Comparisons of treatment protocols for SARS-COV-2 in early pandemic: Single center experience ın Turkey

Öz

Objective: In this retrospective observational study, we aimed to investigate the COVID 19 treatment protocols applied in our hospital in terms of side effects and 28-day mortality. Methods: All 621 patients diagnosed as COVID-19 and treated with any drugs were included in the study. Inclusion criteria for patients were hospitalization with COVID-19 diagnosis and being over 18 years old. The patients were divided into 4 groups according to the treatments against COVID-19: Group 1 (only favipiravir), Group 2 (hydroxychloroquine (HQ)+ Azithromycin (AZ), Group 3 (only HQ), and Group 4 (HCQ+AZ +antibiotics). The gender, age, medications, underlying comorbidities, possible side effects due to the treatments (cardiotoxicity, hepatotoxicity, nephrotoxicity), and mortality rates were evaluated. Results: There was no difference in terms of side effects between treatment groups. Mortality rates were lowest in the HQ+AZ group. HCQ+AZ treatment was the most effective treatment protocol. Conclusion: It can be concluded from the study that the higher mortality rate due to favipiravir may be due to the administration of this drug only to critically ill patients during the initial period of the pandemic.

Anahtar Kelimeler

• COVID-19
• favipiravir
• hydroxychloroquine
• azithromycin
• antibiotics

Erken pandemide SARS-COV-2 tedavi protokollerinin karşılaştırılması: Türkiye'de tek merkez deneyimi

Öz

Amaç: Bu retrospektif gözlemsel çalışmada hastanemizde uygulanan COVID 19 tedavi protokollerini, yan etkileri ve 28 günlük mortaliteyi araştırmayı amaçladık. Yöntemler: Çalışmaya COVID-19 tanısı konan ve herhangi bir ilaçla tedavi edilen 621 hastanın tamamı dahil edildi. Hastalar için dahil edilme kriterleri COVID-19 tanısı ile hastaneye yatış ve 18 yaşından büyük olmaktı. Hastalar COVID-19 tedavisine göre 4 gruba ayrıldı: Grup 1 (sadece favipiravir), Grup 2 (hidroksiklorokin (HQ)+ Azitromisin (AZ), Grup 3 (sadece HQ) ve Grup 4 (HCQ+AZ) +antibiyotikler) Cinsiyet, yaş, ilaçlar, altta yatan komorbiditeler, tedavilere bağlı olası yan etkiler (kardiyotoksisite, hepatotoksisite, nefrotoksisite) ve mortalite oranları değerlendirildi. Bulgular: Tedavi grupları arasında yan etkiler açısından fark yoktu. Mortalite oranları HQ+AZ grubunda en düşüktü. HCQ+AZ tedavisi en etkili tedavi protokolüydü. Sonuç: Çalışmada, favipiravire bağlı daha yüksek ölüm oranının, pandeminin ilk döneminde bu ilacın sadece kritik hastalara uygulanmasına bağlı olabileceği sonucuna varılabilir.

Anahtar Kelimeler

• COVID-19
• favipiravir
• hidroksiklorokin
• azitromisin
• antibiyotikler

Kaynakça

1. 1. https://www.cdc.gov/coronavirus/2019-ncov/index.html [Accessed date: 01.March. 2021].
2. 2. Turkish Republic Ministry of Health Covid-19 Guideline (https://covid19bilgi.saglik.gov.tr/depo/rehberler/COVID-19_Rehberi.pdf) [Accessed date: 01.March. 2021].
3. 3. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/[Accessed date: 01.March. 2021].
4. 4. Sun J, Deng X, Chen X, et al. Incidence of Adverse Drug Reactions in COVID-19 Patients in China: An Active Monitoring Study by Hospital Pharmacovigilance System. Clin Pharmacol Ther. 2020;108(4):791-7.
5. 5. Md Insiat Islam Rabby. Current Drugs with Potential for Treatment of Covid-19: A Literature Review. J Pharm Pharm Sci. 2020;23(1):58–64. 6. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395(10229):1054-62. 7. Şener A. COVİD-19 (SARS COV-2) Tedavisi. J Biotechinol & Strategic Health Res. 2020; 4: 97-104.
6. 8. Arapović J, Skočibušić S. The first two months of the COVID-19 pandemic in Bosnia and Herzegovina: Single-center experience. Bosn J Basic Med Sci. 2020;20(3):396-400.
7. 9. Furuta Y, Komeno T, Nakamura T. Favipiravir (T-705), a broad spectrum inhibitor of viral RNA polymerase. Proc Jpn Acad Ser B Phys Biol Sci. 2017;93(7):449-63. 10. Joshi S, Parkar J, Ansari Aet al. Role of favipiravir in the treatment of COVID-19. Int J Infect Dis. 2021;102:501-8.
8. 11. Ghasemnejad-Berenji M, Pashapour S. Favipiravir and COVID-19: A Simplified Summary. Drug Res (Stuttg). 2021;71(3):166-70.

9. 12. Sreekanth Reddy O, Lai WF. Tackling COVID-19 Using Remdesivir and Favipiravir as Therapeutic Options. Chembiochem. 2021;22(6):939-48.
10. 13. Simonis A, Theobald SJ, Fätkenheuer G et al. A comparative analysis of remdesivir and other repurposed antivirals against SARS-CoV-2. EMBO Mol Med. 2021;13(1):e13105.
11. 14. İzci-Çetinkaya F, Karagöz H, Yıldız O. Comparison of liver safety of favipiravir and hydroxychloroquine in COVID-19 treatment. Klimik Derg 2020; 33(3): 235-40.
12. 15. Doğan E, Alkan-Çeviker S, Vurucu S, et al. [Investigation of the frequency of adverse effects in patients treated with favipiravir as SARS-CoV-2 treatment]. Klimik Derg. 2021; 34(2): 95-8.
13. 16. Wang M, Cao R, Zhang L, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020;30(3):269-71.
14. 17. Liu J, Cao R, Xu M, et al. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Cell Discov. 2020;6:16.
15. 18. Mutlu O, Uygun İ, Erden F. Koronavirüs Hastalığı (COVID-19) Tedavisinde Kullanılan İlaçlar. KOU Sag Bil Derg. 2020; 6(3): 167-73.
16. 19. Borba MGS, Val FFA, Sampaio VS, et al. Effect of high vs low doses of chloroquine diphosphate as adjunctive therapy for patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection: A randomized clinical trial. JAMA Netw Open. 2020; 3(4): e208857
17. 20. Gautret P, Lagier JC, Parola P, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020;56(1):105949. DOI: 10.1016/j.ijantimicag.2020.105949.
18. 21. Seyhan AU, Doganay F, Yilmaz E, et al. Investigation of QT Prolongation with Hydroxychloroquine and Azithromycin for the Treatment of COVID-19. J Coll Physicians Surg Pak. 2020;30(10):153-7.
19. 22. Gedikli MA, Tuzun B, Aktas, A et al. Are clarithromycin, azithromycin and their analogues effective in the treatment of COVID19? Bratisl Lek Listy. 2021;122(2):101-10.
20. 23. Réa-Neto Á, Bernardelli RS, Câmara BMD, et al. An open-label randomized controlled trial evaluating the efficacy of chloroquine/hydroxychloroquine in severe COVID-19 patients. Sci Rep. 2021;11(1):9023. DOI: 10.1038/s41598-021-88509-9.
21. 24. Wang M, Liao Z. SARS-CoV-2 and COVID-19: How much do we know? Acta Virol. 2020;64(3):288-96.