Сomparative analysis of drug efficacy in the treatment for COVID-19 severe forms, based on attribute-based statistic methods and analysis of drug interactions
- 作者: Zhukova O.V.1, Kagramanyan I.N.2, Khokhlov A.L.3
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隶属关系:
- Privolzhsky Research Medical University
- First Moscow State Medical University named after I.M. Sechenov
- Yaroslavl State Medical University
- 期: 卷 8, 编号 5 (2020)
- 页面: 316-324
- 栏目: Articles
- URL: https://journal-vniispk.ru/2307-9266/article/view/111652
- DOI: https://doi.org/10.19163/2307-9266-2020-8-5-316-324
- ID: 111652
如何引用文章
详细
Severe and critical forms of COVID-19 are beset by the development of a “cytokine storm”, which is characterized by increased secretion of proinflammatory cytokines. Therefore, one of leading strategies for treating patients with severe forms of COVID-19, is the reduction of concentration of proinflammatory cytokines and leveling out their effect on the patient. Among the drugs aimed at reducing the concentration of proinflammatory cytokines, IL-6 inhibitors, IL-1 inhibitors, JAK inhibitors and systemic glucocorticosteroids have been found useful in COVID-19. All of these drugs are currently prescribed off-label.
The aim of the work is a comparative analysis of the data from the literature sources in the PubMed system, devoted to the clinical efficacy and safety of IL-6, IL-1, JAK inhibitors and systemic glucocorticosteroids in the treatment for severe forms of COVID-19.
Materials and Methods. In the treatment for severe forms of COVID-19, materials for the comparative analysis were the data from the literature sources in the PubMed system, on the studies devoted to the use of the systemic glucocorticosteroid dexamethasone, IL-6 inhibitor tocilizumab, IL-1 inhibitor anakinra, and JAK inhibitor ruxoliniteb. The analysis was performed by statistical evaluation of the effect of the drugs on the 28th-day survival rate among the patients with severe COVID-19. Attribute-based statistics was used as a statistical tool. The safety of the drug use was assessed by analyzing potential drug interactions. The information about potential drug interactions, was obtained from a specialized website – Drugs.com. Knowmore. Besure (https://www.drugs.com/interaction/list/).
Results. As a result of the analysis, it has been established that tocilizumab has the highest efficacy rates. In this respect, it is followed by dexamethasone. The attributive efficacy rates and 95% confidence interval values for the both drugs, were statistically significant. The indices of relative and population attributive kinds of efficacy, were also higher for tocilizumab, but a 95% confidence interval of these indices, get into the range of statistically insignificant values, requiring additional evidence of their efficacy. According to the data obtained, tocilizumab efficacy is higher than that of the other drugs compared: NNT (dexamethasone) – 32; NNT (tocilizumab) – 4, NNT (ruxolitinib) – 7; NNT (anakinra) – 35.
Conclusion. The choice of a drug should be based on the patient’s condition, comorbidities, and medications used in therapy to minimize the risk of undesirable drug interactions.
Against the background of the lowest efficacy among the compared drugs, a high efficacy for the patients with concomitant hepatobiliary disorders and DIC syndrome, has been established for the inhibitor IL-1 anakinra, which makes it the drug of choice among the patients with these diseases and under these conditions in the development of a “cytokine storm”.
作者简介
Olga Zhukova
Privolzhsky Research Medical University
编辑信件的主要联系方式.
Email: ov-zhukova@mail.ru
ORCID iD: 0000-0002-6454-1346
Candidate of Sciences (Pharmacy), Associate Professor, the Head of the Department of Pharmaceutical Chemistry and Pharmacognosy
俄罗斯联邦, 10/1, Minin and Pozharsky Sq., Nizhny Novgorod, 603950Igor Kagramanyan
First Moscow State Medical University named after I.M. Sechenov
Email: orgzdrav21@yandex.ru
ORCID iD: 0000-0002-2139-6847
Doctor Sciences of (Medicine), Associate Professor, Professor of the Institute of Leadership in Healthcare
俄罗斯联邦, Bld. 4, 2, Bolshaya Pirogovskaya St., Moscow, 119991Aleksandr Khokhlov
Yaroslavl State Medical University
Email: al460935@yandex.ru
ORCID iD: 0000-0002-0032-0341
Doctor of Sciences (Medicine), Professor, Corresponding Member of the Russian Academy of Sciences, the Head of the Department of Clinical Pharmacology and Ethics of the Use of Medicines at UNESCO
俄罗斯联邦, 5, Revolyutsionnaya St., Yaroslavl, Yaroslavl region, 150000参考
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