Prolonged SARS-CoV-2 Viral Shedding in Patients with COVID-19 was Associated with Delayed Initiation of Arbidol Treatment: a retrospective cohort study

Abstract

Objectives: Evaluate the risk factors of prolonged SARS-CoV-2 virus shedding and the impact of arbidol treatment on SARS-CoV-2 virus shedding. Methods: Data were retrospective collected from adults hospitalized with COVID-19 in Wuhan Union Hospital. We described the clinical features and SARS-CoV-2 RNA shedding of patients with COVID-19 and evaluated factors associated with prolonged virus shedding by multivariate regression analysis. Results: Among 238 patients, the median age was 55.5 years, 57.1% were female, 92.9% (221/238) used arbidol, 58.4% (139/238) used arbidol combination with interferon. The median time from illness onset to start arbidol was 8 days (IQR, 5-14 days) and the median duration of SARS-CoV-2 virus shedding was 23 days (IQR, 17.8-30 days). SARS-CoV-2 RNA clearance was significantly delayed in patients who received arbidol >7 days after illness onset, compared with those in whom arbidol treatment was started less than or equal to7 days after illness onset (HR, 1.738 [95% CI, 1.339-2.257], P < .001). Multivariate regression analysis revealed that prolonged viral shedding was significantly associated with initiation arbidol more than seven days after symptom onset (OR 2.078, 95% CI [1.114-3.876], P .004), more than 7 days from onset of symptoms to first medical visitation (OR 3.321, 95% CI[1.559-7.073], P .002), illness onset before Jan.31, 2020 (OR 3.223, 95% CI[1.450-7.163], P .021). Arbidol combination with interferon was also significantly associated with shorter virus shedding (OR .402, 95% CI[.206-.787], P .008). Conclusions: Early initiation of arbidol and arbidol combination with interferon as well as consulting doctor timely after illness onset were helpful for SARS-CoV-2 clearance.

Comparison of antiviral effect for mild-to-moderate COVID-19 cases between lopinavir/ritonavir versus hydroxychloroquine: A nationwide propensity score-matched cohort study

“…On multivariate analysis, old age, malignancy, steroid use, and concomitant pneumonia were identified as risk factors for prolonged viral shedding in this study, consistent with previous studies ( Fu et al, 2020 , Yan et al, 2020a , Yan et al, 2020b , Zhou et al, 2020 ). Old age, comorbidities, and steroid use might blunt the host immune response, thereby promoting viral replication.…”

Janus Kinase-Inhibitor and Type I Interferon Ability to Produce Favorable Clinical Outcomes in COVID-19 Patients: A Systematic Review and Meta-Analysis

“…Although this study presents evidence of JAK-inhibitors and Type I interferon therapies for COVID-19 patients, the evaluated studies included conflicting results; Giudice et al reported a positive association between JAK-inhibitor therapy and the odds of mortality, [27] while the other studies analyzed and the summary statistic calculated demonstrated a negative association between JAK-inhibitor intervention and mortality (23,24,26). In addition, two studies consistently demonstrated opposite associations between Type I interferon therapy and clinical outcomes, [30,33] when comparing summary statistics and other included studies. [28,29,31,34,35] Heterogeneity among populations studied may play a role in the disparate individual results, as half of these studies were conducted in China, one was conducted in Iran, five were conducted in Western Europe, and one was conducted in Cuba.…”

COVID-19 Therapeutic Options Under Investigation

“…Deng et al showed in a retrospective observational study that 16 COVID-19 patients treated with umifenovir plus lopinavir/ritonavir combination had more favorable viral clearance and chest CT findings compared to lopinavir/ ritonavir monotherapy (Deng et al, 2020). A retrospective study demonstrated that early administration of umifenovir or umifenovir in combination IFN significantly shortened the duration of viral shedding in COVID-19 patients (Zhou Y. et al, 2020). Furthermore, a limited retrospective cohort study reported that umifenovir tends to improve the discharging rate and reduce mortality rate (Wang et al, 2020b).…”