con individuos recolectados en la zona urbana de la ciudad de Sincelejo (Colombia). La colonia fue mantenida en el laboratorio durante tres generaciones filiales bajo condiciones experimentales promedio de 26°C de temperatura y 94% de humedad relativa. Resultados: La duración del desarrollo de Lutzomyia evansi fue de 36 a 45 días. El tiempo requerido para el desarrollo de los huevos fue en promedio de 6,75 días (rango de 6 a 8 días). La duración en promedio de los diferentes estadios larvales fue 5,75 días en larvas de primer estadio (rango de 5 a 8 días), 5,75 días en larvas de segundo estadio (rango de 4 a 7 días), 5 días en larvas de tercer estadio (rango de 4 a 7 días) y 7 días en larvas de cuarto estadio (rango e 6 a 8 días). En la fase de pupa, la duración en promedio fue de 9,75 días (rango de 7 a 17 días). Conclusiones: El tiempo promedio requerido para el desarrollo de Lutzomyia evansi, comprendido desde la alimentación sanguínea de la hembra madre hasta la emergencia del adulto, es de 40 días.
Objective: To estimate the mean development time for Lutzomyia evansi. Materials and methods: A laboratory colony of Lutzomyia evansi was started from sand flies collected in the urban area of the City of Sincelejo, Colombia. The colony was main-tained during three filial generations under experimental conditions of 26°C of mean tem-perature, and 94% of average relative humidity. Results: The duration of the development of Lutzomyia evansi was from 36 to 45 days. The development time for eggs was, on average, 6, 75 days (interval from 6 to 8 days). The mean duration of the different larval instars was 5,75 days in first instar (interval from 5 to 8 days), 5,75 days in second instar (interval from 4 to 7 days), 5 days in third instar (in-terval from 4 to 7 days) and 7 days in fourth instar (interval from 6 to 8 days). In the stage of pupa the development time was, on average, 9, 75 days (interval from 7 to 17 days). Conclusions: The mean development time for Lutzomyia evansi, from the female's blood meal to adult emergence, is 40 days.
