CMAAO Coronavirus Facts and Myth Buster: COVID Drugs Update

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With inputs from Dr Monica Vasudev

1007: Redefine cardiac injury marker cut-offs to predict 28 days mortality in COVID-19 inpatients

The abnormal cardiac biomarker pattern that is observed in patients with COVID-19 has a significant association with an increased risk of death. The cut-offs of these markers for effective prognosis of 28-day mortality of COVID-19 seems to be much lower than that for regular heart disease, at 49% of currently recommended thresholds, suggests a study published in Hypertension.

The biomarkers include high-sensitivity cardiac troponin I (hs-cTnI), creatine kinase-MB (CK-MB), NT-proB-type natriuretic peptide (NT-proBNP), creatine phosphokinase (CK) and myoglobin (MYO).

This retrospective cohort study included COVID-19 patients admitted to 9 hospitals in Hubei Province, China, between December 31, 2019, and March 4, 2020. In all, 3219 patients with myocardial biomarker measurement, and 2814 without were included. The primary endpoint was 28-day all-cause mortality.

In comparison with patients without cardiac injury biomarker measurement, those with biomarker values were older (median age 57) and also had higher percentages of pre-existing comorbidities and more severe symptoms. All five myocardial biomarkers appeared to have a significant correlation with 28-day all-cause death of COVID-19.

Adjusting for age, gender and comorbidities including hypertension, diabetes, coronary heart disease and cerebrovascular disease, revealed the 28-day mortality hazard ratio for hs-cTnI as 7.12, NT-proBNP as 5.11, CK-MB as 4.86, MYO as 4.50, and CK, as 3.56. CK was a much less specific biomarker.

In patients showing cardiac injury during the entire hospitalization, neutrophil percentage and CRP demonstrated a rapid and simultaneous elevation after disease onset, immediately followed by the increased CK-MB, MYO, and hs-cTnI.

There was a significant elevation of IL-6 only after the increases of these myocardial markers and was highly increased mainly in patients with cardiac injury. [DG Alerts]

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

Two drugs better than one in severe flu: Time for CMAAO countries to use Favipiavir

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The addition of the drug Favipiavir effective in the treatment of Ebola and Nipah. Favipiavir in the treatment of severe influenza virus infections can save lives. Its time for the DCGI to approve this drug and Indian Pharma companies to launch it in India and neighboring countries. India is already introducing the EBOLA awareness program in the country.

Taking two antivirals ― favipiravir (Avigan, Toyama Chemical) and oseltamivir are more effective for treating severe influenza than taking oseltamivir alone, according to a comparison of results from two clinical trials published online December 11 in the Journal of Infectious Diseases.

Each year, approximately 300,000 to 650,000 people die from seasonal influenza. The only drug oseltamivir, is of limited use, and its efficacy for severe cases has not been adequately studied. Adding an antiviral that works by a different mechanism might boost effectiveness, especially for the most compromised patients.

Favipiravir works differently from oseltamivir, targeting a viral RNA polymerase rather than the neuraminidase. The patients received oseltamivir 75 mg for 10 days and either of two regimens of favipiravir (1600 mg BID on day 1 and 600 mg BID on days 2 to 10, or 1800 mg BID on day 1 and 800 mg BID on days 2 to 10).

On day 14, clinical improvement was greater among the patients who received both drugs. In addition, the proportion of patients with undetectable viral RNA at day 10 was higher in the combination group than in the monotherapy group.

[Source Medscape]

Dr KK Aggarwal

Padma Shri Awardee

President Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

New drugs for heart failure

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Heart failure and reduced ejection fraction (HFrEF) now has two new drugs

  1. Sacubitril/Valsartan
  2. Sodium-glucose cotransporter 2 (SGLT2) inhibitors

In the DAPA-HF trial, treatment with the SGLT2 inhibitor dapagliflozin on top of standard HFrEF medicines, compared with standard medicines only, led to significantly improved risk not only for its clinical composite primary endpoint, but for mortality and a slew of other meaningful secondary outcomes.

The benefits are not mediated by the well-recognized antiglycemic effects of the SGLT2 inhibitor.

DAPA-HF entered more than 4700 patients with HFrEF without regard to their diabetes status.

Patients assigned to receive dapagliflozin on top of standard HFrEF medicines showed at least a one-fourth drop in risk of the clinical primary endpoint compared with those on standard medicines alone over a median of 18 months — also regardless of diabetes status.

The drug had also been shown, in the recent DEFINE-HF trial, to improve symptoms and quality of life in a similar HF population, again in patients with or without diabetes.

SGLT2 inhibitor benefits for HF endpoints in patients who primarily have diabetes have already been established.

(Source: American Heart Association (AHA) Scientific Sessions 2019)

Dr KK Aggarwal

Padma Shri Awardee

President Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

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