Treatments Administered to the First 9152 Reported Cases of COVID-19: A Systematic Review

Fajgenbaum, David C; Khor, Johnson S.; Gorzewski, Alexander; Tamakloe, Mark-Avery; Powers, Victoria; Kakkis, Joseph J.; Repasky, Mileva; Taylor, Anne; Beschloss, Alexander; Hernandez-Miyares, Laura; Go, Beatrice; Nimgaonkar, Vivek; McCarthy, Madison; Kim, Casey; Pai, Ruth-Anne Langan; Frankl, Sarah; Angelides, Philip; Jiang, Jue; Rasheed, Rozena; Napier, Erin; Mackay, Duncan; Pierson, Sheila K

doi:10.1007/s40121-020-00303-8

Cited by 50 publications

(64 citation statements)

References 45 publications

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“…[64][65][66] Almost 60 years of experience in the prophylaxis and therapy of a variety of clinical conditions have established the safety of this drug, even at very high doses and for long-term treatments. Drug repurposing is the fastest strategy toward an effective and accessible treatment against COVID-19 before a vaccine is available, 67 and molecules working via multiple mechanisms of action, such as NAC, are more likely to be effective as compared with drugs having a single target.…”

Section: Resultsmentioning

confidence: 99%

Rationale for the use of N ‐acetylcysteine in both prevention and adjuvant therapy of COVID‐19

Balansky²,

2020

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COVID‐19 may cause pneumonia, acute respiratory distress syndrome, cardiovascular alterations, and multiple organ failure, which have been ascribed to a cytokine storm, a systemic inflammatory response, and an attack by the immune system. Moreover, an oxidative stress imbalance has been demonstrated to occur in COVID‐19 patients. N‐ Acetyl‐L‐cysteine (NAC) is a precursor of reduced glutathione (GSH). Due to its tolerability, this pleiotropic drug has been proposed not only as a mucolytic agent, but also as a preventive/therapeutic agent in a variety of disorders involving GSH depletion and oxidative stress. At very high doses, NAC is also used as an antidote against paracetamol intoxication. Thiols block the angiotensin‐converting enzyme 2 thereby hampering penetration of SARS‐CoV‐2 into cells. Based on a broad range of antioxidant and anti‐inflammatory mechanisms, which are herein reviewed, the oral administration of NAC is likely to attenuate the risk of developing COVID‐19, as it was previously demonstrated for influenza and influenza‐like illnesses. Moreover, high‐dose intravenous NAC may be expected to play an adjuvant role in the treatment of severe COVID‐19 cases and in the control of its lethal complications, also including pulmonary and cardiovascular adverse events.

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Section: Resultsmentioning

confidence: 99%

Rationale for the use of N ‐acetylcysteine in both prevention and adjuvant therapy of COVID‐19

Balansky²,

2020

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“…The first study performed a systematic review of published studies that reported drug therapies for COVID-19 patients. 3 The authors screened 2706 publications and identified 155 published studies that met their inclusion criteria. Two individuals read all 155 studies and manually extracted information about administered drugs into spreadsheets, and a third person reviewed the extracted data to resolve discrepancies.…”

Section: Discussionmentioning

confidence: 99%

“…Although it is beneficial to disseminate this information quickly, culling information from this large publication volume can be difficult and time-consuming. 3 There is a tremendous amount of information relating to symptoms at the onset of disease, and disease symptoms, treatments, and management for hospitalized patients. Responses of individual patients can vary widely, from asymptomatic or mild disease to multi-organ failure and death.…”

Section: Introductionmentioning

confidence: 99%

Social Listening as a Rapid Approach to Collecting and Analyzing COVID-19 Symptoms and Disease Natural Histories Reported by Large Numbers of Individuals

