[Clinical efficiency and safety of riamilovir under various dosage regimens for treatment of acute respiratory viral infections in adults].

AIM: To evaluate the clinical efficacy and safety of antiviral drug riamilovir in patients with acute respiratory viral infections (ARVI) of non-coronavirus (SARS-CoV-2) etiology with different dosing regimens. MATERIALS AND METHODS: The study included 150 patients with ARVI aged 18-27 years (50 patients received riamilovir in the regimen of 250 mg 3 times a day for 5 days, 50 patients received riamilovir in the off label regimen of 250 mg 5 times a day for 5 days, 50 patients received only pathogenetic treatment). RESULTS: The use of riamilovir in both treatment regimens led to a reduction in the duration of inpatient treatment. The shortest periods of hospitalization were noted in patients who received the study drug at higher daily dosages. The use of riamilovir reduced the duration and severity of general infectious manifestations of the disease, while the shortest total duration of fever and a number of respiratory tract syndromes was registered among people who received riamilovir in the regimen of 1250 mg per day for 5 days, no adverse events were registered, additionally, 100% elimination of ARVI pathogens was noted in 1250 mg per day group. CONCLUSION: Riamilovir has shown clinical efficacy and a good safety profile in in both treatment regimens. The dosage regimen of 1250 mg per day led to more significant clinical effects and to 100% elimination of ARVI pathogens in the study group by the 6th day of hospitalization.

Clinical efficacy of umifenovir in influenza and ARVI (study ARBITR).

AIM: The aim of the study is to obtain additional data on safety and therapeutic efficacy of the antiviral drug Arbidol (umifenovir) in patients with a diagnosis of influenza and common cold. MATERIALS AND METHODS: Double-blind, randomized, placebo-controlled clinical study investigating efficacy and safety of Arbidol (umifenovir) in Treatment and Prophylaxis of Influenza and Common Cold (ARBITR) IV phase started in November 2011 and completed in April 2016 on the basis of 15 research centers in various regions of the Russian Federation. A total of 359 patients, aged 18 to 65 years with influenza or acute respiratory tract infection, of no more than 36 hours' duration were enrolled in the study. Patients were randomized into two groups: a group of patients (therapy group) treated by Arbidol (umifenovir) at a dosage of 800 mg/day (2 capsules) for 5 days (n=181), and a group of patients receiving placebo 4 times a day for 5 days (n=178). The primary outcome measures of the study were the duration of clinical illness among patients with common cold and influenza/ARVI, the duration and severity of the main symptoms. Number of clinical complications associated with influenza and common cold was assessed as a secondary outcome. Safety was assessed by analyzing number of adverse events that are probably or definitely related to Arbidol, assessing vital signs, examining the physical condition of patients and general clinical laboratory parameters. RESULTS: In the group treated by umifenovir, the number of full recover patients on the 4th day from the disease onset were significantly differed from the number of such cases in the placebo group. The number of cases of complete recovery after 96 hours was 98 patients (54.1%) and 77 (43.3%), p<0.05, and after 108 hours - 117 (64.6%) and 98 (55.1%), p<0.05. Duration of intoxication was reduced with umifenovir compared to placebo, amounted to 77.76 and 88.91 hours, respectively, p=0.013. The duration of all intoxication syndrome symptoms was also lower in the group receiving umifenovir. Thus, in the therapy group and placebo group, these parameters were respectively: fever duration - 67.96 and 75.32 hours (p=0.037), muscle pain - 52.23 and 59.08 hours (p=0.023), headache - 52.78 and 63.28 hours (p=0.013), weakness - 76.90 and 88.89 hours (p=0.008). The incidence of complications in the umifenovir group was 3.8%, in the placebo group 5.62%. Cases of acute tracheobronchitis was an increase in the placebo group (p<0.02). Umifenovir and placebo were well tolerated. A total of 42 cases of adverse events were registered in 11 patients in the treatment group and in 18 patients in the placebo group, which were not associated with umifenovir or placebo. CONCLUSION: The results of this study indicate umifenovir safety and confirm its effectiveness to the treatment of influenza and other acute respiratory viral infections in adult patients. It was found that effect of umifenovir in the treatment of influenza in adults is most pronounced in the acute stage of the disease and appears in the reduction of time to resolution of all symptoms of the disease, reducing the severity of symptoms of the disease.

[Pharmacoepidemiological study of the course of influenza and other acute respiratory viral infections in risk groups]. / Farmakoépidemiologicheskoe issledovanie techeniia grippa i drugikh ORVI v gruppakh riska.

