The European respiratory journal. Supplement最新文献

{"title":"The paradox of pulmonary arterial hypertension in Italy in the COVID-19 era: is risk of disease progression around the corner?","authors":"R. Badagliacca, S. Papa, M. D'alto, S. Ghio, P. Agostoni, P. Ameri, P. Argiento, N. Brunetti, V. Casamassima, G. Casu, N. Cedrone, M. Confalonieri, M. Corda, M. Correale, C. D'Agostino, L. De Michele, G. Famoso, G. Galgano, A. Greco, C. Lombardi, G. Manzi, R. Madonna, V. Mercurio, M. Mulé, G. Paciocco, A. Romaniello, E. Romeo, L. Scelsi, W. Serra, D. Stolfo, M. Toma, M. Vatrano, P. Vitulo, C. Vizza","doi":"10.1183/13993003.02276-2021","DOIUrl":"https://doi.org/10.1183/13993003.02276-2021","url":null,"abstract":"Objective The coronavirus disease 2019 (COVID-19) outbreak has led to significant restrictions on routine medical care. We conducted a multicentre nationwide survey of patients with pulmonary arterial hypertension (PAH) to determine the consequences of governance measures on PAH management and risk of poor outcome in patients with COVID-19. Materials and methods The present study, which included 25 Italian centres, considered demographic data, the number of in-person visits, 6-min walk and echocardiographic test results, brain natriuretic peptide/N-terminal pro-brain natriuretic peptide test results, World Health Organization functional class assessment, presence of elective and non-elective hospitalisation, need for treatment escalation/initiation, newly diagnosed PAH, incidence of COVID-19 and mortality rates. Data were collected, double-checked and tracked by institutional records between March 1 and May 1, 2020, to coincide with the first peak of COVID-19 and compared with the same time period in 2019. Results Among 1922 PAH patients, the incidences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 were 1.0% and 0.46%, respectively, with the latter comparable to that in the overall Italian population (0.34%) but associated with 100% mortality. Less systematic activities were converted into more effective remote interfacing between clinicians and PAH patients, resulting in lower rates of hospitalisation (1.2% versus 1.9%) and related death (0.3% versus 0.5%) compared with 2019 (p<0.001). A high level of attention is needed to avoid the potential risk of disease progression related to less aggressive escalation of treatment and the reduction in new PAH diagnoses compared with 2019. Conclusion A cohesive partnership between healthcare providers and regional public health officials is needed to prioritise PAH patients for remote monitoring by dedicated tools. COVID-19 showed low incidence among PAH patients, but high mortality rates. A high level of attention is needed to avoid the potential risk of disease progression in the near future. https://bit.ly/3s1lEYM","PeriodicalId":77419,"journal":{"name":"The European respiratory journal. Supplement","volume":"08 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90202300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fraction of exhaled nitric oxide is associated with disease burden in the German Asthma Net severe asthma cohort","authors":"C. Bal, M. Idzko, S. Škrgat, A. Koch, K. Milger, C. Schulz, S. Zehetmayer, E. Hamelmann, R. Buhl, S. Korn","doi":"10.1183/13993003.01233-2021","DOIUrl":"https://doi.org/10.1183/13993003.01233-2021","url":null,"abstract":"The fraction of exhaled nitric oxide (FENO) is a biomarker for type 2 asthma, reflecting the degree of local pulmonary inflammation linked to immune pathways, including interleukin (IL)-13 [1]. In clinical practice, FENO is a reliable marker for inhaled corticosteroid (ICS) responsiveness [2] and the efficacy of biological therapies, such as those targeting IL-4/IL-13 pathways [3, 4], as well as the detection of steroid nonadherence or resistance in severe asthma [2]. The prospective Severe Asthma Registry of the German Asthma Net (GAN) enrols patients with severe asthma for in-depth assessment of phenotypes, underlying mechanisms and therapeutic strategies; GAN has been approved by respective ethics committees, with all included patients having signed informed consent [5]. Prior studies of FENO either included patients with asthma of any severity [6] or did not involve a comprehensive analysis in a large cohort [7]. We therefore used cross-sectional data from GAN to determine the correlation of FENO with epidemiological, laboratory, clinical, lung function, or quality of life parameters and the need for oral corticosteroid (OCS) maintenance therapy in a carefully selected severe asthma cohort to better characterise the severe asthma subtype with high FENO values. In a severe asthma cohort of 1007 patients, high FENO was associated with chronic rhinosinusitis/polyps, later asthma onset, poor lung function and asthma control, low quality of life, frequent exacerbations