Épisode 59 COVID19-11 MàJ sur les traitements

Mathieu discute des dernières données sur différents traitements de la COVID-19!

Dans ce 59e épisode de FrancoFOAM, on discute principalement

la littérature sur différents traitements contre la COVID-19
- Colchicine
- Remdesivir
- Tocilizumab
- Corticostéroïdes
- Anticoagulation
- Vitamine-D
- Anti-H2 vs IPP

Suite à l’enregistrement et la publication de l’épisode, les données préliminaires pré-publication du bras Tocilizumab de l’étude RECOVERY sont sorties le jeudi 11 février 2021.

Les objectifs de l’épisode :

Discuter des données supportant ou non différents traitements contre la COVID-19
Adapter un plan de traitement pour un patient atteint de la COVID-19

Les messages clé de l’épisode :

Les données ne supportent pas l’utilisation de la colchicine pour le moment
Le données ne supportent pas l’utilisation du remdesivir
La place du tocilizumab reste à préciser.
Les doses de corticostéroïdes seraient-elles à moduler selon le profil inflammatoire et l’évolution clinique ?
Les données ne supportent pas une anticoagulation systématique chez les patients en état sévère mais à considérer chez les patients modérés.
Les suppléments de vitamine D pourraient diminuer le risque de myopathie
Les données supportent l’utilisation des IPP et des anti-H2 comme gastroprophylaxie chez les patients COVID

Mathieu déclare aucun conflit d’intérêt.

La déclaration de conflit d’intérêt des membres de l’équipe du FrancoFOAM est disponible ici

Les références :

Colchicine

Tardif JC, Bouabdallaoui N, L’Allier PL et al. Efficacy of Colchicine in Non-Hospitalized Patients with COVID-19 doi:https://doi.org/10.1101/2021.01.26.21250494 Version pre-print non révisé par les pairs disponible su MedRxIV
Vrachatis DA, Giannopoulos GV, Giotaki SG, et al. Impact of colchicine on mortality in patients with COVID-19. A meta-analysis. Hellenic J Cardiol. 2021 Jan 6:S1109-9666(20)30285-2. doi: 10.1016/j.hjc.2020.11.012. Epub ahead of print. PMID: 33421583; PMCID: PMC7833703.

Remdesivir

WHO Solidarity Trial Consortium, Pan H, Peto R, Henao-Restrepo AM, Preziosi MP et al. Repurposed Antiviral Drugs for Covid-19 – Interim WHO Solidarity Trial Results. N Engl J Med. 2020 Dec 2:NEJMoa2023184. doi: 10.1056/NEJMoa2023184. Epub ahead of print. PMID: 33264556; PMCID: PMC7727327.
Beigel JH, Tomashek KM, Dodd LE, et al; ACTT-1 Study Group Members. Remdesivir for the Treatment of Covid-19 – Final Report. N Engl J Med. 2020 Nov 5;383(19):1813-1826. doi: 10.1056/NEJMoa2007764. Epub 2020 Oct 8. PMID: 32445440; PMCID: PMC7262788.

Tocilizumab

Position de l’INESSS sur la place du tocilizumab
Parr JB. Time to Reassess Tocilizumab’s Role in COVID-19 Pneumonia. JAMA Intern Med. 2020 Oct 20. doi: 10.1001/jamainternmed.2020.6557. Epub ahead of print. PMID: 33079980.
Salvarani C, Dolci G, Massari M; RCT-TCZ-COVID-19 Study Group. Effect of Tocilizumab vs Standard Care on Clinical Worsening in Patients Hospitalized With COVID-19 Pneumonia: A Randomized Clinical Trial. JAMA Intern Med. 2020 Oct 20. doi: 10.1001/jamainternmed.2020.6615. Epub ahead of print. PMID: 33080005.
Hermine O, Mariette X, Tharaux PL, Resche-Rigon M, Porcher R, Ravaud P; CORIMUNO-19 Collaborative Group. Effect of Tocilizumab vs Usual Care in Adults Hospitalized With COVID-19 and Moderate or Severe Pneumonia: A Randomized Clinical Trial. JAMA Intern Med. 2021 Jan 1;181(1):32-40. doi: 10.1001/jamainternmed.2020.6820. PMID: 33080017; PMCID: PMC7577198.
Gupta S, Wang W, Hayek SS, Chan L; STOP-COVID Investigators. Association Between Early Treatment With Tocilizumab and Mortality Among Critically Ill Patients With COVID-19. JAMA Intern Med. 2020 Oct 20. doi: 10.1001/jamainternmed.2020.6252. Epub ahead of print. PMID: 33080002.
Veiga VC, Prats JAGG, Farias DLC, et al; Coalition covid-19 Brazil VI Investigators. Effect of tocilizumab on clinical outcomes at 15 days in patients with severe or critical coronavirus disease 2019: randomised controlled trial. BMJ. 2021 Jan 20;372:n84. doi: 10.1136/bmj.n84. PMID: 33472855; PMCID: PMC7815251.
The REMAP-CAP Investigators, Anthony C. Gordon, Paul R. Mouncey, Farah Al-Beidh, et al. Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19 – Preliminary report

