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Yonsei Med J ; 61(9): 826-830, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: covidwho-745127


We retrospectively reviewed patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections who were admitted to an intensive care unit in Daegu, South Korea. The outcomes of patients who did (cases) or did not (controls) receive darunavir-cobicistat (800-150 mg) therapy were compared. Fourteen patients received darunavir-cobicistat treatment, and 96 received other antiviral therapy (controls). Overall, the darunavir-cobicistat group comprised patients with milder illness, and the crude mortality rate of all patients in the darunavir-cobicistat group was lower than that in the controls [odds ratio (OR) 0.20, 95% confidence interval (CI) 0.04-0.89, p=0.035]. After 1:2 propensity-score matching, there were 14 patients in the darunavir-cobicistat group, and 28 patients in the controls. In propensity score-matched analysis, the darunavir-cobicistat group had lower mortality than the controls (OR 0.07, 95% CI 0.01-0.52, p=0.009). In conclusion, darunavir-cobicistat therapy was found to be associated with a significant survival benefit in critically ill patients with SARS-CoV-2 infection.

Fármacos Anti-VIH/uso terapéutico , Cobicistat/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Darunavir/uso terapéutico , Inhibidores de la Proteasa del VIH/uso terapéutico , Neumonía Viral/tratamiento farmacológico , Adulto , Fármacos Anti-VIH/administración & dosificación , Fármacos Anti-VIH/efectos adversos , Betacoronavirus , Estudios de Casos y Controles , Cobicistat/administración & dosificación , Cobicistat/efectos adversos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/mortalidad , Enfermedad Crítica , Darunavir/administración & dosificación , Darunavir/efectos adversos , Femenino , Inhibidores de la Proteasa del VIH/administración & dosificación , Inhibidores de la Proteasa del VIH/efectos adversos , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/mortalidad , República de Corea/epidemiología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
Eur Rev Med Pharmacol Sci ; 24(15): 8219-8225, 2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-724284


OBJECTIVE: At the end of 2019, the Novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), spread rapidly from China to the whole world. Circadian rhythms can play crucial role in the complex interplay between viruses and organisms, and temporized schedules (chronotherapy) have been positively tested in several medical diseases. We aimed to compare the possible effects of a morning vs. evening antiviral administration in COVID patients. PATIENTS AND METHODS: We retrospectively evaluated all patients admitted to COVID internal medicine units with confirmed SARS-CoV-2 infection, and treated with darunavir-ritonavir (single daily dose, for seven days). Age, sex, length of stay (LOS), pharmacological treatment, and timing of antiviral administration (morning or evening), were recorded. Outcome indicators were death or LOS, and laboratory parameters, e.g., variations in C-reactive protein (CRP) levels, ratio of arterial oxygen partial pressure (PaO2, mmHg) to fractional inspired oxygen (FiO2) (PaO2/FiO2), and leucocyte count. RESULTS: The total sample consisted of 151 patients, 33 (21.8%) of whom were selected for antiviral treatment. The mean age was 61.8±18.3 years, 17 (51.5%) were male, and the mean LOS was 13.4±8.6 days. Nine patients (27.3%) had their antiviral administration in the morning, and 24 (72.7%) had antiviral administration in the evening. No fatalities occurred. Despite the extremely limited sample size, morning group subjects showed a significant difference in CRP variation, compared to that in evening group subjects (-65.82±33.26 vs. 83.32±304.89, respectively, p<0.032). No significant differences were found for other parameters. CONCLUSIONS: This report is the first study evaluating temporized morning vs. evening antiviral administration in SARS-CoV-2 patients. The morning regimen was associated with a significant reduction in CRP values. Further confirmations with larger and multicenter samples of patients could reveal novel potentially useful insights.

Antivirales/administración & dosificación , Infecciones por Coronavirus/tratamiento farmacológico , Darunavir/administración & dosificación , Cronoterapia de Medicamentos , Mortalidad Hospitalaria , Tiempo de Internación/estadística & datos numéricos , Neumonía Viral/tratamiento farmacológico , Ritonavir/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Betacoronavirus , Análisis de los Gases de la Sangre , Proteína C-Reactiva , Infecciones por Coronavirus/metabolismo , Quimioterapia Combinada , Humanos , Italia , Recuento de Leucocitos , Persona de Mediana Edad , Oxígeno/metabolismo , Pandemias , Presión Parcial , Neumonía Viral/metabolismo , Estudios Retrospectivos
J Popul Ther Clin Pharmacol ; 27(S Pt 1): e26-e30, 2020 Jul 03.
Artículo en Inglés | MEDLINE | ID: covidwho-638865


At the end of December 2019, the Health Commission of the city of Wuhan, China, alerted the World Health Organization (WHO) to a pneumonia cluster in the city. The cause was identified as being a new virus, later named SARS-CoV-2. We can distinguish three clinical phases of the disease with a distinct pathogenesis, manifestations and prognosis. Here, we describe the case of a 45-year-old male, successfully treated for Coronavirus disease (COVID-19). The patient was feeling sick in early April 2020; he had a fever and pharyngodynia. When he came to our COVID hospital, his breathing was normal. The nasopharyngeal swab specimen turned out positive. High-resolution computed tomography (HRCT) showed mild interstitial pneumonia. The patient was admitted to our department and treated with hydroxychloroquine, ritonavir, darunavir, azithromycin and enoxaparin. On day seven of the disease, the patient's respiratory condition got worse as he was developing acute respiratory distress syndrome (ARDS). He was given tocilizumab and corticosteroids and was immediately treated with non-invasive mechanical ventilation (NIMV). His condition improved, and in the ensuing days, the treatment gradually switched to a high-flow nasal cannula (HFNC); after 18 days, the patient's clinical condition was good.The successful results we have been able to obtain are closely associated with avoidance of invasive ventilation that may lead to intensive care unit (ICU)-related superinfections. In our opinion, it is fundamental to understand that COVID-19 is a systemic disease that is a consequence of an overwhelming inflammatory response, which can cause severe medical conditions, even in young patients.

Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Corticoesteroides/administración & dosificación , Corticoesteroides/uso terapéutico , Anticuerpos Monoclonales Humanizados/administración & dosificación , Anticuerpos Monoclonales Humanizados/uso terapéutico , Azitromicina/administración & dosificación , Azitromicina/uso terapéutico , China , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/patología , Darunavir/administración & dosificación , Darunavir/uso terapéutico , Progresión de la Enfermedad , Enoxaparina/administración & dosificación , Enoxaparina/uso terapéutico , Humanos , Hidroxicloroquina/administración & dosificación , Hidroxicloroquina/uso terapéutico , Masculino , Persona de Mediana Edad , Ventilación no Invasiva , Pandemias , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/patología , Síndrome de Dificultad Respiratoria del Adulto/tratamiento farmacológico , Síndrome de Dificultad Respiratoria del Adulto/etiología , Síndrome de Dificultad Respiratoria del Adulto/terapia , Ritonavir/administración & dosificación , Ritonavir/uso terapéutico