Tratamiento De COVID-19. Mitos Y Realidades Bajo La Perspectiva De La Investigación Clínica
[Treatment Of COVID-19. Myths And Realities Under The Perspective Of Clinical Research]
[Tratamiento De COVID-19. Mitos Y Realidades Bajo La Perspectiva De La Investigación Clínica [Treatment Of COVID-19. Myths And Realities Under The Perspective Of Clinical Research]]
Osvaldo Reyes1
1. Maternidad del Hospital Santo Tomás, Panamá Miembro del Sistema Nacional de Investigadores de Panamá Coordinación de investigaciones de la Maternidad del Hospital Santo Tomás;
Downloads
Abstract
La enfermedad producida por el SARS-CoV-2, conocida como COVID-19 (Coronavirus Disease 19), ha puesto el mundo en pausa y generado una respuesta masiva de la comunidad científica en todo el mundo, buscando una cura. Sin embargo, el deseo de obtener un tratamiento nunca debe ir por encima de la rigurosidad del proceso y, desafortunadamente, cada cierto tiempo aparece alguna noticia o publicación garantizando que cierto medicamento ha demostrado dar buenos resultados. Estas conclusiones, muchas veces, distan de la realidad, cuando se analiza la investigación que sustenta dicha aseveración. En este artículo reviso la evidencia disponible a la fecha sobre los potenciales tratamientos para el COVID-19, analizando las debilidades y fortalezas de cada uno y su potencial para el futuro.
Palabras claves: COVID-19, tratamiento, hidroxicloroquina,remdesivir, lopinavir, ritonavir, ivermectina, tocilizumab, suero convaleciente.
Abstract
The disease produced by SARS-CoV-2, known as COVID-19 (Coronavirus Disease 19), has put the world on hold and generated a massive response from the scientific community worldwide in search of a cure. However, the desire to obtain a treatment should never override the rigor of the process and unfortunately, every so often there is some news or publication guaranteeing that a certain drug has been shown to work. These conclusions are often far from the truth when the research supporting the claim is scrutinized. In this article, I review the evidence to date on potential treatments for COVID-19, analyzing the strengths and weaknesses of each and its potential for the future.
Key words: COVID-19, treatment, hydroxychloroquine, remdesivir, lopinavir, ritonavir, ivermectin, tocilizumab, convalescent sera.
Abstract
La enfermedad producida por el SARS-CoV-2, conocida como COVID-19 (Coronavirus Disease 19), ha puesto el mundo en pausa y generado una respuesta masiva de la comunidad científica en todo el mundo, buscando una cura. Sin embargo, el deseo de obtener un tratamiento nunca debe ir por encima de la rigurosidad del proceso y, desafortunadamente, cada cierto tiempo aparece alguna noticia o publicación garantizando que cierto medicamento ha demostrado dar buenos resultados. Estas conclusiones, muchas veces, distan de la realidad, cuando se analiza la investigación que sustenta dicha aseveración. En este artículo reviso la evidencia disponible a la fecha sobre los potenciales tratamientos para el COVID-19, analizando las debilidades y fortalezas de cada uno y su potencial para el futuro.
Palabras claves: COVID-19, tratamiento, hidroxicloroquina,remdesivir, lopinavir, ritonavir, ivermectina, tocilizumab, suero convaleciente.
Abstract
The disease produced by SARS-CoV-2, known as COVID-19 (Coronavirus Disease 19), has put the world on hold and generated a massive response from the scientific community worldwide in search of a cure. However, the desire to obtain a treatment should never override the rigor of the process and unfortunately, every so often there is some news or publication guaranteeing that a certain drug has been shown to work. These conclusions are often far from the truth when the research supporting the claim is scrutinized. In this article, I review the evidence to date on potential treatments for COVID-19, analyzing the strengths and weaknesses of each and its potential for the future.
Key words: COVID-19, treatment, hydroxychloroquine, remdesivir, lopinavir, ritonavir, ivermectin, tocilizumab, convalescent sera.
References
[1] Zhou, P., Yang, X., Wang, X. et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature, 2020; 579:270–273.
[2] Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet, 2020; 395(10223): 497-506.
[3] Novel Coronavirus (2019-nCoV): situation report, 22 (Report). World Health Organization. 11 February 2020. hdl:10665/330991.
