Effect of combination antiviral therapy on hematological profiles in 151 adults hospitalized with severe coronavirus disease 2019

Abstract

The current diagnosis and medicines approach in coronavirus disease 2019 (COVID-19) does not reflect the heterogeneous characteristics of this disease. This study aims to find a new antiviral combination regimen by investigating the frequency of clinically relevant and objectively identified comorbidities, and the clustering of these clinical syndromes and varying results of treatment with antiviral drugs in patients hospitalized with severe COVID-19. Methods: This study recruited 151 severe COVID-19 infection cases diagnosed in our hospital examination and illustrated the clinical potential during a consecutive 25-day medication period. Potential differences in disease severity and clinical characteristics, hematological profile, and current pharmacologic treatments (single agent, double or triple combinations, and the combined antiviral drugs plus Lianhua Qingwen) among comorbidity clusters were explored. Results: Although disease severity was comparable among three clusters, it was markedly different in terms of laboratory test status. Coagulable abnormality was mainly present in cluster 1 and cluster 2. Other indicators were normal, except for a significant increase of neutrophils presented in cluster 2. Patients showed the most complicated haematological results in cluster 3, including severe coagulation abnormalities, leukocytosis, neutrophilic granulocytosis, and lymphopenia. Our results for the first time suggest that a quadruple combination therapy (Ribavirin, Lopinavir/ritonavir, Umifenovir, and Lianhua Qingwen) can be considered as a preferred treatment approach to severe COVID-19 patients. After treatment, abnormal coagulation and leukocyte had markedly improved with a better prognosis. Conclusion: This study expands the understanding of the co-occurrence of combination therapy in patients with COVID-19, which provides the probability of developing novel combined therapy. Furthermore, explore clinical trials of variable antivirus treatments based on subgroup analyses or on using subgroups in the selection criteria would be the next step.

Natural product derived phytochemicals in managing acute lung injury by multiple mechanisms

“…Rutin, quercetin, luteolin, kaempferol, chlorogenic acid, hyperoside and emodin are the main ingredients of LHQWC, which is approved by China SFDA (Number: Z20040063) [ 424 ]. During COVID-19, LHQWC was widely and effectively used for the treatment of COVID-19, and the effect of a combination of other drugs (umifenovir, ribavirin, lopinavir/ritonavir) plus LHQWC was superior to single or dual agents [ 425 , 426 ]. Chun-juan Ye found that the combination of LHQWC and other drugs like ribavirin and cefuroxime resulted in higher total efficiency than other drugs alone (90.63 % and 68.75 %, respectively) [ 427 ].…”

A 21st Century Evil: Immunopathology and New Therapies of COVID-19

“…Elfiky (320) conducted an in silico study demonstrating that ribavirin and other antivirals such as sofosbuvir can strongly bind to coronavirus RdRp, preventing the transcription of new copies of viral RNA. Only a few clinical studies have investigated the effect of ribavirin on COVID-19 patients, with the studies available generally focusing on the association of ribavirin and other therapeutic schemes (321)(322)(323). Nevertheless, China's government (324) has recommended the use of ribavirin in COVID-19 patients.…”

Insights into forsythia honeysuckle (Lianhuaqingwen) capsules: A Chinese herbal medicine repurposed for COVID-19 pandemic

“…The results show that the use of LH capsules in combination with conventional treatment methods, such as antiviral drugs and oxygen therapy, can effectively improve the clinical cure rate and exert obvious therapeutic effects on symptoms such as fever, fatigue, and cough( Liu et al, 2020b ; Liu et al, 2020c ; Ping et al, 2016 ; Xiao et al, 2020 ; Zhang et al, 2020d ). This finding might be related to the antiviral activity of LH capsules and their anti-inflammatory effects( Li et al, 2020d ). In addition, the experimental results show that LH capsules have a good safety profile.…”