Picone¹,

Inoue²,

DeFelice³

et al. 2020

Population Health Management

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Given the severe and rapid impact of COVID-19, the pace of information sharing has been accelerated. However, traditional methods of disseminating and digesting medical information can be time-consuming and cumbersome. In a pilot study, the authors used social listening to quickly extract information from social media channels to explore what people with COVID-19 are talking about regarding symptoms and disease progression. The goal was to determine whether, by amplifying patient voices, new information could be identified that might have been missed through other sources. Two data sets from social media groups of people with or presumed to have COVID-19 were analyzed: a Facebook group poll, and conversation data from a Reddit group including detailed disease natural history-like posts. Content analysis and a customized analytics engine that incorporates machine learning and natural language processing were used to quickly identify symptoms mentioned. Key findings include more than 20 symptoms in the data sets that were not listed in online lists of symptoms from 4 respected medical information sources. The disease natural history-like posts revealed that people can experience symptoms for many weeks and that some symptoms change over time. This study demonstrates that social media can offer novel insights into patient experiences as a source of real-world data. This inductive research approach can quickly generate descriptive information that can be used to develop hypotheses and new research questions. Also, the method allows rapid assessments of large numbers of social media conversations that could be applied to monitor public health for emerging and rapidly spreading diseases such as COVID-19.

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“…However, information on trials that are planned, ongoing, finished, or published are spread across trial registries, preprint servers, publication databases and other repositories. In June, 2020, the number of ongoing trials outweighed by far completed trials; however, no overview of COVID-19 trials has followed up on actual enrolment in ongoing trials [5][6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

The worldwide clinical trial research response to the COVID-19 pandemic - the first 100 days

et al. 2020

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Background: Never before have clinical trials drawn as much public attention as those testing interventions for COVID-19. We aimed to describe the worldwide COVID-19 clinical research response and its evolution over the first 100 days of the pandemic. Methods: Descriptive analysis of planned, ongoing or completed trials by April 9, 2020 testing any intervention to treat or prevent COVID-19, systematically identified in trial registries, preprint servers, and literature databases. A survey was conducted of all trials to assess their recruitment status up to July 6, 2020. Results: Most of the 689 trials (overall target sample size 396,366) were small (median sample size 120; interquartile range [IQR] 60-300) but randomized (75.8%; n=522) and were often conducted in China (51.1%; n=352) or the USA (11%; n=76). 525 trials (76.2%) planned to include 155,571 hospitalized patients, and 25 (3.6%) planned to include 96,821 health-care workers. Treatments were evaluated in 607 trials (88.1%), frequently antivirals (n=144) or antimalarials (n=112); 78 trials (11.3%) focused on prevention, including 14 vaccine trials. No trial investigated social distancing. Interventions tested in 11 trials with >5,000 participants were also tested in 169 smaller trials (median sample size 273; IQR 90-700). Hydroxychloroquine alone was investigated in 110 trials. While 414 trials (60.0%) expected completion in 2020, only 35 trials (4.1%; 3,071 participants) were completed by July 6. Of 112 trials with detailed recruitment information, 55 had recruited <20% of the targeted sample; 27 between 20-50%; and 30 over 50% (median 14.8% [IQR 2.0-62.0%]). Conclusions: The size and speed of the COVID-19 clinical trials agenda is unprecedented. However, most trials were small investigating a small fraction of treatment options. The feasibility of this research agenda is questionable, and many trials may end in futility, wasting research resources. Much better coordination is needed to respond to global health threats.

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Treatments Administered to the First 9152 Reported Cases of COVID-19: A Systematic Review

Cited by 50 publications

References 45 publications

Rationale for the use of N ‐acetylcysteine in both prevention and adjuvant therapy of COVID‐19

Rationale for the use of N ‐acetylcysteine in both prevention and adjuvant therapy of COVID‐19

Social Listening as a Rapid Approach to Collecting and Analyzing COVID-19 Symptoms and Disease Natural Histories Reported by Large Numbers of Individuals

The worldwide clinical trial research response to the COVID-19 pandemic - the first 100 days

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