Antonio Desai1,2, Giuseppe Caltagirone1,2, Sharon Sari3, Daria Pocaterra4, Maria Kogan1, Elena Azzolini2,5, Victor Savevski6, Filippo Martinelli-Boneschi7,8, Antonio Voza1. 1. Emergency Department, Humanitas Clinical and Research Center, IRCCS, 20089 Milan, Italy. 2. Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Italy. 3. Internal Medicine Department, Geriatrics, Santa Margherita Rehabilitation and Cure Institute, ASP, 27100 Pavia, Italy. 4. Department of Infectious Diseases, Humanitas Clinical and Research Center, IRCCS, 20089 Milan, Italy. 5. Health Directorate, Humanitas Clinical and Research Center, IRCCS, 20089 Milan, Italy. 6. Artificial Intelligence Center, Humanitas Clinical and Research Center, IRCCS, 20089 Milan, Italy. 7. Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation (DEPT), University of Milan, 20122 Milan, Italy. 8. Neurology Unit and MS Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore, Policlinico, 20122 Milan, Italy.
Abstract
BACKGROUND: Our aim was to investigate the impact of therapeutics with antiviral activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on mortality of older adults affected by coronavirus disease 2019 (COVID-19), taking into consideration the time interval from symptoms onset to drugs administration. METHODS: Data from 143 COVID-19 patients over 65 years of age admitted to the Humanitas Clinical and Research Center Emergency Department (Milan, Italy) and treated with Lopinavir/ritonavir (LPV/r) or Darunavir/cobicistat (DVR/c) associated to Hydroxychloroquine (HCQ) were retrospectively analyzed. Statistical analysis was performed by using a logistic regression model and survival analysis to assess the role of different predictors of in-hospital mortality, including an early (<6 days from symptoms onset) vs. late treatment onset, signs and symptoms at COVID-19 presentation, type of antiviral treatment (LPV/r or DVR/c) and patients' age (65-80 vs. >80 years old). RESULTS: Multivariate analysis showed that an older age (OR: 2.54) and dyspnea as presenting symptom (OR: 2.01) were associated with higher mortality rate, whereas cough as presenting symptom (OR: 0.53) and a timely drug administration (OR: 0.44) were associated with lower mortality. Survival analysis demonstrated that the timing of drug administration had an impact on mortality in 65-80 years-old patients (p = 0.02), whereas no difference was seen in those >80 years-old. This impact was more evident in patients with dyspnea as primary symptom of COVID-19, in whom mortality decreased from 57.1% to 38.3% due to timely drug administration (OR: 0.5; p = 0.04). CONCLUSIONS: There was a significant association between the use of a combined antiviral regimen and HCQ and lower mortality, when timely-administered, in COVID-19 patients aged 65-80 years. Our findings support timely treatment onset as a key component in the treatment of COVID-19.
BACKGROUND: Our aim was to investigate the impact of therapeutics with antiviral activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on mortality of older adults affected by coronavirus disease 2019 (COVID-19), taking into consideration the time interval from symptoms onset to drugs administration. METHODS: Data from 143 COVID-19patients over 65 years of age admitted to the Humanitas Clinical and Research Center Emergency Department (Milan, Italy) and treated with Lopinavir/ritonavir (LPV/r) or Darunavir/cobicistat (DVR/c) associated to Hydroxychloroquine (HCQ) were retrospectively analyzed. Statistical analysis was performed by using a logistic regression model and survival analysis to assess the role of different predictors of in-hospital mortality, including an early (<6 days from symptoms onset) vs. late treatment onset, signs and symptoms at COVID-19 presentation, type of antiviral treatment (LPV/r or DVR/c) and patients' age (65-80 vs. >80 years old). RESULTS: Multivariate analysis showed that an older age (OR: 2.54) and dyspnea as presenting symptom (OR: 2.01) were associated with higher mortality rate, whereas cough as presenting symptom (OR: 0.53) and a timely drug administration (OR: 0.44) were associated with lower mortality. Survival analysis demonstrated that the timing of drug administration had an impact on mortality in 65-80 years-old patients (p = 0.02), whereas no difference was seen in those >80 years-old. This impact was more evident in patients with dyspnea as primary symptom of COVID-19, in whom mortality decreased from 57.1% to 38.3% due to timely drug administration (OR: 0.5; p = 0.04). CONCLUSIONS: There was a significant association between the use of a combined antiviral regimen and HCQ and lower mortality, when timely-administered, in COVID-19patients aged 65-80 years. Our findings support timely treatment onset as a key component in the treatment of COVID-19.