and the need for maintenance OCS. #GANregistry https://bit.ly/3sNrtIQ","PeriodicalId":77419,"journal":{"name":"The European respiratory journal. Supplement","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76136544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality after admission with pneumonia is higher than after admission with an exacerbation of COPD","authors":"J. Vestbo, G. Waterer, D. Leather, C. Crim, N. Diar Bakerly, L. Frith, L. Jacques, C. Harvey, I. Satia, A. Woodcock","doi":"10.1183/13993003.02899-2021","DOIUrl":"https://doi.org/10.1183/13993003.02899-2021","url":null,"abstract":"Patients with COPD often experience exacerbations and pneumonia that are occasionally severe and lead to hospital admission [1–3]. The risk of pneumonia is further increased by treatment with inhaled corticosteroids (ICS) [4–6]. Although potentially difficult to distinguish [7], there could be differences in the risk of death associated with these events that need to be taken into account when planning management and clinical follow-up. The Salford Lung Study was set up to evaluate the effectiveness and safety of the once-daily inhaled combination of fluticasone furoate and vilanterol (FF/VI; in ELLIPTA dry powder inhaler) compared with existing maintenance therapy (usual care) in a large, real-world population of patients with COPD in conditions of normal care [8]. Strengths of the study include the relatively unselected patient population, the completeness of follow-up using a joint electronic record system and the fact that all patients were provided usual standard of care for their exacerbations and during admissions. We used this study database to examine mortality after an admission with a severe exacerbation or pneumonia, and the impact of classification of these events. Mortality after an admission for pneumonia is considerably higher than for an admission for an exacerbation in COPD patients recruited from usual clinical practice. A proper diagnosis in acute worsenings of symptoms in COPD is therefore important. https://bit.ly/3LyhnnC","PeriodicalId":77419,"journal":{"name":"The European respiratory journal. Supplement","volume":"47 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83138169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inspiratory muscle training enhances recovery post-COVID-19: a randomised controlled trial","authors":"M. McNarry, R. Berg, J. Shelley, J. Hudson, Z. Saynor, J. Duckers, K. Lewis, Gwyneth A. Davies, K. Mackintosh","doi":"10.1183/13993003.03101-2021","DOIUrl":"https://doi.org/10.1183/13993003.03101-2021","url":null,"abstract":"Background Many people recovering from coronavirus disease 2019 (COVID-19) experience prolonged symptoms, particularly breathlessness. We urgently need to identify safe and effective COVID-19 rehabilitative strategies. The aim of the current study was to investigate the potential rehabilitative role of inspiratory muscle training (IMT). Methods 281 adults (age 46.6±12.2 years; 88% female) recovering from self-reported COVID-19 (9.0±4.2 months post-acute infection) were randomised 4:1 to an 8-week IMT or a “usual care” waitlist control arm. Health-related quality-of-life and breathlessness questionnaires (King's Brief Interstitial Lung Disease (K-BILD) and Transition Dyspnoea Index (TDI)), respiratory muscle strength, and fitness (Chester Step Test) were assessed pre- and post-intervention. The primary end-point was K-BILD total score, with the K-BILD domains and TDI being key secondary outcomes. Results According to intention to treat, there was no difference between groups in K-BILD total score post-intervention (control: 59.5±12.4; IMT: 58.2±12.3; p<0.05) but IMT elicited clinically meaningful improvements in the K-BILD domains for breathlessness (control: 59.8±12.6; IMT: 62.2±16.2; p<0.05) and chest symptoms (control: 59.2±18.7; IMT: 64.5±18.2; p<0.05), along with clinically meaningful improvements in breathlessness according to TDI (control: 0.9±1.7 versus 2.0±2.0; p<0.05). IMT also improved respiratory muscle strength and estimated aerobic fitness. Conclusions IMT may represent an important home-based rehabilitation strategy for wider implementation as part of COVID-19 rehabilitative strategies. Given the diverse nature of long COVID, further research is warranted on the individual responses to rehabilitation; the withdrawal rate herein highlights that no one strategy is likely to be appropriate for all. IMT can significantly improve breathlessness and respiratory muscle function in people with long COVID, and represents an effective, home-based rehabilitation strategy that could be widely implemented as part of COVID-19 recovery strategies https://bit.ly/3HiEyz0","PeriodicalId":77419,"journal":{"name":"The European respiratory