Pharmacotherapy in COVID-19; A narrative review for emergency providers

Mehta, Nikita; Mazer‐Amirshahi, Maryann; Alkindi, Nour; Pourmand, Ali

doi:10.1016/j.ajem.2020.04.035

Cited by 105 publications

(110 citation statements)

References 30 publications

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“…ACE inhibitors, which are commonly used to treat hypertension, may increase COVID‐19 severity in T2D patients, especially those with poorly controlled blood glucose 157 . While discontinuing use of ACE inhibitors is not advisable at this time due to offsetting cardiovascular benefits, 158 current clinical trials are investigating mitigation of the spread of SARS‐CoV‐2 through inhibition of ACE2 binding. How these treatments in patients with obesity contribute to COVID‐19 severity, however, will be a key question in their overall effectiveness.…”

Section: Why Are Individuals With Obesity At Serious Risk For Covid‐19?mentioning

confidence: 99%

Individuals with obesity and COVID‐19: A global perspective on the epidemiology and biological relationships

et al. 2020

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Summary The linkage of individuals with obesity and COVID‐19 is controversial and lacks systematic reviews. After a systematic search of the Chinese and English language literature on COVID‐19, 75 studies were used to conduct a series of meta‐analyses on the relationship of individuals with obesity–COVID‐19 over the full spectrum from risk to mortality. A systematic review of the mechanistic pathways for COVID‐19 and individuals with obesity is presented. Pooled analysis show individuals with obesity were more at risk for COVID‐19 positive, >46.0% higher (OR = 1.46; 95% CI, 1.30–1.65; p < 0.0001); for hospitalization, 113% higher (OR = 2.13; 95% CI, 1.74–2.60; p < 0.0001); for ICU admission, 74% higher (OR = 1.74; 95% CI, 1.46–2.08); and for mortality, 48% increase in deaths (OR = 1.48; 95% CI, 1.22–1.80; p < 0.001). Mechanistic pathways for individuals with obesity are presented in depth for factors linked with COVID‐19 risk, severity and their potential for diminished therapeutic and prophylactic treatments among these individuals. Individuals with obesity are linked with large significant increases in morbidity and mortality from COVID‐19. There are many mechanisms that jointly explain this impact. A major concern is that vaccines will be less effective for the individuals with obesity.

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Section: Why Are Individuals With Obesity At Serious Risk For Covid‐19?mentioning

confidence: 99%

Individuals with obesity and COVID‐19: A global perspective on the epidemiology and biological relationships

et al. 2020

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“…Majority of the confirmed COVID-19 patients are asymptomatic but the potential to transmit the virus continues to be high. (11,12) RT-PCR and rapid antigen tests by collecting saliva swab tests (91% sensitivity) and nasopharyngeal swab test (98% sensitivity) weredone to detect the presence of the COVID- conventional plasma therapy have emerged for use as adjuvants. However, unfortunately, these drug candidates are becoming controversial over time due to various safety and efficacy concerns.…”

Section: Prospero Registration: Crd42020205433mentioning

confidence: 99%

“Safety and efficacy of pharmacotherapy used for the management of COVID 19: A systematic review and meta-analysis of randomized control trials”

