The Reply
2021; Elsevier BV; Volume: 134; Issue: 7 Linguagem: Inglês
10.1016/j.amjmed.2021.02.024
ISSN1555-7162
Autores Tópico(s)Health Promotion and Cardiovascular Prevention
ResumoDrs. Shamy and Dewar take exception to one out of the 4-6 drugs we utilize for the early ambulatory treatment of SARS-CoV-2 infection (COVID-19) illness.1McCullough PA Kelly RJ Ruocco G Lerma E Tumlin J Wheelan KR Katz N Lepor NE Vijay K Carter H Singh B McCullough SP Bhambi BK Palazzuoli A De Ferrari GM Milligan GP Safder T Tecson KM Wang DD McKinnon JE O'Neill WW Zervos M Risch HA. Pathophysiological Basis and Rationale for Early Outpatient Treatment of SARS-CoV-2 (COVID-19) Infection.Am J Med. 2021 Jan; 134 (Epub 2020 Aug 7. PMID:32771461PMCID: PMC7410805): 16-22https://doi.org/10.1016/j.amjmed.2020.07.003Abstract Full Text Full Text PDF PubMed Scopus (86) Google Scholar Hydroxychloroquine (HCQ) is one of five intracellular anti-infectives positioned in sequenced, multi-drug therapy for high-risk, early outpatient treatment.2Prodromos C Rumschlag T. Hydroxychloroquine is effective, and consistently so when provided early, for COVID-19: a systematic review.New Microbes New Infect. 2020 Nov; 38 (Epub 2020 Oct 5. PMID:33042552PMCID: PMC7534595)100776https://doi.org/10.1016/j.nmni.2020.100776Crossref PubMed Scopus (26) Google Scholar,3Ladapo J, McKinnon JE, McCullough PA, Risch H. Randomized Controlled Trials of Early Ambulatory Hydroxychloroquine in the Prevention of COVID-19 Infection, Hospitalization, and Death: Meta-Analysis doi: https://doi.org/10.1101/2020.09.30.20204693Google Scholar Each physician can use their individual judgment on the choice of drugs within the boxes. We expect that Shamy and Dewar would choose away from HCQ based on their viewpoint and utilize either ivermectin or favipiravir combined with azithromycin or doxycycline for that step. It is important to understand that anti-infectives play a partial role in treatment, and that the regimen additionally calls for nutraceuticals, corticosteroids, and anticoagulants. We have updated the algorithm since the time of the original publication in the Journal to include bamlanivimab, casirivimab and imdevimab, and ivermectin.4McCullough PA Alexander PE Armstrong R Arvinte C Bain AF Bartlett RP Berkowitz RL Berry AC Borody TJ Brewer JH Brufsky AM Clarke T Derwand R Eck A Eck J Eisner RA Fareed GC Farella A Fonseca SNS Geyer Jr, CE Gonnering RS Graves KE Gross KBV Hazan S Held KS Hight HT Immanuel S Jacobs MM Ladapo JA Lee LH Littell J Lozano I Mangat HS Marble B McKinnon JE Merritt LD Orient JM Oskoui R Pompan DC Procter BC Prodromos C Rajter JC Rajter JJ Ram CVS Rios SS Risch HA Robb MJA Rutherford M Scholz M Singleton MM Tumlin JA Tyson BM Urso RG Victory K Vliet EL Wax CM Wolkoff AG Wooll V Zelenko V. Multifaceted highly targeted sequential multidrug treatment of early ambulatory high-risk SARS-CoV-2 infection (COVID-19).Rev Cardiovasc Med. 2020 Dec 30; 21 (PMID:33387997): 517-530https://doi.org/10.31083/j.rcm.2020.04.264Crossref PubMed Google Scholar In the last several months, colchicine is now better supported by the Colchicine Coronavirus SARS-CoV2 Trial (COLCORONA) and inhaled budesonide has a stronger signal of benefit as shown in the STerOids in COVID-19 Study (STOIC) trial.5Efficacy of Colchicine in Non-Hospitalized Patients with COVID-19. Tardif JC, Bouabdallaoui N, L'Allier PL, Gaudet D, Shah B, Pillinger MH, Lopez-Sendon J, da Luz P, Verret L, Audet S, Dupuis J, Denault J, Pelletier M, Tessier PA, Samson S, Fortin D, Tardif JD, Busseuil D, Goulet E, Lacoste C, Dubois A, Joshi AY, Waters DD, Hsue P, Lepor NE, Lesage F, Sainturet N, Roy-Clavel E, Bassevitch, Orfanos A, Grégoire JC, Busque L, Lavallée C, Hétu PO, Paquette JS, Levesque S, Cossette M, Nozza A, Chabot-Blanchet M, Dubé MP, Guertin MC, Boivin G, for the COLCORONA Investigators medRxiv 2021.01.26.21250494; doi: https://doi.org/10.1101/2021.01.26.21250494Google Scholar,6Ramakrishnan S, Nicolau DV Jr., Langford B, Mahdi B, Jeffers H, Mwasuku C, Krassowska K, Fox R, Binnian I, Glover V, Bright S, Butler C, Cane JL, Halner A, Matthews PC, Donnelly LE, Simpson JL, Baker JR, Fadai NT, Peterson S, Bengtsson T, Barnes PJ, Russell REK, Bafadhel M. Inhaled budesonide in the treatment of early COVID-19 illness: a randomised controlled trial. medRxiv 2021.02.04.21251134; doi: https://doi.org/10.1101/2021.02.04.21251134Google Scholar Similar to cancer or other fatal illnesses where combination chemotherapy is deployed, we encourage and support Drs. Shamy and Dewar to find the multidrug treatment program that is best aligned with their clinical judgement and take immediate action to treat high-risk patients with COVID-19 in their community to reduce the risks of hospitalization and death. Real-world data suggest that ∼85% of COVID-19 hospitalizations and deaths are avoidable and thus the merits of early treatment far outweigh academic arguments concerning one drug in the regimen.7Derwand R Scholz M Zelenko V. COVID-19 outpatients: early risk-stratified treatment with zinc plus low-dose hydroxychloroquine and azithromycin: a retrospective case series study.Int J Antimicrob Agents. 2020 Dec; 56 (Epub 2020 Oct 26. PMID:33122096PMCID: PMC7587171)106214https://doi.org/10.1016/j.ijantimicag.2020.106214Crossref PubMed Scopus (66) Google Scholar,8Procter BC Ross C Pickard V Smith E Hanson C McCullough PA. Clinical outcomes after early ambulatory multidrug therapy for high-risk SARS-CoV-2 (COVID-19) infection.Rev Cardiovasc Med. 2020 Dec 30; 21 (PMID:33388006): 611-614https://doi.org/10.31083/j.rcm.2020.04.260Crossref PubMed Google Scholar,9Procter BC Ross C Pickard V Smith E Hanson C McCullough PA. Early Ambulatory Multidrug Therapy Reduces Hospitalization and Death in High-Risk Patients with SARS-CoV-2 (COVID-19).Authorea. January 07, 2021; https://doi.org/10.22541/au.161000355.54720791/v1Crossref Google Scholar
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