[4] Hinton DM. Food and Drug Administration. FDA Emergency use authorization (EUA) of chloroquine and hydroxychloroquine. 28 Mar 2020.
[5] Yan Y, Zou Z, Sun Y, Li X, Xu KF, Wei Y et al. Anti-malaria drug chloroquine is highly effective in treating avian influenza A H5N1 virus infection in an animal model. Cell Res. 2013 Feb;23(2):300-2.
[6] Vincent MJ, Bergeron E, Benjannet S, Erickson BR, Rollin PE, Ksiazek TG, Seidah NG, Nichol ST: Chloroquine is a potent inhibitor of SARS coronavirus infection and spread. Virol J. 2005 Aug 22;2:69.
[7] Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Mailhe M et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents, 2020;105949.
[8] Chen Z, Hu J, Zhang Z, Jiang S, Han S, Yan D et al. Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial. medRxiv 2020.03.22.20040758; doi: https://doi.org/10.1101/2020.03.22.20040758.
[9] Chen J, Liu D1, Liu L, Liu P, Xu Q, Xia L et al. A pilot study of hydroxychloroquine in treatment of patients with moderate COVID-19. Zhejiang Da XueXueBao Yi Xue Ban. 2020 May 25;49(2):215-219.
[10] Molina JM, Delaugerre C, Le Goff J, Mela-Lima B, Ponscarme D, Goldwirt L et al. No evidence of rapid antiviral clearance or clinical benefit with the combination of hydroxychloroquine and azithromycin in patients with severe COVID-19 infection. Med Mal Infect, 2020. pii: S0399-077X(20)30085-8.
[11] Mahévas M, Tran VT, Roumier M, Chabrol A, Paule R, Guillaud. Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data. BMJ. 2020 May 14;369:m1844.
[12] Geleris J, Sun Y, Platt J, Zucker J, Baldwin M, Hripcsak G. Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19. May 7, 2020. DOI: 10.1056/NEJMoa2012410.
[13] Borba MGS, Val FFA, Sampaio VS, et al. Effect of High vs Low Doses of Chloroquine Diphosphate as Adjunctive Therapy for Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection: A Randomized Clinical Trial. JAMA Netw Open. 2020;3(4):e208857.
[14] Magagnoli J, Narendran S, Pereira F, Cummings T, Hardin JW, Sutton SS et al. Outcomes of hydroxychloroquine usage in United States veterans hospitalized with Covid-19. medRxiv 2020.04.16.20065920; doi: https://doi.org/10.1101/2020.04.16.20065920.
[15] Mehra MR, Desai SS, Ruschitzka F, Patel AN. Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. The Lancet. Published online May 22, 2020; pp:1-10. https://doi.org/10.1016/S0140-6736(20)31180-6.
[16] Scavone C, Brusco S, Bertini M, et al. Current pharmacological treatments for COVID-19: What's next? Br J Pharmacol. 2020; Published online 2020 Apr 24]. doi:10.1111/bph.15072.
[17] Amiriana ES, Levy JK. Current knowledge about the antivirals remdesivir (GS-5734) and GS-441524 as therapeutic options for coronaviruses. One Health, June 2020; 9(100128):1-6.
[18] Wang Y, Zhang D, Du G, Du R, Zhao J, Jin Y et al. Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial, May 2020; 395(10236): 1569-1578.
[19] ClinicalTrials.gov [Internet]. Identifier NCT04292899, Study to Evaluate the Safety and Antiviral Activity of Remdesivir (GS-5734™) in Participants With Severe Coronavirus Disease (COVID-19); May 2020]. Available from: https://clinicaltrials.gov/ct2/show/NCT04292899.
[20] Gilead Sciences. (2020) Gilead Announces Results From Phase 3 Trial of Investigational Antiviral Remdesivir in Patients With Severe COVID-19 [Press release]. 29 April. https://www.gilead.com/news-and-press/press-room/press-releases/2020/4/gilead-announces-results-from-phase-3-trial-of-investigational-antiviral-remdesivir-in-patients-with-severe-covid-19.
[21] AbbVie. Kaletra Prescribing Information 2020 [Available from: www.rxabbvie.com/pdf/kaletratabpi.pdf accessed 03 April 2020.
