Meta-analysis on outcome-worsening comorbidities of COVID-19 and related potential drug-drug interactions.
Meta-analysis on outcome-worsening comorbidities of COVID-19 and related potential drug-drug interactions.
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DOI：
10.1016/j.phrs.2020.105250
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发表时间：
2020-11
影响因子：
9.3
通讯作者：
Cascorbi I
中科院分区：
文献类型：
--
作者：
Awortwe C;Cascorbi I
在COVID-19感染过程中使用的药物与用于管理基础合并症的药物之间可能发生的药物相互作用（DDI）可能导致药物不良反应（ADR），导致受影响患者的临床结局恶化。首先，我们进行了一项荟萃分析，以确定在24项已发表的研究中，在COVID-19疾病过程中观察到的与临床结局恶化风险增加相关的合并症。此外，评价了这些研究中COVID-19治疗过程中使用的药物与用于管理观察到的合并症的药物之间DDI的潜在风险，以确定临床结局可能恶化。我们的荟萃分析显示，（例如心血管疾病、脑血管疾病、高血压和糖尿病）、慢性肾脏疾病和慢性阻塞性肺疾病作为与恶化临床结局（包括死亡率）相关的主要合并症（风险差异RD 0.12，95%-CI 0.05−0.19，p = 0.001），入住ICU（RD 0.10，95%-CI 0.04−0.16，p = 0.001）和严重感染（RD 0.05，95%-CI 0.01−0.09，p = 0.01）。确定了抗病毒药物阿扎那韦和洛匹那韦/利托那韦与某些用于治疗心血管疾病的药物（如抗凝剂和抗凝剂）之间的药代动力学水平潜在DDI，这些药物可能影响临床结局，包括心脏损伤或由于QTc时间延长或出血导致的心脏骤停。总之，抗COVID-19治疗过程中发生的DDI和合并症可能导致ADR，增加住院风险，延长恢复时间或在极端情况下死亡。患有心脏代谢性疾病、慢性肾脏疾病和慢性阻塞性肺疾病的COVID-19患者应接受特别仔细的不良事件临床监测，必要时可调整剂量。
Drug-drug interactions (DDI) potentially occurring between medications used in the course of COVID-19 infection and medications prescribed for the management of underlying comorbidities may cause adverse drug reactions (ADRs) contributing to worsening of the clinical outcome in affected patients. First, we conducted a meta-analysis to determine comorbidities observed in the course of COVID-19 disease associated with an increased risk of worsened clinical outcome from 24 published studies. In addition, the potential risk of DDI between medications used in the course of COVID-19 treatment in these studies and those for the management of observed comorbidities was evaluated for possible worsening of the clinical outcome. Our meta-analysis revealed an implication cardiometabolic syndrome (e.g. cardiovascular disease, cerebrovascular disease, hypertension, and diabetes), chronic kidney disease and chronic obstructive pulmonary disease as main co-morbidities associated with worsen the clinical outcomes including mortality (risk difference RD 0.12, 95 %-CI 0.05−0.19, p = 0.001), admission to ICU (RD 0.10, 95 %-CI 0.04−0.16, p = 0.001) and severe infection (RD 0.05, 95 %-CI 0.01−0.09, p = 0.01) in COVID-19 patients. Potential DDI on pharmacokinetic level were identified between the antiviral agents atazanavir and lopinavir/ritonavir and some drugs, used in the treatment of cardiovascular diseases such as antiarrhythmics and anti-coagulants possibly affecting the clinical outcome including cardiac injury or arrest because of QTc-time prolongation or bleeding. Concluding, DDI occurring in the course of anti-Covid-19 treatment and co-morbidities could lead to ADRs, increasing the risk of hospitalization, prolonged time to recovery or death on extreme cases. COVID-19 patients with cardiometabolic diseases, chronic kidney disease and chronic obstructive pulmonary disease should be subjected to particular carefully clinical monitoring of adverse events with a possibility of dose adjustment when necessary.
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DOI：
10.1164/rccm.202002-0445oc
发表时间：
2020-06-01
影响因子：
24.7
作者：
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影响因子：
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