AIM: To identify risk factors (RFs) for the development of bacterial complications and the prolonged course of influenza and other acute respiratory viral infections (ARVIs) among inpatients treated in Russian healthcare facilities in the post-pandemic period; to determine the clinical presentation of the disease (flu-like syndrome) in risk-group people and to evaluate the efficacy of antiviral therapy with arbidol (umifenovir). MATERIAL AND METHODS: The investigators retrospectively analyzed randomly selected medical records of inpatients with influenza and other ARVI in 88 hospitals from 50 regions of the Russian Federation: those of 3532 and 1755 patients in the 2010-2011 and 2014-2015 seasons, respectively, by applying parametric and nonparametric statistical methods. RESULTS: The built database of patients with influenza-like syndrome contained data from the histories of 2072 men and 2537 women, of whom there were 317 (12.49%) pregnant women; gender evidence was not given in the medical records for 678 patients. 382 (7.2%) were vaccinated against influenza. 1528 (28.9%) people were admitted to hospital with various complications. Information on laboratory tests was available in 1691 (31.98%) patients; of these, 1291 (76.4%) were detected to have influenza and other respiratory viruses. Influenza viruses were found in 1026 (60.7%) examinees; influenza A viruses in 712 (42.1%) people while pandemic strain of swine influenza A/H1N1 and A/H3N2 viruses was detected in 487 (28.8%) and 107 (6.3%) patients, respectively; influenza A subtype was indicated in 118 (7%) persons with laboratory-confirmed influenza virus. Influenza B viruses were found in 314 (18.6%) examinees. Other types of respiratory viruses were detected in 265 (15.7%) patients. The body mass index exceeded 30 kg/m2 in 227 (4.3%) patients. Single-factor analysis of variance revealed factors influencing the course of flu-like syndrome and identified risk groups: children younger than 2 years old and adults over 65, pregnant women, and people with chronic somatic diseases and obesity. The high-risk groups exhibited a more severe course of flu-like syndrome than did the patients outside the risk groups. The incidence of complications was higher, especially in the under 2-year-year-old children and in patients with endocrine, metabolic, or respiratory diseases, with a large proportion of complications being pneumonia. The efficacy of antiviral therapy was higher in the elderly, patients with chronic diseases, and pregnant women than in patients not at risk. In patients treated with umifenovir (provided that it was administered in the first 48 hours after disease onset), the duration of fever and frequency of complications proved to be lower than those in patients who did not receive antiviral therapy. CONCLUSION: The FRs for influenza and ARVI complications are patient's age (children under 3 years of age and adults older than 65 years), the presence of chronic somatic diseases, and pregnancy. Patients with endocrine, eating, metabolic (including obesity), circulatory, and respiratory disorders are at high risk for influenza and ARVI complications. Umifenovir therapy substantially reduces the duration of fever and risk of complications, especially in patients with laboratory-confirmed influenza infection.

[The application of micro-cultural enzyme-linked immunosorbent assay of modified immunofluorescence technique for diagnostic of adenovirus infection.]

The particular conditions of professional activities of drafty military personnel determine wide-spread of of respiratory viruses in crew of Armed Forces. The frequent mixing of military staff conditions of carrying of infection agents , including adenoviruses. It is known, that up to 60% of acute respiratory viral disease in newly formed staff have adenovirus etiology. In these cases, the most frequently are isolated serotonins 4 and 7 of adenovirus. The diagnostic possibilities of monoclonal immunologic tests of indirect enzyme-linked immunosorbent assay and micro-cultural enzyme-linked immunosorbent assay for diagnostic of adenovirus infection are investigated. The analysis was applied to 40 clinical samples from patients with diagnosis of acute respiratory viral disease residing for treatment in military medical organizations during April-June 2014. The culture of cells A-549 infected with materials from patients was used for analysis. The evaluation of reproduction of adenovirus in infected culture of cells using both techniques was implemented by application of monoclonal antibodies to hexon of adenovirus on stage of detection. The availability of adenovirus was proved applying polymerase chain reaction in 20 samples; isolation of cell culture in 19 samples; indirect enzyme-linked immunosorbent assay - in 14 samples; micro-cultural enzyme-linked immunosorbent assay - in 14 samples. For detection of serotypes of adenovirus isolation of DNA and sequencing of 10 of analyzed samples positive for adenovirus according results of polymerase chain reaction were implemented. The results of phylogenetic analysis on site of gene string demonstrated belonging pofadenovirus out of all samples to serotype 4 (subgroup E). The sensitivity of indirect enzyme-linked immunosorbent assay and micro-cultural enzyme-linked immunosorbent assay in detection of adenovirus in cell cultures infected with materials from patients, in comparison with polymerase chain reaction, made up to 85% and 87% correspondingly. The specificity of both techniques reached 100%.

GENETIC DIVERSITY OF ADENOVIRUSES CIRCULATING AMONG THE MILITARY IN THE NORTH-WEST REGION.

The contribution of adenovirus (AV) infections to the overall structure of acute viral respiratory infections among young people of draft age can reach as high as 64.6%. Wide dissemination, the incidence of AV-associated pneumonias and lethal outcomes in the case of some complicated infections illustrate the urgency of studying the antigenic diversity of AVs circulating among the military. 991 nasopharyngeal swabs from patients hospitalized in military health facilities with symptoms of acute respiratory infections from 2014 to 2017 were detected by real-time PCR. Sanger sequencing was performed using forward and reverse primers matching the fiber gene. AVs were detected in 326 samples. In 80 of those, AVs were present in combination with other respiratory viruses, as follows: 26 with respiratory syncytial viruses (RSV), 49 with rhinoviruses, 2 with bocaviruses, 1 with RSV and rhinovirus, 1 with parainfluenza virus, and 1 with metapneumovirus. 31 samples were sequenced. Thirty AVs belonged to group E (serotype 4), and 1 AV belonged to group B (serotype 7).