Early Start of Oral Clarithromycin Is Associated with Better Outcome in COVID-19 of Moderate Severity: The ACHIEVE Open-Label Single-Arm Trial.

Autor: Tsiakos K; 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece., Tsakiris A; 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece., Tsibris G; 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece., Voutsinas PM; 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece., Panagopoulos P; 2nd Department of Internal Medicine, Medical School, Democritus University of Thrace, 681 00, Alexandroupolis, Greece., Kosmidou M; 1st Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Ioannina, 455 00, Ioannina, Greece., Petrakis V; 2nd Department of Internal Medicine, Medical School, Democritus University of Thrace, 681 00, Alexandroupolis, Greece., Gravvani A; 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece., Gkavogianni T; 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece., Klouras E; 1st Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Ioannina, 455 00, Ioannina, Greece., Katrini K; 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece., Koufargyris P; 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece., Rapti I; 1st Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Ioannina, 455 00, Ioannina, Greece., Karageorgos A; 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece., Vrentzos E; 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece., Damoulari C; 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece., Zarkada V; 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece., Sidiropoulou C; 2nd Department of Internal Medicine, Tzaneion General Hospital of Piraeus, Piraeus, Greece., Artemi S; 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece., Ioannidis A; Department of Nursing, Faculty of Health Sciences, University of Peloponnese, Tripoli, Greece., Papapostolou A; 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece., Michelakis E; 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece., Georgiopoulou M; 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece., Myrodia DM; 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece., Tsiamalos P; 2nd Department of Internal Medicine, Tzaneion General Hospital of Piraeus, Piraeus, Greece., Syrigos K; 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece., Chrysos G; 2nd Department of Internal Medicine, Tzaneion General Hospital of Piraeus, Piraeus, Greece., Nitsotolis T; 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece., Milionis H; 1st Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Ioannina, 455 00, Ioannina, Greece., Poulakou G; 3rd Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece., Giamarellos-Bourboulis EJ; 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, ATTIKON University General Hospital, 1 Rimini Street, 124 62, Athens, Greece. egiamarel@med.uoa.gr.
Jazyk: angličtina
Zdroj: Infectious diseases and therapy [Infect Dis Ther] 2021 Dec; Vol. 10 (4), pp. 2333-2351. Date of Electronic Publication: 2021 Aug 06.
DOI: 10.1007/s40121-021-00505-8
Abstrakt: Introduction: The anti-inflammatory effect of macrolides prompted the study of oral clarithromycin in moderate COVID-19.
Methods: An open-label non-randomized trial in 90 patients with COVID-19 of moderate severity was conducted between May and October 2020. The primary endpoint was defined at the end of treatment (EOT) as no need for hospital re-admission and no progression into lower respiratory tract infection (LRTI) for patients with upper respiratory tract infection and as at least 50% decrease of the respiratory symptoms score without progression into severe respiratory failure (SRF) for patients with LRTI. Viral load, biomarkers, the function of mononuclear cells and safety were assessed.
Results: The primary endpoint was attained in 86.7% of patients treated with clarithromycin (95% CIs 78.1-92.2%); this was 91.7% and 81.4% among patients starting clarithromycin the first 5 days from symptoms onset or later (odds ratio after multivariate analysis 6.62; p 0.030). The responses were better for patients infected by non-B1.1 variants. Clarithromycin use was associated with decreases in circulating C-reactive protein, tumour necrosis factor-alpha and interleukin (IL)-6; by increase of production of interferon-gamma and decrease of production of interleukin-6 by mononuclear cells; and by suppression of SARS-CoV-2 viral load. No safety concerns were reported.
Conclusions: Early clarithromycin treatment provides most of the clinical improvement in moderate COVID-19.
Trial Registration: ClinicalTrials.gov, NCT04398004.
(© 2021. The Author(s).)
Databáze: MEDLINE
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