Efficacy and tolerability of bevacizumab in patients with severe Covid -19

Abstract

On the basis of Covid-19-induced pulmonary pathological and vascular changes, we hypothesized that the anti-VEGF drug bevacizumab might be beneficial for treating Covid-19 patients. We recruited 26 patients from 2-centers (China and Italy) with confirmed severe Covid-19, with respiratory rate ≥30 times/min, oxygen saturation ≤93% with ambient air, or partial arterial oxygen pressure to fraction of inspiration O2 ratio (PaO2/FiO2) >100mmHg and ≤300 mmHg, and diffuse pneumonia confirmed by chest radiological imaging. This trial was conducted from Feb 15 to April 5, 2020, and followed up for 28 days. Relative to comparable control patients with severe Covid-19 admitted in the same centers, bevacizumab showed clinical efficacy by improving oxygenation and shortening oxygen-support duration. Among 26 hospitalized patients with severe Covid-19 (median age, 62 years, 20 [77%] males), bevacizumab plus standard care markedly improved the PaO2/FiO2 ratios at days 1 and 7 (elevated values, day 1, 50.5 [4.0,119.0], p<0.001; day 7, 111.0 [85.0,165.0], p<0.001). By day 28, 24 (92%) patients showed improvement in oxygen-support status, 17 (65%) patients were discharged, and none showed worsen oxygen-support status nor died. Significant reduction of lesion areas and ratios were shown in chest CT or X-ray analysis within 7 days. Of 14 patients with fever, body temperature normalized within 72 hours in 13 (93%) patients. Lymphocyte counts in peripheral blood were significantly increased and CRP levels were markedly decreased as shown in available data. Our findings suggested bevacizumab plus standard care was highly beneficial for treating patients with severe Covid-19. Clinical efficacy of bevacizumab warrants double blind, randomized, placebo-controlled trials.

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“…The results showed that patients receiving bevacizumab improved their oxygen support by 92% without leading to any deaths whereas patients receiving standard care the improvement rate of oxygen was only 62% with deterioration rate 19% and 3 deaths. Also, rapid improvement of the PaO2/FiO2 ratio in patients with severe COVID-19, fever reduction, anti-inflammatory action, and increase in peripheral blood lymphocytes were observed (Pang et al, 2020).…”

COVID-19 Pandemic: Advances in Diagnosis, Treatment, Organoid Applications and Impacts on Cancer Patient Management

“…Bevacizumab, a recombinant humanized anti-VEGF monoclonal antibody, is widely used to treat a number of types of solid malignancies, including lung cancer, colon cancer, glioblastoma, and renal-cell carcinoma ( 127 ), and is now being evaluated for treating severe or critical patients with COVID-19 pneumonia ( Table 2 ). The result of one clinical trial (ClinicalTrials.gov: NCT04275414) indicated that bevacizumab plus standard care showed remarkable efficacy for treating severe COVID-19 patients ( 128 ).…”

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“… 46 A recent clinical study with Bevacizumab showed therapeutic efficacy by improving oxygenation and shortening oxygen-support duration in patients with severe COVID-19. 47 Likewise, Thalidomide, another angiogenesis inhibitor, has anti-inflammatory and anti-fibrotic effects and is also used for treatment of COVID-19 (NCT04273529 and NCT04273581). Two recent clinical studies suggested Thalidomide combined with low-dose short-term glucocorticoid as an effective therapeutic option in patients with severe COVID-19.…”