[22] Cai Q, Huang D, Ou P, et al. COVID-19 in a Designated Infectious Diseases Hospital Outside Hubei Province,ChinamedRxiv 2020 doi: 10.1101/2020.02.17.20024018.
[23] Yan D, Liu X, Zhu Y, et al. Factors associated with prolonged viral shedding and impact of Lopinavir/Ritonavir treatment in patients with SARS-CoV-2 infection. 2020 doi: 10.1101/2020.03.22.20040832.
[24] Hu L, Chen S, Fu Y, et al. Risk Factors Associated with Clinical Outcomes in 323 COVID-19 Patients in Wuhan, China. medRxiv 2020 doi: 10.1101/2020.03.25.20037721.
[25] Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet 2020;395(10229):1054-62. doi: 10.1016/s0140-6736(20)30566-3.
[26] Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G. A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19. N Engl J Med. 2020 May 7;382(19):1787-1799.
[27] Li Y, Xie Z, Lin W, et al. An exploratory randomized, controlled study on the efficacy and safety of lopinavir/ritonavir or arbidol treating adult patients hospitalized with mild/moderate COVID-19 (ELACOI). medRxiv 2020 doi: 10.1101/2020.03.19.20038984.
[28] Caly L, Drucea JL, Catton MG, Jans DA, Wagstaff KM. The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antiviral Research, June 2020; 178(104787): 1-4.
[29] Momekov G, Moekova D. Ivermectin as a potential COVID-19 treatment from the pharmacokinetic point of view. medRxiv 2020.04.11.20061804; doi: https://doi.org/10.1101/2020.04.11.20061804.
[30] Y Li, M Chen, H Cao, Y Zhu, J Zheng, H Zhou. Extraordinary GU-rich single-strand RNA identified from SARS coronavirus contributes an excessive innate immune response. Microbes Infect, 2013; 15:88–95.
[31] Michot JM, Albiges L, Chaput N, Saada V, Pommeret F, Griscelli F, et al. Tocilizumab, an anti-IL6 receptor antibody, to treat Covid-19-related respiratory failure: a case report,Annals of Oncology (2020), doi: https://doi.org/10.1016/j.annonc.2020.03.300.
[32] Cao, X. COVID-19: immunopathology and its implications for therapy. Nat Rev Immunol20, 269–270 (2020). https://doi.org/10.1038/s41577-020-0308-3.
[33] Luo P, Liu Y, Qiu L, Liu X, Liu D, Li J. Tocilizumab treatment in COVID‐19: A single center experience. J Med Virol. 2020;1–5.
[34] Xu X, Han M, Li T, Sun W, Wang D, Fu B. Effective treatment of severe COVID-19 patients with tocilizumab, Apr 2020. Proceedings of the National Academy of Sciences Apr 2020, 202005615; DOI: 10.1073/pnas.2005615117.
[35] Cheng Y, et al. Use of convalescent plasma therapy in SARS patients in Hong Kong. Eur J ClinMicrobiol Infect Dis. 2005;24(1):44–46.
[36] Shen C, Wang Z, Zhao F, et al. Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma. JAMA. 2020;323(16):1582–1589. doi:10.1001/jama.2020.4783.
[37] Duan K, Liu B, Li C, Zhang H, Yu Y, Qu J et al. Effectiveness of convalescent plasma therapy in severe COVID-19 patients. Proceedings of the National Academy of Sciences Apr 2020, 117 (17) 9490-9496; DOI: 10.1073/pnas.2004168117.
[38] Glasziou P, Sanders S, Hoffman T. Waste in covid-19 research. BMJ 2020; 369:1847.
License
Derechos autoriales y de reproducibilidad. La Revista RevCog es un ente académico, sin fines de lucro, que forma parte de la Sociedad Centroamericana de Ginecología y Obstetricia. Sus publicaciones son de tipo ACCESO GRATUITO y PERMANENTE de su contenido para uso individual y académico, sin restricción. Los derechos autoriales de cada artículo son retenidos por sus autores. Al Publicar en la Revista, el autor otorga Licencia permanente, exclusiva, e irrevocable a la Sociedad para la edición del manuscrito, y otorga a la empresa editorial, Infomedic International Licencia de uso de distribución, indexación y comercial exclusiva, permanente e irrevocable de su contenido y para la generación de productos y servicios derivados del mismo.