Sah

Undela

Chand

et al. 2020

Preprint

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Background: COVID-19 is a novel coronavirus, which is highly contagious and a threat to human health, spreading across nearly 235 countries, affecting 33.8 million and causing 1.01 million fatalities as of 22 September 2020. Researchers have invested tremendous efforts to develop vaccines or effective drug therapy but have not yet been fruitful. Hence, we planned to conduct this systematic review and meta-analysis to supplement the readers with comprehensive data and credible information on the safety and efficacyof essential pharmacotherapy during the pharmacological management of COVID-19. Methods: Theprotocol will be designed based on the updated PRISMA-P 2015 guidelines. An elaborate search of electronic databases such as PubMed/Medline, Web of Science, Scopus, The Cochrane Library, ClinicalTrials.gov, Google Scholar, Medrxiv and other potential databases for articles published during January 2020 to 10 October 2020 is planned to be conducted. Following this,randomized control trials published in English language that assess the safety and efficacy of pharmacotherapy versusplacebo or standard of care or usual care will be evaluated for inclusion. The primary outcomes will include time to clinical recovery and the probability for the negative conversion of COVID-19. Secondary outcomes will quantifythe proportion of patients relieved of symptoms, the all-cause mortality, morbidity, detection of viral RNA, time needed to achieve a negative viral load, ordinal scale changes, ventilatorand oxygen requirements,length of hospital stayand the incidence of adverse and serious adverse events.RevMan V.5.3 computer software packages will be utilised to conduct an accurate statistical analysis of the study. Thebinary random-effects model will be used at a 95 % confidence interval to estimate the weighted effect size ofdichotomous data and continuous data studies. The results of statistical analysis will be considered statistically significant whena p-value <0.05 is attained. Results: Selected studies will be used to evaluate the safety and efficacy of pharmacotherapy used during the management of the novel COVID-19. Conclusion: This study will be a qualitative and quantitative pool of comprehensive evidence regarding the safety and efficacy of pharmacotherapy on COVID-19.

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“…To balance inflammatory response, researchers hope that steroids may also provide some contributions. Corticosteroid therapy can be another option that is limited to severe COVID-19 patients with refractory sepsis, septic shock, and ARDS ( 85 - 87 ). Since corticosteroids bind to cytoplasmic receptors, change the transcription of mRNA, and reduce inflammatory mediator production, they may be useful in limiting COVID-19 associated inflammatory damages ( 85 - 87 ).…”

Section: Introductionmentioning

confidence: 99%

“…Corticosteroid therapy can be another option that is limited to severe COVID-19 patients with refractory sepsis, septic shock, and ARDS ( 85 - 87 ). Since corticosteroids bind to cytoplasmic receptors, change the transcription of mRNA, and reduce inflammatory mediator production, they may be useful in limiting COVID-19 associated inflammatory damages ( 85 - 87 ). However, it should not be under-considered that the administration of corticosteroids may be like a double-edged sword and may delay viral clearance and increase the risk of secondary infections and mortality ( 85 - 87 ).…”

Section: Introductionmentioning

confidence: 99%

Inflammation and thrombosis in patients with COVID-19: a prothrombotic and inflammatory disease caused by SARS Coronavirus-2

Pamukçu¹

2020

Anatol J Cardiol

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Coronavirus disease 2019 (COVID-19) caused by “Severe Acute Respiratory Syndrome Coronavirus-2” (SARS-CoV-2) infection emerged in Wuhan, a city of China, and spread to the entire planet in early 2020. The virus enters the respiratory tract cells and other tissues via ACE2 receptors. Approximately 20% of infected subjects develop severe or critical disease. A cytokine storm leads to over inflammation and thrombotic events. The most common clinical presentation in COVID-19 is pneumonia, typically characterized by bilateral, peripheral, and patchy infiltrations in the lungs. However multi-systemic involvement including peripheral thromboembolic skin lesions, central nervous, gastrointestinal, circulatory, and urinary systems are reported. The disease has a higher mortality compared to other viral agents causing pneumonia and unfortunately, no approved specific therapy, nor vaccine has yet been discovered. Several clinical trials are ongoing with hydroxychloroquine, remdesivir, favipiravir, and low molecular weight heparins. This comprehensive review aimed to summarize coagulation abnormalities reported in COVID-19, discuss the thrombosis, and inflammation-driven background of the disease, emphasize the impact of thrombotic and inflammatory processes on the progression and prognosis of COVID-19, and to provide evidence-based therapeutic guidance, especially from antithrombotic and anti-inflammatory perspectives.

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Pharmacotherapy in COVID-19; A narrative review for emergency providers

Cited by 105 publications

References 30 publications

Individuals with obesity and COVID‐19: A global perspective on the epidemiology and biological relationships

Individuals with obesity and COVID‐19: A global perspective on the epidemiology and biological relationships

“Safety and efficacy of pharmacotherapy used for the management of COVID 19: A systematic review and meta-analysis of randomized control trials”

Inflammation and thrombosis in patients with COVID-19: a prothrombotic and inflammatory disease caused by SARS Coronavirus-2

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