medRxiv 2021.01.07.21249390; doi: Rapport préliminaire non révisé par les pairs

Cortico

Mongardon N, Piagnerelli M, Grimaldi D, Perrot B, Lascarrou JB; COVADIS study group investigators. Impact of late administration of corticosteroids in COVID-19 ARDS. Intensive Care Med. 2020 Nov 6:1–3. doi: 10.1007/s00134-020-06311-z. Epub ahead of print. PMID: 33156381; PMCID: PMC7645397.
Villar J, Ferrando C, Martínez D, et al; dexamethasone in ARDS network. Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial. Lancet Respir Med. 2020 Mar;8(3):267-276. doi: 10.1016/S2213-2600(19)30417-5. Epub 2020 Feb 7. PMID: 32043986.
Emami Ardestani M, Kalantary E, Samaiy V, Taherian K. Methyl prednisolone vs Dexamethasone in Management of COPD Exacerbation; a Randomized Clinical Trial. Emerg (Tehran). 2017;5(1):e35. Epub 2017 Jan 11. PMID: 28286842; PMCID: PMC5325905.
Doymaz S, Ahmed YE, Francois D, Pinto R, Gist R, Steinberg M, Giambruno C. Methylprednisolone, dexamethasone or hydrocortisone for acute severe pediatric asthma: does it matter? J Asthma. 2021 Jan 16:1-10. doi: 10.1080/02770903.2020.1870130. Epub ahead of print. PMID: 33380248.
Edara L, Suvvari TK, Kutikuppala LVS. High Dose Steroid Therapy to Prevent Severe Hypoxia in COVID-19 Patients: A Potential Solution for Low Resource Clinical Setting. Cureus. 2020 Dec 27;12(12):e12330. doi: 10.7759/cureus.12330. PMID: 33520528; PMCID: PMC7837645.
López Zúñiga MÁ, Moreno-Moral A, Ocaña-Granados A, et al. High-dose corticosteroid pulse therapy increases the survival rate in COVID-19 patients at risk of hyper-inflammatory response. PLoS One. 2021 Jan 28;16(1):e0243964. doi: 10.1371/journal.pone.0243964. PMID: 33507958; PMCID: PMC7842890.
Papamanoli A, Yoo J, Grewal P, et al. High-dose methylprednisolone in nonintubated patients with severe COVID-19 pneumonia. Eur J Clin Invest. 2021 Feb;51(2):e13458. doi: 10.1111/eci.13458. Epub 2020 Dec 1. PMID: 33219551; PMCID: PMC7744876.

Anticoagulation

Iba T, Warkentin TE, Thachil J, Levi M, Levy JH. Proposal of the Definition for COVID-19-Associated Coagulopathy. J Clin Med. 2021 Jan 7;10(2):E191. doi: 10.3390/jcm10020191. PMID: 33430431.
Lemos ACB, do Espírito Santo DA, Salvetti MC, Gilio RN, Agra LB, Pazin-Filho A, Miranda CH. Therapeutic versus prophylactic anticoagulation for severe COVID-19: A randomized phase II clinical trial (HESACOVID). Thromb Res. 2020 Sep 21;196:359-366. doi: 10.1016/j.thromres.2020.09.026. Epub ahead of print. PMID: 32977137; PMCID: PMC7503069.
Résultats intérim REMAP-CAP, ACTIV 4a et ATTACC présenté le 28 janvier 2021 disponible sur la plateforme REMAP-CAP et en format présentation

