Use of Ivermectin Is Associated With Lower Mortality in Hospitalized Patients With Coronavirus Disease 2019: The Ivermectin in COVID Nineteen Study.
Use of Ivermectin Is Associated With Lower Mortality in Hospitalized Patients With Coronavirus Disease 2019: The Ivermectin in COVID Nineteen Study.
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DOI：
10.1016/j.chest.2020.10.009
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发表时间：
2021-01
期刊：
影响因子：
9.6
通讯作者：
Rajter JJ
中科院分区：
文献类型：
--
作者：
Rajter JC;Sherman MS;Fatteh N;Vogel F;Sacks J;Rajter JJ
伊维菌素在体外被证明可以抑制严重急性呼吸综合征冠状病毒2型的复制，这导致了超说明书使用，但临床疗效以前没有描述过。伊维菌素是否有益于住院的2019冠状病毒病（COVID-19）患者？审查了2020年3月15日至5月11日期间在佛罗里达的四家布劳沃德健康医院住院的确诊COVID-19的连续患者的图表，这些患者接受或不接受伊维菌素治疗。提供了医院伊维菌素给药指南，但治疗决定由治疗医生决定。主要结局为全因住院死亡率。次要结果包括严重肺部受累患者的死亡率、机械通气患者的拔管率和住院时间。重度肺部受累定义为入组研究时需要Fio 2 ≥ 50%、无创通气或有创通气。Logistic回归和倾向评分匹配用于调整混杂因素。280例患者，173例伊维菌素治疗和107没有伊维菌素，进行了审查。两组中的大多数患者还接受了羟氯喹、阿奇霉素或两者兼而有之。单变量分析显示伊维菌素组的死亡率较低（15.0% vs 25.2%; OR，0.52; 95% CI，0.29-0.96; P = 0.03）。伊维菌素治疗的严重肺部受累患者的死亡率也较低（38.8% vs 80.7%; OR，0.15; 95% CI，0.05-0.47; P = .001）。拔管率（36.1% vs 15.4%; OR，3.11; 95% CI，0.88-11.00; P = 0.07）或住院时间无显著差异。在对混杂因素和死亡风险进行多变量校正后，死亡率差异仍然显著（OR，0.27; 95%CI，0.09-0.80; P = 0.03）。196例患者被纳入倾向匹配队列。伊维菌素组的死亡率显著降低（13.3% vs 24.5%; OR，0.47; 95%CI，0.22-0.99; P <0.05），绝对风险降低11.2%（95%CI，0.38%-22.1%），需要治疗的人数为8.9（95%CI，4.5-263）。伊维菌素治疗与COVID-19治疗期间较低的死亡率相关，特别是在严重肺部受累的患者中。需要随机对照试验来证实这些发现。
Ivermectin was shown to inhibit severe acute respiratory syndrome coronavirus 2 replication in vitro, which has led to off-label use, but clinical efficacy has not been described previously. Does ivermectin benefit hospitalized coronavirus disease 2019 (COVID-19) patients? Charts of consecutive patients hospitalized at four Broward Health hospitals in Florida with confirmed COVID-19 between March 15 and May 11, 2020, treated with or without ivermectin were reviewed. Hospital ivermectin dosing guidelines were provided, but treatment decisions were at the treating physician’s discretion. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included mortality in patients with severe pulmonary involvement, extubation rates for mechanically ventilated patients, and length of stay. Severe pulmonary involvement was defined as need for Fio2 ≥ 50%, noninvasive ventilation, or invasive ventilation at study entry. Logistic regression and propensity score matching were used to adjust for confounders. Two hundred eighty patients, 173 treated with ivermectin and 107 without ivermectin, were reviewed. Most patients in both groups also received hydroxychloroquine, azithromycin, or both. Univariate analysis showed lower mortality in the ivermectin group (15.0% vs 25.2%; OR, 0.52; 95% CI, 0.29-0.96; P = .03). Mortality also was lower among ivermectin-treated patients with severe pulmonary involvement (38.8% vs 80.7%; OR, 0.15; 95% CI, 0.05-0.47; P = .001). No significant differences were found in extubation rates (36.1% vs 15.4%; OR, 3.11; 95% CI, 0.88-11.00; P = .07) or length of stay. After multivariate adjustment for confounders and mortality risks, the mortality difference remained significant (OR, 0.27; 95% CI, 0.09-0.80; P = .03). One hundred ninety-six patients were included in the propensity-matched cohort. Mortality was significantly lower in the ivermectin group (13.3% vs 24.5%; OR, 0.47; 95% CI, 0.22-0.99; P < .05), an 11.2% (95% CI, 0.38%-22.1%) absolute risk reduction, with a number needed to treat of 8.9 (95% CI, 4.5-263). Ivermectin treatment was associated with lower mortality during treatment of COVID-19, especially in patients with severe pulmonary involvement. Randomized controlled trials are needed to confirm these findings.
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DOI：
10.15585/mmwr.mm6915e3
发表时间：
2020-04-17
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
--
作者：
Garg S;Kim L;Whitaker M;O'Halloran A;Cummings C;Holstein R;Prill M;Chai SJ;Kirley PD;Alden NB;Kawasaki B;Yousey-Hindes K;Niccolai L;Anderson EJ;Openo KP;Weigel A;Monroe ML;Ryan P;Henderson J;Kim S;Como-Sabetti K;Lynfield R;Sosin D;Torres S;Muse A;Bennett NM;Billing L;Sutton M;West N;Schaffner W;Talbot HK;Aquino C;George A;Budd A;Brammer L;Langley G;Hall AJ;Fry A
通讯作者：
Fry A
影响因子：
9.6
作者：
Price CC;Altice FL;Shyr Y;Koff A;Pischel L;Goshua G;Azar MM;Mcmanus D;Chen SC;Gleeson SE;Britto CJ;Azmy V;Kaman K;Gaston DC;Davis M;Burrello T;Harris Z;Villanueva MS;Aoun-Barakat L;Kang I;Seropian S;Chupp G;Bucala R;Kaminski N;Lee AI;LoRusso PM;Topal JE;Dela Cruz C;Malinis M
通讯作者：
Malinis M
影响因子：
7.6
作者：
Caly, Leon;Druce, Julian D;Wagstaff, Kylie M
通讯作者：
Wagstaff, Kylie M
DOI：
10.1001/jama.2020.6775
发表时间：
2020-01-01
期刊：
JAMA, Journal of the American Medical Association
影响因子：
--
作者：
Richardson, Safiya;Hirsch, Jamie S.;,
通讯作者：
,
伊维菌素是进口蛋白α/β介导的核进口的特异性抑制剂，能够抑制HIV-1和登革热病毒的复制。
DOI：
10.1042/bj20120150
发表时间：
2012-05-01
期刊：
The Biochemical journal
影响因子：
--
作者：
Wagstaff KM;Sivakumaran H;Heaton SM;Harrich D;Jans DA
通讯作者：
Jans DA