Preventive effects of Pycnogenol® on cardiovascular risk factors (including endothelial function) and microcirculation in subjects recovering from coronavirus disease 2019 (COVID-19)

Belcaro, Gianni; Cornelli, Umberto; Cesarone, M. R.; Scipione, Claudia; Scipione, Valeria; Hu, Shu; Feragalli, Beatrice; Corsi, M; Cox, David; Cotellese, Roberto; Hosoi, Morio; Bürki, Carolina

doi:10.23736/s0026-4806.21.07650-3

Cited by 10 publications

(16 citation statements)

References 43 publications

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“…Currently, there is some evidence suggesting that rehabilitation might have a beneficial effect on recovery from Covid-19 (68)(69)(70)(71), and that there may be a positive effect of medications on post-acute clinical outcomes of Covid-19 (72,73). These studies were not included in our synthesis due to either short follow-up time or the outcomes not being prioritized by the working group and patient panel for inclusion.…”

Section: Interventionsmentioning

confidence: 99%

Risk factors and preventive interventions for post Covid-19 condition: systematic reviews

Pillay

Rahman

Guitard

et al. 2022

Preprint

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Background: The Covid-19 outbreak has presented many challenges to governments and healthcare systems, including observations of symptoms that persist beyond acute infection labelled as post Covid-19 condition. Objectives: To systematically identify and synthesize evidence around pre-existing and clinical risk factors for post Covid-19 condition (occurring ≥12 weeks after positive test/symptom onset) (KQ1), and interventions during the acute and post-acute phases of the illness that could potentially prevent post Covid-19 condition (KQ2). Methods: We searched Medline and Embase (Jan 2021-Aug 12 2021 [KQ1], and Jan 2020-Jul 28, 2021 [KQ2]), Clinicaltrials.gov, organizational websites, and reference lists of included studies and relevant systematic reviews. Two investigators independently reviewed abstracts and full-text articles against a priori inclusion criteria, and disagreements were resolved through discussion or by consulting a third reviewer. One investigator abstracted data and assessed risk of bias using design-specific criteria, and a second investigator checked data abstraction and assessments for completeness and accuracy. Meta-analysis was performed when there was sufficient clinical and methodological similarity in an exposure-outcome comparison, based on prespecified variables. We assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach (GRADE). A relative effect/association of 0.75-1.49 was considered as little-to-no, whereas 0.50-0.74/1.5-1.99 was small-to-moderate and <0.50/≥2.00 was large for fewer/benefit or more/harm, respectively Results: From 4,672 (KQ1) and 3,781 (KQ2) citations we included 17 and 18 studies, though 4 studies were included for both KQs. We found small-to-moderate associations between female sex and higher non-recovery, fatigue, and dyspnea (moderate certainty). Severe or critical acute-phase Covid-19 severity (versus not) has probably (moderate certainty) a large association with increased cognitive impairment, a small-to-moderate association with more non-recovery, and a little-to-no association with dyspnea. There may be (low certainty) large associations between hospitalization during the acute illness and increased non-recovery, increased dyspnea, and reduced return to work. There may be small-to-moderate associations between several other risk factors and post Covid-19 condition outcomes, including age ≥60 versus <60 (functional incapacity), non-White people (lower return to work), children age >6 versus <2 years (non-recovery), having ≥1 versus no comorbidities (non-recovery), chronic pulmonary disease (fatigue), rheumatologic disorder (depression/anxiety), and chronic obstructive pulmonary disease or hypertension (cognitive impairment). Several other risk factors had low certainty for little-to-no association with one or more outcomes (e.g. diabetes, cardiovascular disease) or very low certainty. Interventions to prevent post Covid-19 condition included medications (standard and traditional/ayurvedic), stem cell therapy, rehabilitation or similar therapies, and screening/referrals at either acute phase (symptom onset to 4 weeks) or early post-acute phase (4-8 week), with short (12-16 weeks) or longer (>16 weeks) follow-up for outcomes. We are very uncertain about the effects of preventive interventions, mainly due to risk of bias, inconsistency/lack of consistency (single studies), and in some cases imprecision. Conclusions: Guidelines in relation to surveillance, screening services, and other services such as access to sickness and disability benefits, might need to focus on females and those with previously severe Covid-19 illness. Interventions targeting fatigue, dyspnea, and cognitive impairment (especially in those who had severe Covid-19) may be good to prioritize for development and evaluation to provide evidence on their effects. Inputs from patients and primary care providers should be taken into account when developing new care pathways and some tailoring to individual needs will likely be paramount. Continuous assessment of the rapidly emerging evidence is important to better shape our understanding as the body of evidence grows. Sufficiently powered prospective trials of preventive interventions are warranted. PROSPERO registration: CRD42021270354

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Section: Interventionsmentioning

confidence: 99%

Risk factors and preventive interventions for post Covid-19 condition: systematic reviews

Pillay

Rahman

Guitard

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…There is some evidence suggesting that rehabilitation might have a beneficial effect on recovery from Covid-19 [ 67–70 ], and that there may be a positive effect of medications on post-acute clinical outcomes of Covid-19 [ 71 , 72 ]. These studies were not included in our synthesis due to either short follow-up time or the outcomes not being prioritized by the working group and patient panel for inclusion.…”

