ABSTRACT
BACKGROUND: Given the rapidly evolving pandemic of COVID-19 in 2020, authorities focused on the repurposing of available drugs to develop timely and cost-effective therapeutic strategies. Evidence suggested the potential utility of remdesivir in the framework of an early access program. REMDECO-19 is a multicenter national cohort study assessing the ability of remdesivir to improve the outcome of patients hospitalized with COVID-19. METHODS: We conducted a retrospective real-life study that included all patients from the early access program of remdesivir in France. The primary endpoint was the clinical course evolution of critically ill and hospitalized COVID-19 patients treated with remdesivir. Secondary endpoints were the SOFA score evolution within 29 days following the admission and mortality at 29 and 90 days. RESULTS: Eighty-five patients were enrolled in 22 sites from January to April 2020. The median WHO and SOFA scores were respectively reduced by two and six points between days 1 and 29. Improvement in the WHO-CPS and the SOFA score were observed in 83.5% and 79.3% of patients, respectively, from day 10. However, there was no effect of remdesivir on the 90-day survival based on the control cohort for hospitalized COVID-19 patients with invasive ventilation. CONCLUSIONS: SOFA score appeared to be an attractive approach to assess remdesivir efficacy and stratify its utilization or not in critically ill patients with COVID-19. This study brings a new clinical benchmark for therapeutic decision making and supports the use of remdesivir for some hospitalized COVID-19 patients.
ABSTRACT
BACKGROUND: Patients with hematological malignancies are at greater risk of severe COVID-19 and have been prioritized for COVID-19 vaccination. A significant proportion of them have an impaired vaccine response, both due to the underlying disease and to the treatments. METHODS: We conducted a prospective observational study to identify the specific risks of the outpatient population with hematological diseases. RESULT: Between 22 December 2021 to 12 February 2022, we followed 338 patients of which 16.9% (n = 57) developed SARS-CoV-2 infection despite previous vaccination (94.7%). COVID-19 patients were more likely to have received immunotherapy (85.5% vs. 41%, p < 10-4), and particularly anti-CD20 monoclonal antibodies (40% vs. 14.9%, p < 10-4) and Bruton's tyrosine kinase inhibitors (BTKi) (7.3% vs. 0.7%, p < 10-2). There was no significant difference in demographic characteristics or hematological malignancies between COVID-19-positive and non-positive patients. Patients hospitalized for COVID-19 had more frequently received immunotherapy than patients with asymptomatic or benign forms (100% vs. 77.3%, p < 0.05). Hospitalized COVID-19 patients had a higher proportion of negative or weakly positive serologies than non-hospitalized patients (92.3% vs. 61%, p < 0.05). Patients who received tixagevimab/cilgavimab prophylaxis (n = 102) were less likely to be COVID-19-positive (4.9 vs. 22%, p < 0.05) without significant difference in hospitalization rates. CONCLUSION: In the immunocompromised population of patients with hematological malignancies, the underlying treatment of blood cancer by immunotherapy appears to be a risk factor for SARS-CoV-2 infection and for developing a severe form.
Subject(s)
COVID-19 , Hematologic Neoplasms , Humans , COVID-19/therapy , SARS-CoV-2 , COVID-19 Vaccines , T-Lymphocytes , Hematologic Neoplasms/therapy , Hematologic Neoplasms/drug therapy , VaccinationABSTRACT
Résumé Introduction La Covid-2019 est une maladie infectieuse ;des recommandations de gestes barrières ont été émises participant à la lutte contre la diffusion de l’épidémie. L’objectif est d’évaluer la réalisation de ces pratiques et d’identifier les axes d’amélioration possibles. Méthode Cette évaluation des pratiques professionnelles (EPP) est une étude transversale descriptive et évaluative, réalisée du 14 avril au 28 mai 2020. Elle porte sur l’hygiène des mains (HDM), le port du masque, la désinfection des chariots de médicaments des services de soins ainsi que la mise en quarantaine des retours de médicaments. Elle est destinée à l’ensemble du personnel de la pharmacie à usage intérieur (PUI). Résultats Cent deux personnes de la PUI ont été évaluées. Concernant le port du masque, la moyenne des pourcentages d’acquis obtenus est de 83 %, de 73 % pour l’HDM et de 95 % pour la désinfection des chariots de médicaments et la mise en quarantaine. Discussion et conclusion Concernant le port du masque, le personnel a des connaissances mais des axes d’amélioration restent possibles. Concernant l’HDM, les résultats obtenus pour la friction hydroalcoolique (FHA) sont similaires à ceux retrouvés dans la littérature. L’EPP a été ressenti comme une aide à l’amélioration des pratiques. Summary Background COVID-19 is an infectious disease. Recommendations for barrier practices have been issued to help control the spread of the epidemic. The objective is the assessment of these practices and to identify the possible area of improvement. Methods This assessment of professional practices (APP) is a descriptive and evaluative cross-sectional study, conducted from April 14th to May 28th, 2020. It aims to assess hand hygiene, mask wearing, disinfection of medicine trolleys in the care services and quarantine of drugs returned by services. This study concerned all pharmacy staff. Results One hundred and two people of the hospital pharmacy were evaluated. About mask wearing, the average percentage of the acquired skills is 83% and about hand hygiene, 73%. About the disinfection of medicines trolleys and quarantine of drugs, the average percentage of acquired skills is 95%. Discussion and conclusion Regarding mask wearing, staff has some skills which can be improved for some items. About hand hygiene, results for hydro-alcoholic hand friction are similar to those observed in the literature. The APP was perceived as an aid to improve practices.
ABSTRACT
BACKGROUND: Although the efficacy of lopinavir/ritonavir has not been proven, it has been proposed as an off-label treatment for COVID-19. Previously, it has been reported that the plasma concentrations of lopinavir significantly increase in inflammatory settings. As COVID-19 may be associated with major inflammation, assessing the plasma concentrations and safety of lopinavir in COVID-19 patients is essential. METHODS: Real-world COVID-19 data based on a retrospective study. RESULTS: Among the 31 COVID-19 patients treated with lopinavir/ritonavir between March 18, 2020 and April 1, 2020, higher lopinavir plasma concentrations were observed, which increased by 4.6-fold (interquartile range: 3.6-6.2), compared with the average plasma concentrations in HIV. Lopinavir concentrations in all except one patient were above the upper limit of the concentration range of HIV treatment. Approximately one to 5 patients prematurely stopped treatment mainly because of an ADR related to hepatic or gastrointestinal disorders. CONCLUSIONS: Lopinavir plasma concentrations in patients with moderate-to-severe COVID-19 were higher than expected, and they were associated with the occurrence of hepatic or gastrointestinal adverse drug reactions. However, a high plasma concentration may be required for in vivo antiviral activity against SARS-CoV-2, as suggested by previous studies. Therefore, in the absence of adverse drug reaction, lopinavir dosage should not be reduced. Caution is essential because off-label use can be associated with a new drug safety profile.