journal. Supplement","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82941426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A longitudinal analysis of pneumococcal vaccine serotypes in pneumonia patients in Germany","authors":"C. Bahrs, M. Kesselmeier, M. Kolditz, S. Ewig, G. Rohde, G. Barten-Neiner, J. Rupp, M. Witzenrath, T. Welte, M. W. Pletz","doi":"10.1101/2021.10.07.21264682","DOIUrl":"https://doi.org/10.1101/2021.10.07.21264682","url":null,"abstract":"Pneumococcal infections are globally the most frequent vaccine-preventable cause of death [1], and community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae is the main burden of pneumococcal disease in the elderly [2]. Since respiratory and blood cultures often remain negative in hospitalised patients with pneumococcal CAP due to prior antibiotic treatment, most cases are detected by the pneumococcal urinary antigen test (PUAT; BinaxNOW S. pneumoniae) [2, 3]. As the PUAT does not allow serotype discrimination, data on serotype distribution in adult non-bacteraemic pneumococcal CAP patients are sparse [4]. In Germany, the recently approved 20-valent pneumococcal conjugate vaccine had a substantially higher coverage against pneumonia in adults than the 13-valent vaccine, while the coverage gap compared to the 23-valent polysaccharide vaccine was small https://bit.ly/3q4skov","PeriodicalId":77419,"journal":{"name":"The European respiratory journal. Supplement","volume":"71 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74363511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung function from school age to adulthood in primary ciliary dyskinesia","authors":"F. Halbeisen, E. Pedersen, M. Goutaki, B. Spycher, I. Amirav, M. Boon, M. Cohen-Cymberknoh, S. Crowley, N. Emiralioğlu, E. Haarman, B. Karadag, C. Koerner-Rettberg, P. Latzin, M. Loebinger, J. Lucas, H. Mazurek, L. Morgan, June K. Marthin, P. Pohunek, F. Santamaria, N. Schwerk, G. Thouvenin, P. Yiallouros, K. Nielsen, C. Kuehni","doi":"10.1101/2021.07.08.21260172","DOIUrl":"https://doi.org/10.1101/2021.07.08.21260172","url":null,"abstract":"Primary ciliary dyskinesia (PCD) presents with symptoms early in life and the disease course may be progressive, but longitudinal data on lung function are scarce. This multinational cohort study describes lung function trajectories in children, adolescents and young adults with PCD. We analysed data from 486 patients with repeated lung function measurements obtained between the age of 6 and 24 years from the International PCD Cohort and calculated z-scores for forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio using the Global Lung Function Initiative 2012 references. We described baseline lung function and change of lung function over time and described their associations with possible determinants in mixed-effects linear regression models. Overall, FEV1, FVC and FEV1/FVC z-scores declined over time (average crude annual FEV1 decline was −0.07 z-scores), but not at the same rate for all patients. FEV1 z-scores improved over time in 21% of patients, remained stable in 40% and declined in 39%. Low body mass index was associated with poor baseline lung function and with further decline. Results differed by country and ultrastructural defect, but we found no evidence of differences by sex, calendar year of diagnosis, age at diagnosis, diagnostic certainty or laterality defect. Our study shows that on average lung function in PCD declines throughout the entire period of lung growth, from childhood to young adult age, even among patients treated in specialised centres. It is essential to develop strategies to reverse this tendency and improve prognosis. Lung function in children with PCD is reduced by the age of 6 years and further declines during the growth period. It is essential to develop strategies to improve prognosis. https://bit.ly/34EBekm","PeriodicalId":77419,"journal":{"name":"The European respiratory journal. Supplement","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84418681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term exposure to low-level air pollution and incidence of asthma: the ELAPSE project.","authors":"Shuo Liu, J. Jørgensen, P. Ljungman, Göran Pershagen, T. Bellander, K. Leander, P. Magnusson, D. Rizzuto, U. Hvidtfeldt, O. Raaschou-Nielsen, K. Wolf, Barbara Hoffmann, Bert Brunekreef, M. Strak, Jie Chen, Amar Mehta, Richard W Atkinson, M. Bauwelinck, R. Varraso, M. Boutron‐Ruault, J. Brandt, G. Cesaroni, F. Forastiere, D. Fecht, J. Gulliver, Ole Hertel, K. de Hoogh, N. Janssen, K. Katsouyanni, M. Ketzel, J. Klompmaker, G. Nagel, B. Oftedal, A. Peters, A. Tjønneland, Sophia Rodopoulou, E. Samoli, D. T. Kristoffersen, T. Sigsgaard, M. Stafoggia, D. Vienneau, G. Weinmayr, Gerard Hoek, Z. Andersen","doi":"10.1183/13993003.030992020","DOIUrl":"https://doi.org/10.1183/13993003.030992020","url":null,"abstract":"BACKGROUND\u0000Long-term exposure to ambient air pollution has been linked to childhood-onset asthma, while evidence is still insufficient. Within the multicentre project \"Effects of Low-Level Air Pollution: A Study in Europe\" (ELAPSE), we examined the associations of long-term exposures to particulate matter with diameter<2.5 µm (PM2.5), nitrogen dioxide (NO2), and black carbon (BC) with asthma incidence in adults.