Section: Discussionmentioning

confidence: 99%

Risk factors and preventive interventions for post Covid-19 condition: systematic review

Pillay

Rahman

Guitard

et al. 2022

Emerging Microbes & Infections

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This systematic review examined pre-existing and clinical risk factors for post Covid-19 condition (≥12 weeks after onset), and interventions during acute and post-acute phases of illness that could potentially prevent post Covid-19 condition. The review focuses on studies collecting data during the early phases of the pandemic and prior to the emergence of variants of concern and widespread vaccination. We searched bibliographic databases and grey literature. Two investigators independently reviewed abstracts and full-text articles, and data extraction and risk of bias assessments were verified. Meta-analysis was performed when suitable and we assessed the certainty of evidence using GRADE. We included 31 studies. We found small-to-moderate associations (e.g. adjusted odds ratios 1.5 to <2.0) between female sex and higher non-recovery, fatigue, and dyspnea (moderate certainty). Severe or critical acute-phase Covid-19 severity (versus not) has probably (moderate certainty) a large association (adjusted ratio ≥2.0) with increased cognitive impairment, a small-to-moderate association with more non-recovery, and a little-to-no association with dyspnea. There may be (low certainty) large associations between hospitalization and increased non-recovery, increased dyspnea, and reduced return to work. Other outcomes had low certainty of small-to-moderate or little-to-no association or very low certainty. Several potential preventive interventions were examined, but effects are very uncertain. Guidelines in relation to surveillance, screening, and other services such as access to sickness and disability benefits, might need to focus on females and those with previously severe Covid-19 illness. Continuous assessment of emerging evidence, especially on whether different variants and vaccination impact outcomes, will be important. PROSPERO registration: CRD42021270354.

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“…28,[90][91][92] Six studies with available data assessed PASC symptoms of fatigue, among other symptoms. [47][48][49][50][51][52] However, it is There are numerous other proposed mechanisms of various PASC symptoms. However, beyond treatments for discrete PASC symptoms with well-known pathophysiology, there is not enough evidence to recommend any medication for the more nebulous symptoms of PASC.…”

Section: Discussionmentioning

confidence: 99%

“…28,90–92 Six studies with available data assessed PASC symptoms of fatigue, among other symptoms. 47–52 However, it is difficult to draw conclusions about treatment of PASC-related fatigue from these studies because 3 studied proprietary supplements and were funded solely by the supplement manufacturers and the other contained very low-quality evidence, in 2 cases just a single case report, each studying a very different potential treatment.…”

Section: Discussionmentioning

confidence: 99%

“…50 Three of the 26 records with published data investigate proprietary nutritional supplements also for treatment of PASC fatigue, among other symptoms. [47][48][49] ImmunoSEB and ProbioSEB CSC3 were shown in combination in a randomized controlled trial to have benefit in treating fatigue symptoms (91% resolution of fatigue vs. 15% in treatment vs. placebo groups after 14 days). 47 ImmunoSEB is a multienzyme formulation, which contains enzymes such as bromelain and papain, and Pro-bioSEB CSC3 contains various strains of Bacillus probiotics.…”

Section: Scoping Reviewmentioning

confidence: 99%

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A Scoping Review of Pharmacological Management of Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection in 2021

Carson¹,

Hemenway²

2022

American Journal of Therapeutics

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Background: Postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC), or long-COVID, are signs and symptoms that persist after the acute phase of Coronavirus disease 2019 infection has passed. PASC is newly recognized, and research is ongoing to answer questions about pathology, symptoms, diagnosis, and optimal treatment. Areas of Uncertainty: Use of pharmacologic treatment for symptoms of PASC is currently evolving. This scoping review aims to assess medical literature for any evidence supporting or refuting use of any medications to specifically treat PASC.Data Sources: PubMed, EMBASE, Web of Science, and gray literature sources were searched for any study of medication use for PASC. Studies were included if they described medication use in patients with PASC. There were no exclusion criteria based on study type or if results were reported. Studies were divided into completed works and ongoing research.Results: Fifty-two records were included in final analysis from an initial 3524 records found, including 2 randomized controlled trials, 7 prospective, open-label or observational studies, 14 case reports or case series, 1 survey, 1 correspondence, 1 retrospective analysis, and 26 studies in progress. Seven of the 26 completed works investigate ivabradine or beta-blockers, whereas 7 investigate local or systemic corticosteroids. Three investigate multi-ingredient nutritional supplements. The other 9 completed works as well as the 26 studies in progress investigate a wide variety of other treatments including drugs in development, drugs used for other conditions, herbals, supplements, and vitamins.Conclusions: There is limited, but evolving, literature on medication treatment for PASC. Providers who opt to use pharmacologic therapy for PASC need to be vigilant in their knowledge of these evolving data.

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Preventive effects of Pycnogenol® on cardiovascular risk factors (including endothelial function) and microcirculation in subjects recovering from coronavirus disease 2019 (COVID-19)

Cited by 10 publications

References 43 publications

Risk factors and preventive interventions for post Covid-19 condition: systematic reviews

Risk factors and preventive interventions for post Covid-19 condition: systematic reviews

Risk factors and preventive interventions for post Covid-19 condition: systematic review

A Scoping Review of Pharmacological Management of Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection in 2021

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