Effect of Bevacizumab in Treatment of Severe COVID-19- Observations from a Tertiary Care ICU in South India ABS0032)

ABSTRACT

Aim and background: One of the primary causes of mortality and morbidity in the COVID-19 pandemic is dyspnea and hypoxia secondary to the pulmonary ARDS caused by the SARS-CoV-2 virus. It results in the increased expression of VEGF (vascular endothelial growth factor) triggered by the hypoxia. VEGF is responsible for increased permeablity of the vasculature causing leaky capillaries in the alveoli and flooding of the air spaces. VEGF also participates in the lung inflammation. Bevacizumab is an anti-VEGF monoclonal antibody being used in cancer treatment since more than a decade without any serious adverse effects. Objective: Whether the addition of bevacizumab to standard treatment helps to have an effect on the need for invasive ventilation, duration of ICU stay, and all-cause mortality caused by the SARS-CoV-2 infection. Materials and methods: We retrospectively compared patients of either gender aged between 18 and 80 years who tested positive with RT-PCR for SARS-CoV-2 and were hypoxic but not needing mechanical ventilation at admission from a single tertiary care hospital ICU in southern India admitted between April 2021 and July 2021. We excluded pregnant women and patients with chronic kidney and liver disease. The control group received standard treatment which included remdesivir, steroids, anticoagulants, and oxygen supplementation as required whereas the test group received a single intravenous dose of bevacizumab (400-500 mg@7.5 mg/kg/iv) along with standard treatment. We compared the need of invasive ventilation, length of stay in ICU, and all-cause mortality. Results: 16 patients (57.1%) in the bevacizumab group required invasive ventilation later, whereas 15 patients (60%) in the control group ended up requiring invasive ventilation (p = 0.63). 10 patients (35.7%) in bevacizumab group died whereas 5 patients (20%) in the control group died during their stay in ICU P(0.2), the rest got discharged home. The average length of stay in ICU was 13.8 ± 7.05 days in bevacizumab group compared with 18.48 ± 15.21 days in the control group. Mortality rates in patients who needed invasive ventilation were 45.5% in the bevacizumab group vs 50% in the control group, whereas mortality rates in patients not needing invasive ventilation were 31.2% in the bevacizumab group vs 0% in the control group. The average length of stay in ICU in patients needing invasive ventilation was 18.8 ± 6.95 days in the bevacizumab group vs 25.2 ± 20.8 days in the control group, whereas the average length of stay in ICU in patients not needing invasive ventilation was 11.06 ± 5.5 days in the bevacizumab group vs 14 ± 8.03 days in the control group. Conclusion: The addition of bevacizumab to standard treatment did not have any statistically significant effect on the need for invasive ventilation, length of stay in ICU, and all-cause mortality caused by the SARS-CoV-2 infection. Patients who required invasive ventilation had longer lengths of stay and higher mortality rates as compared to patients who did not need invasive ventilation in both the groups, but it was not statistically significant.