A HOME-TREATMENT ALGORITHM BASED ON ANTI-INFLAMMATORY DRUGS TO PREVENT HOSPITALIZATION OF PATIENTS WITH EARLY COVID-19: A MATCHED-COHORT STUDY (COVER 2)

Abstract

Background and Aim: While considerable success has been achieved in the management of patients hospitalized with severe coronavirus disease 2019 (COVID-19), far less progress has been made with early outpatient treatment. We assessed whether the implementation of a home treatment algorithm, designed based upon on a pathophysiologic and pharmacologic rationale, during the initial, mild phase of COVID-19, could effectively reduce hospital admissions. Methods: This fully academic, matched-cohort study evaluated outcomes in 108 consecutive consenting patients with mild COVID-19 managed at home by their family doctors from January 2021 to May 2021, according to the proposed treatment algorithm and in 108 age-, sex-, and comorbidities-matched patients who were given other therapeutic schedules (ClinicalTrials.gov: NCT04854824). The primary outcome was COVID-19-related hospitalization. Analyses were by intention-to-treat. Results: One (0.9%) patient in the recommended cohort and 12 (11.1%) in the control cohort were admitted to hospital (P=0.0136). The proposed algorithm reduced, by 85%, the cumulative length of hospital stays (from 141 to 19 days) and related costs (from Euro 60.316 to Euro 9.058). Only 9.8 patients needed to be treated with the recommended algorithm to prevent one hospitalization event. The rate of resolution of major symptoms was numerically, but not significantly, higher in the recommended compared to the control cohort (97.2% versus 93.5%, respectively; P=0.322). Other symptoms lingered in a lower proportion of patients in the recommended than in the control cohort (20.4% versus 63.9%, respectively; P<0.001), and for a shorter period. Conclusion: The adoption of the proposed outpatient treatment algorithm during the early, mild phase of COVID-19 reduced the incidence of subsequent hospitalization and related costs.

NSAIDs and Kelleni’s protocol as potential early COVID-19 treatment game changer: could it be the final countdown?

“…They have confirmed an earlier published one (Kow and Hasan 2021) and a third preprinted article with similar findings (Zhou et al 2021). Interestingly, a large study by Drake et al (2021) has urged policy-makers to review their advice regarding prescribing NSAIDs in COVID-19 and some colleagues have recently suggested that earliest COVID-19 home therapy with NSAIDs may greatly prevent hospitalizations (Consolaro et al 2021;Pandolfi and Chirumbolo 2021). As early mentioned, all these observations and recommendations side with our old one that started since May 2020 when we started to recommend adopting NSAIDs as lifesaving and of choice in COVID-19 management, unless contraindicated due to other reasons or diseases.…”

A Review of the Potential Roles of Antioxidant and Anti-Inflammatory Pharmacological Approaches for the Management of Mild-to-Moderate Symptomatic COVID-19

“…Therefore, these potentially confounding factors should be controlled in the protocol of any comparative multicenter study of different treatment approaches. Equally important will be to take note of the delay of initiation of therapy compared to the onset of symptoms, as this factor seems crucial in determining outcome [ 2 – 4 , 6 ].…”

“…In such patients, lacking a widely approved therapeutic strategy and pending evidence-based guidance, the health authorities suggest a “watchful waiting” or “monitoring” of clinical evolution and the use of symptomatic drugs, such as paracetamol or non-steroidal anti-inflammatory agents (NSAIDs), unless there are specific contraindications. However, lack of treatment in the first 72 h or limiting it to symptomatic medications could be risky in many patients, whose disease is destined to progress to more severe forms [ 1 – 4 ]. Indeed, many patients have a significant increase in D-dimer levels, an indicator of thrombosis, which correlates with a worse prognosis [ 5 , 6 ].…”

Home pharmacological therapy in early COVID‐19 to prevent hospitalization and reduce mortality: Time for a suitable proposal

“…To date, no official proposal reached the attention of leading authorities, as COVID‐19 home therapy would be based on affordable and widely available anti‐inflammatory and anti‐thrombotic drugs to reduce the impact on any socio‐economic burden and reduce hospitalization overload. Recent clinical data, despite someone yet published as a pre‐print, assessed that COX‐2 inhibitors, either commonly purchasable NSAIDs and selective inhibitors, are a better choice to treat COVID‐19 in its early symptomatology 19,156 . Pharmaceuticals such as nimesulide and celecoxib are strongly suggested to greatly reduce the risk of being hospitalized for the patient with early COVID‐19 symptoms 19,156 .…”

“…19,156 Pharmaceuticals such as nimesulide and celecoxib are strongly suggested to greatly reduce the risk of being hospitalized for the patient with early COVID-19 symptoms. 19,156 The proposal should be exerted usually at home, as in the first stages of COVID-19 symptomatology the patient feels pain, discomfort, even cough or dyspnoea and fever while staying at her/his own home. Major recommended NSAIDs may be therefore celecoxib, nimesulide, ibuprofen and indomethacin, 156 taking into account that any protocol considering one of these NSAIDs might include ASA (>44%) and antibiotics such as azithromycin (>48%).…”