Retrospective Evaluation of COVID-19 Therapeutics

Abstract

Background: The pandemic outbreak of COVID-19 created panic all over the world. As therapeutics that can effectively wipe out the virus and terminate transmission is not available, supportive therapeutics is the main clinical treatments for COVID-19. Repurposing available therapeutics from other viral infections is the primary surrogate in ameliorating and treating COVID-19. The therapeutics should be tailored individually by analyzing the severity of COVID-19, age, gender, and the underlying conditions. Here, we retrospectively revisit the clinical data collected in China and systematically analyze the efficacy and target patients of different therapeutics and find that Arbidol and Traditional Chinese Medicine (TCM) increase the survival rate significantly, whereas antibacterial treatment is ineffective for viral and bacterial co infection. Multicenter collaboration and large cohort of patients will be required to evaluate therapeutics combinations in the future. Methods: This study is a single-center retrospective observational study of COVID-19 clinical data in China. We screen 2844 COVID-19 patients from the patients admitted to Tongji Hospital (Wuhan) between January 18, 2020, and April 25, 2020 and exclude cases with missing information or false positive diagnosis. Then the patients’ information with different severity will be study to evaluate the efficacy of treatment, including treatment modalities, past medical records, individual disease history, and clinical outcomes were analyzed. As the severity of illness is correlated with laboratory or clinical data, the information can be used to evaluate disease severity. We divide the patients into three groups with moderate, severe, and critical illness. Kaplan-Meier method, univariate and multivariate Cox regression are used to explore different treatment methods on clinical outcomes. Results: After screening, 2844 patients are selected for the study. The mean age of all the patients was 58.74 years (Standard Deviation, SD =15.28), and 49.0% is male. It shows that treatment with TCM (Hazard Ratio (HR) 0.191 [95% Confidence Interval (CI), 0.14 – 0.25]; p < 0.0001), antiviral therapy (HR 0.331 [95% CI 0.19 – 0.58]; p =0.000128), or Arbidol (HR 0.454 [95% CI 0.34 – 0.60]; p < 0.0001) is associated with good prognostic of patients. Multivariate Cox regression showed TCM treatment decreased the mortality hazard ratio by 69.4% (p < 0.0001). Larger Mean Platelet Volume (MPV), international standardized ratio of prothrombin (PT-INR), and K+ are associated with poorer survival. In contrast, larger Eosinophil Count (Eos#), Basophil Count (Baso#), Percentage of Basophils (Baso%), Total Calcium (Ca), Albumin/Globulin Ratio (ALB/GLO), Lymphocyte Count (Lymph#), and Percentage of Eosinophils (Eos%) are associated with better survival.