\u0000\u0000\u0000METHODS\u0000We pooled data from three cohorts in Denmark and Sweden with information on asthma hospital diagnoses. The average concentrations of air pollutants in 2010 were modelled by hybrid land use regression models at participants' baseline residential addresses. Associations of air pollution exposures with asthma incidence were explored with Cox proportional hazard models, adjusting for potential confounders.\u0000\u0000\u0000RESULTS\u0000Of 98 326 participants, 1965 developed asthma during a 16.6 years mean follow-up. We observed associations in fully adjusted models with hazard ratios and 95% confidence intervals of 1.22 (1.04-1.43) per 5 μg·m-3 for PM2.5, 1.17 (1.10-1.25) per 10 µg·m-3 for NO2, and 1.15 (1.08-1.23) per 0.5 10-5 m-1 for BC. Hazard ratios were larger in cohort subsets with exposure levels below the EU and US limit values and possibly WHO guidelines for PM2.5 and NO2. NO2 and BC estimates remained unchanged in two-pollutant models with PM2.5, whereas PM2.5 estimates were attenuated to unity. The concentration response curves showed no evidence of a threshold.\u0000\u0000\u0000CONCLUSIONS\u0000Long-term exposure to air pollution, especially from fossil fuel combustion sources such as motorised traffic, was associated with adult-onset asthma, even at levels below the current limit values.","PeriodicalId":77419,"journal":{"name":"The European respiratory journal. Supplement","volume":"170 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73646674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The burden of progressive fibrotic interstitial lung disease across the UK","authors":"T. Simpson, S. Barratt, P. Beirne, N. Chaudhuri, A. Crawshaw, Louise E. Crowley, S. Fletcher, M. Gibbons, Philippa Hallchurch, L. Horgan, I. Jakaityte, Thomas Lewis, T. Mclellan, K. Myall, Ryan Miller, David J F Smith, S. Stanel, M. Thillai, Fiona Thompson, T. Wallis, Zhe Wu, P. Molyneaux, A. West","doi":"10.1101/2020.11.16.20229591","DOIUrl":"https://doi.org/10.1101/2020.11.16.20229591","url":null,"abstract":"While idiopathic pulmonary fibrosis (IPF) remains the exemplar progressive fibrotic lung disease, there remains a cohort of non-IPF fibrotic lung diseases (fILD) which adopt a similar clinical behaviour to IPF despite therapy [1]. This phenotypically related group of conditions, where progression of disease is similar to that seen in IPF, have recently been described as progressive fibrotic interstitial lung diseases (PF-ILD) [2]. Historically, treatments for these cases have been limited though given the phenotypic similarities many cases may have been given a multidisciplinary working diagnosis of IPF based on their disease behaviour [3]. The INBUILD trial broadened the scope of treatable fILD by demonstrating a significant benefit of Nintedanib in patients with fILD and progressive disease [4]. In response to this the European Commission approved an additional indication for nintedanib in adults for the treatment of PF-ILD in July 2020. Almost 15% of new referrals with non-IPF fibrotic ILD go on to develop a progressive fibrotic phenotype and would benefit from antifibrotic therapy https://bit.ly/3uPhClN","PeriodicalId":77419,"journal":{"name":"The European respiratory journal. Supplement","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73280467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Profiling of lung SARS-CoV-2 and influenza virus infection dissects virus-specific host responses and gene signatures","authors":"A. Kulasinghe, Chin Wee Tan, Anna Flavia Ribeiro dos Santos Miggiolaro, J. Monkman, H. Sadeghirad, Dharmesh D. Bhuva, Jarbas da Silva Motta Junior, Caroline Busatta Vaz de Paula, Seigo Nagashima, C. Baena, Paulo Souza-Fonseca-Guimaraes, L. de Noronha, T. Mcculloch, G. Rossi, C. Cooper, B. Tang, K. R. Short, Melissa J. Davis, F. Souza-Fonseca-Guimaraes, G. Belz, K. O'Byrne","doi":"10.1101/2020.11.04.20225557","DOIUrl":"https://doi.org/10.1101/2020.11.04.20225557","url":null,"abstract":"Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which emerged in late 2019 has spread globally, causing a pandemic of respiratory illness designated coronavirus disease 2019 (COVID-19). A better definition of the pulmonary host response to SARS-CoV-2 infection is required to understand viral pathogenesis and to validate putative COVID-19 biomarkers that have been proposed in clinical studies. Methods Here, we use targeted transcriptomics of