A RETROSPECTIVE ANALYSIS OF REPURPOSED THERAPEUTICS USED DURING THE DELTA VARIANT INDUCED COVID-19 CRISIS OF INDIA, 2021
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Abstract
COVID-19 has led to a major worldwide health and economic crisis, with more than 27 million people having contracted the disease and more than 800 000 deaths.
Objectives – to study the effects of repurposed therapeutics such as ivermectin/favipiravir with or without steroids in clinical outcomes of mild to moderately severe COVID-19 disease in India.
Methods. 99 nonhospitalized patients with mild to moderate symptomatic COVID-19 who received repurposed drugs like ivermectin or favipiravir or both with or without steroids were included 3 groups of patients were formed. The clinical outcome like oxygen saturation, hospitalization, recovery time, mortality, side effects or complications within 2 weeks after treatment were analyzed. Retrospective data analysis done by appropriate statistical tests using SPSS statistical package version 23.
Results. Ivermectin or favipiravir, independently had no effect on clinical outcome (18/99, 25/99 patients respectively), whereas ivermectin plus favipiravir in combination positively affected recovery time to less than or equal to 4 days (56/99 patients). However ivermectin plus favipiravir plus steroids (51/99 patients) showed a positive effect in terms of recovery time. Patients recovered in 4 days or less.
Conclusion. This study demonstrated the relative safety and efficacy of ivermectin and favipiravir including steroids when appropriately monitored/tailored in managing mild to moderate COVID-19 patients.
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The authors declare that they have no apparent or potential conflicts of interest related to the publication of this article.
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References
Guan WJ, Ni ZY, Hu Y, Liang W-H, Ou C-Q, He J-X, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020; 382(18): 1708-1720
WHO Coronavirus Disease (COVID-19) Dashboard available at https://COVID-19.who.int/
Delang L, Abdelnabi R, Neyts J. Favipiravir as a potential countermeasure against neglected and emerging RNA viruses. Antiviral Res. 2018; 153: 85-94. DOI: 10.1016/j.antiviral.2018.03.003
Furuta Y, Gowen BB, Takahashi K, Shiraki K, Smee DF, Barnard DL. Favipiravir (T-705), a novel viral RNA polymerase inhibitor. Antiviral Res. 2013; 100: 446-454. DOI: 10.1016/j.antiviral.2013.09.015
Shiraki K, Daikoku T. Favipiravir, an anti-influenza drug against life-threatening RNA virus infections. Pharmacol Ther. 2020; 209: 107512. DOI: 10.1016/j.pharmthera.2020.107512
Wagstaff KM, Sivakumaran H, Heaton SM, Harrich D, Jans DA. Ivermectin is a specific inhibitor of importin alpha/beta-mediated nuclear import able to inhibit replication of HIV-1 and dengue virus. Biochem J. 2012; 443: 851-856. DOI: 10.1042/BJ20120150
Barrows NJ, Campos RK, Powell ST, Prasanth KR, Schott-Lerner G, Soto-Acosta R, et al. A screen of FDA-approved drugs for inhibitors of Zika virus infection. Cell Host Microbe. 2016; 20: 259-270. DOI: 10.1016/j.chom.2016.07.004
Mastrangelo E, Pezzullo M, De Burghgraeve T, Kaptein S, Pastorino B, Dallmeier K, et al. Ivermectin is a potent inhibitor of flavivirus replication specifically targeting NS3 helicase activity: new prospects for an old drug. J Antimicrob Chemother. 2012; 67: 1884-1894. DOI: 10.1093/jac/dks147
Caly L, Druce J, Catton M, Jans D, Wagstaff KM. The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Res. 2020; 178: 104787. DOI: 10.1016/j.antiviral.2020.104787
Manjili RH, Zarei M, Habibi M, Manjili MH. COVID-19 as an Acute Inflammatory Disease. J Immunol. 2020; 205(1): 12-19. DOI: 10.4049/jimmunol.2000413
Kim J-M, Chung Y-S, Jo HJ, Lee N-J, Kim MS, Woo SH, et al. Identification of coronavirus isolated from a patient in Korea with Covid-19. Osong Public Health Res Perspect. 2020; 11: 3-7. DOI: 10.24171/j.phrp.2020.11.1.02
Bai Y, Yao L, Wei T, Tian F, Jin DY, Chen L, Wang M. Presumed asymptomatic carrier transmission of COVID-19. JAMA. 2020; 323(14): 1406-1407. DOI: 10.1001/jama.2020.2565
Guan W-J, Ni Z-Y, Hu Y, Liang W-H, Ou C-Q, He J-X, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020; 382(18): 1708-1720
Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, et al. The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application. Ann Intern Med. 2020; 172(9): 577-582. DOI: 10.7326/M20-0504
Mizumoto K, Kagaya K, Zarebski A, Chowell G. Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Euro Surveill. 2020; 25(10): 2000180. DOI: 10.2807/1560-7917.ES.2020.25.10.2000180
Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med. 2020; 382(12): 1177-1179. DOI: 10.1056/NEJMc2001737
Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese center for disease control and prevention. JAMA. 2020; 323(13): 1239-1242. DOI: 10.1001/jama.2020.2648
Vaninov N. In the eye of the COVID-19 cytokine storm. Nat Rev Immunol. 2020; 20: 277. DOI: 10.1038/s41577-020-0305-6
Okumuş N, Demirtürk N, Çetinkaya RA, Güner R, Avcı İY, Orhan S , et al. Evaluation of the effectiveness and safety of adding ivermectin to treatment in severe COVID-19 patients. BMC Infect Dis. 2021; 21(1): 411. DOI: 10.1186/s12879-021-06104-9
Jean S-S, Lee P-I, Husueh P-R. Treatment options for COVID-19: the reality and challenges. J Microbiol Immunol Infect. 2020; 53(3): 436-443. DOI: 10.1016/j.jmii.2020.03.034
Hassanipour S, Arab-Zozani M, Amani B, Heidarzad F, Fathalipour M, Martinez-de-Hoyo R. The efficacy and safety of Favipiravir in treatment of COVID-19: a systematic review and meta-analysis of clinical trials. Sci Rep. 2021; 11(1): 11022. DOI: 10.1038/s41598-021-90551-6
Bryant A, Lawrie TA, Dowswell T, Fordham EJ, Mitchell S, Hill SR, Tham TC. Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines. Am J Ther. 2021; 28(4): e434-e460. DOI: 10.1097/MJT.0000000000001402
Horby P, Lim WS, Emberson J, Mafham M, Bell J, Linsell L, et al. Effect of dexamethasone in hospitalized patients with COVID-19 – preliminary report. MedRxIv. Published online June 22, 2020. DOI: 10.1101/2020.06.22.20137273
Lester M, Sahin A, Pasyar A. The use of dexamethasone in the treatment of COVID-19. Ann Med Surg (Lond). 2020; 56: 218-219. DOI: 10.1016/j.amsu.2020.07.004
Low-cost dexamethasone reduces death by up to one third in hospitalised patients with severe respiratory complications of COVID-19. News release. University of Oxford. June 16, 2020. Accessed July 6, 2020. bit.ly/2O603K2