Vitamine D

Muthuvattur Pallath M, Ahirwar AK, Chandra Tripathi S, Asia P, Sakarde A, Gopal N. COVID-19 and nutritional deficiency: a review of existing knowledge. Horm Mol Biol Clin Investig. 2021 Feb 3. doi: 10.1515/hmbci-2020-0074. Epub ahead of print. PMID: 33544528.
Li S, Cao Z, Yang H, Zhang Y, Xu F, Wang Y. Metabolic Healthy Obesity, Vitamin D Status, and Risk of COVID-19. Aging Dis. 2021 Feb 1;12(1):61-71. doi: 10.14336/AD.2020.1108. PMID: 33532128; PMCID: PMC7801267.
Barassi A, Pezzilli R, Mondoni M, Rinaldo RF, DavÌ M, Cozzolino M, Melzi D’Eril GV, Centanni S. Vitamin D in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients with non-invasive ventilation support. Panminerva Med. 2021 Jan 25. doi: 10.23736/S0031-0808.21.04277-4. Epub ahead of print. PMID: 33494567.
Demir M, Demir F, Aygun H. Vitamin D deficiency is associated with COVID-19 positivity and the severity of the disease. J Med Virol. 2021 Jan 29. doi: 10.1002/jmv.26832. Epub ahead of print. PMID: 33512007.
Brighthope I, Avni Sali AM, Ried K. Vitamin-D and COVID-19: time for the profession to take a stand. Adv Integr Med. 2021 Jan 21. doi: 10.1016/j.aimed.2021.01.003. Epub ahead of print. PMID: 33520645; PMCID: PMC7826030.
Griffin G, Hewison M, Hopkin J, Kenny R, Quinton R, Rhodes J, Subramanian S, Thickett D. Vitamin D and COVID-19: evidence and recommendations for supplementation. R Soc Open Sci. 2020 Dec 1;7(12):201912. doi: 10.1098/rsos.201912. PMID: 33489300; PMCID: PMC7813231.

Anti-H2 vs Inhibiteurs de la pompe à Protons

Lee SW, Ha EK, Yeniova AÖ, Moon SY, Kim SY, Koh HY, Yang JM, Jeong SJ, Moon SJ, Cho JY, Yoo IK, Yon DK. Severe clinical outcomes of COVID-19 associated with proton pump inhibitors: a nationwide cohort study with propensity score matching. Gut. 2021 Jan;70(1):76-84. doi: 10.1136/gutjnl-2020-322248. Epub 2020 Jul 30. PMID: 32732368.
Zhou J, Wang X, Lee S, Wu WKK, Cheung BMY, Zhang Q, Tse G. Proton pump inhibitor or famotidine use and severe COVID-19 disease: a propensity score-matched territory-wide study. Gut. 2020 Dec 4:gutjnl-2020-323668. doi: 10.1136/gutjnl-2020-323668. Epub ahead of print. PMID: 33277346.

Fluvoxamine

A Double-blind, Placebo-controlled Clinical Trial of Fluvoxamine for Symptomatic Individuals With COVID-19 Infection (STOP COVID)
Fluvoxamine for Adults With Mild to Moderate COVID-19
Fluvoxamine Administration in Moderate SARS-CoV-2 (COVID-19) Infected Patients

NAC

Peivandi Yazdi A, Razavi M, Sheikh S, Boroumand N, Salehi M, Hashemy SI. Clinical Trial Assessment of Intermittent and Continuous Infusion Dose of N-Acetylcysteine on Redox Status of the Body in Patients with Sepsis Admitted to the ICU. J Intensive Care Med. 2020 Dec;35(12):1383-1388. doi: 10.1177/0885066618823152. Epub 2019 Jan 13. PMID: 30636490.
Shi Z, Puyo CA. N-Acetylcysteine to Combat COVID-19: An Evidence Review. Ther Clin Risk Manag. 2020 Nov 2;16:1047-1055. doi: 10.2147/TCRM.S273700. PMID: 33177829; PMCID: PMC7649937.
Zhou N, Yang X, Huang A, Chen Z. The potential mechanism of N-acetylcysteine in treating COVID-19. Curr Pharm Biotechnol. 2020 Dec 28. doi: 10.2174/1389201021999201228212043. Epub ahead of print. PMID: 33371832.
Domenighetti G, Suter PM, Schaller MD, Ritz R, Perret C. Treatment with N-acetylcysteine during acute respiratory distress syndrome: a randomized, double-blind, placebo-controlled clinical study. J Crit Care. 1997 Dec;12(4):177-82. doi: 10.1016/s0883-9441(97)90029-0. PMID: 9459113.
Zhang Y, Ding S, Li C, Wang Y, Chen Z, Wang Z. Effects of N-acetylcysteine treatment in acute respiratory distress syndrome: A meta-analysis. Exp Ther Med. 2017 Oct;14(4):2863-2868. doi: 10.3892/etm.2017.4891. Epub 2017 Aug 7. PMID: 28928799; PMCID: PMC5590037.
de Alencar JCG, Moreira CL, Müller AD, Chaves CE, Fukuhara MA, da Silva EA, Miyamoto MFS, et al. Double-blind, randomized, placebo-controlled trial with N-acetylcysteine for treatment of severe acute respiratory syndrome caused by COVID-19. Clin Infect Dis. 2020 Sep 23:ciaa1443. doi: 10.1093/cid/ciaa1443. Epub ahead of print. PMID: 32964918; PMCID: PMC7543361.

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