formalin-fixed paraffin-embedded tissue using the NanoString GeoMX platform to generate an in-depth picture of the pulmonary transcriptional landscape of COVID-19, pandemic H1N1 influenza and uninfected control patients. Results Host transcriptomics showed a significant upregulation of genes associated with inflammation, type I interferon production, coagulation and angiogenesis in the lungs of COVID-19 patients compared to non-infected controls. SARS-CoV-2 was non-uniformly distributed in lungs (emphasising the advantages of spatial transcriptomics) with the areas of high viral load associated with an increased type I interferon response. Once the dominant cell type present in the sample, within patient correlations and patient–patient variation, had been controlled for, only a very limited number of genes were differentially expressed between the lungs of fatal influenza and COVID-19 patients. Strikingly, the interferon-associated gene IFI27, previously identified as a useful blood biomarker to differentiate bacterial and viral lung infections, was significantly upregulated in the lungs of COVID-19 patients compared to patients with influenza. Conclusion Collectively, these data demonstrate that spatial transcriptomics is a powerful tool to identify novel gene signatures within tissues, offering new insights into the pathogenesis of SARS-COV-2 to aid in patient triage and treatment. Spatial transcriptomics revealed a significant upregulation of genes associated with inflammation, type 1 interferon production, coagulation and angiogenesis in the lungs of COVID-19 patients compared to non-infected controls https://bit.ly/30k9or0","PeriodicalId":77419,"journal":{"name":"The European respiratory journal. Supplement","volume":"214 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76547802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early use of nitazoxanide in mild COVID-19 disease: randomised, placebo-controlled trial","authors":"P. Rocco, P. Silva, F. Cruz, Marco Antonio C. Melo-Junior, P. Tierno, Marcos A. Moura, Luís Frederico G. De Oliveira, Cristiano C. Lima, Ezequiel A. Dos Santos, W. F. Júnior, A. Fernandes, K. Franchini, Erick Magri, N. F. de Moraes, José Mário J. Gonçalves, Melanie N. Carbonieri, Ivonise S. Dos Santos, N. F. Paes, Paula V.M. Maciel, R. P. Rocha, A. D. de Carvalho, P. Alves, J. Proença-Módena, A. Cordeiro, D. Trivella, R. E. Marques, R. Luiz, P. Pelosi, J. R. Lapa e Silva","doi":"10.1101/2020.10.21.20217208","DOIUrl":"https://doi.org/10.1101/2020.10.21.20217208","url":null,"abstract":"Background Nitazoxanide is widely available and exerts broad-spectrum antiviral activity in vitro. However, there is no evidence of its impact on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods In a multicentre, randomised, double-blind, placebo-controlled trial, adult patients presenting up to 3 days after onset of coronavirus disease 2019 (COVID-19) symptoms (dry cough, fever and/or fatigue) were enrolled. After confirmation of SARS-CoV-2 infection using reverse transcriptase PCR on a nasopharyngeal swab, patients were randomised 1:1 to receive either nitazoxanide (500 mg) or placebo, three times daily, for 5 days. The primary outcome was complete resolution of symptoms. Secondary outcomes were viral load, laboratory tests, serum biomarkers of inflammation and hospitalisation rate. Adverse events were also assessed. Results From June 8 to August 20, 2020, 1575 patients were screened. Of these, 392 (198 placebo, 194 nitazoxanide) were analysed. Median (interquartile range) time from symptom onset to first dose of study drug was 5 (4–5) days. At the 5-day study visit, symptom resolution did not differ between the nitazoxanide and placebo arms. Swabs collected were negative for SARS-CoV-2 in 29.9% of patients in the nitazoxanide arm versus 18.2% in the placebo arm (p=0.009). Viral load was reduced after nitazoxanide compared to placebo (p=0.006). The percentage viral load reduction from onset to end of therapy was higher with nitazoxanide (55%) than placebo (45%) (p=0.013). Other secondary outcomes were not significantly different. No serious adverse events were observed. Conclusions In patients with mild COVID-19, symptom resolution did not differ between nitazoxanide and placebo groups after 5 days of therapy. However, early nitazoxanide therapy was safe and reduced viral load significantly. This was the first study to evaluate the effect of early nitazoxanide therapy in mild COVID-19. Nitazoxanide did not accelerate symptom resolution after 5 days of therapy, but did reduce viral load significantly with no serious adverse events. https://bit.ly/37i75pr","PeriodicalId":77419,"journal":{"name":"The European respiratory journal. Supplement","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88793855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}