Authors: W S Lim; M M van der Eerden; R Laing; W G Boersma; N Karalus; G I Town; S A Lewis; J T Macfarlane Journal: Thorax Date: 2003-05 Impact factor: 9.139
Authors: M J Fine; T E Auble; D M Yealy; B H Hanusa; L A Weissfeld; D E Singer; C M Coley; T J Marrie; W N Kapoor Journal: N Engl J Med Date: 1997-01-23 Impact factor: 91.245
Authors: David Ellinghaus; Frauke Degenhardt; Luis Bujanda; Maria Buti; Agustín Albillos; Pietro Invernizzi; Javier Fernández; Daniele Prati; Guido Baselli; Rosanna Asselta; Marit M Grimsrud; Chiara Milani; Fátima Aziz; Jan Kässens; Sandra May; Mareike Wendorff; Lars Wienbrandt; Florian Uellendahl-Werth; Tenghao Zheng; Xiaoli Yi; Raúl de Pablo; Adolfo G Chercoles; Adriana Palom; Alba-Estela Garcia-Fernandez; Francisco Rodriguez-Frias; Alberto Zanella; Alessandra Bandera; Alessandro Protti; Alessio Aghemo; Ana Lleo; Andrea Biondi; Andrea Caballero-Garralda; Andrea Gori; Anja Tanck; Anna Carreras Nolla; Anna Latiano; Anna Ludovica Fracanzani; Anna Peschuck; Antonio Julià; Antonio Pesenti; Antonio Voza; David Jiménez; Beatriz Mateos; Beatriz Nafria Jimenez; Carmen Quereda; Cinzia Paccapelo; Christoph Gassner; Claudio Angelini; Cristina Cea; Aurora Solier; David Pestaña; Eduardo Muñiz-Diaz; Elena Sandoval; Elvezia M Paraboschi; Enrique Navas; Félix García Sánchez; Ferruccio Ceriotti; Filippo Martinelli-Boneschi; Flora Peyvandi; Francesco Blasi; Luis Téllez; Albert Blanco-Grau; Georg Hemmrich-Stanisak; Giacomo Grasselli; Giorgio Costantino; Giulia Cardamone; Giuseppe Foti; Serena Aneli; Hayato Kurihara; Hesham ElAbd; Ilaria My; Iván Galván-Femenia; Javier Martín; Jeanette Erdmann; Jose Ferrusquía-Acosta; Koldo Garcia-Etxebarria; Laura Izquierdo-Sanchez; Laura R Bettini; Lauro Sumoy; Leonardo Terranova; Leticia Moreira; Luigi Santoro; Luigia Scudeller; Francisco Mesonero; Luisa Roade; Malte C Rühlemann; Marco Schaefer; Maria Carrabba; Mar Riveiro-Barciela; Maria E Figuera Basso; Maria G Valsecchi; María Hernandez-Tejero; Marialbert Acosta-Herrera; Mariella D'Angiò; Marina Baldini; Marina Cazzaniga; Martin Schulzky; Maurizio Cecconi; Michael Wittig; Michele Ciccarelli; Miguel Rodríguez-Gandía; Monica Bocciolone; Monica Miozzo; Nicola Montano; Nicole Braun; Nicoletta Sacchi; Nilda Martínez; Onur Özer; Orazio Palmieri; Paola Faverio; Paoletta Preatoni; Paolo Bonfanti; Paolo Omodei; Paolo Tentorio; Pedro Castro; Pedro M Rodrigues; Aaron Blandino Ortiz; Rafael de Cid; Ricard Ferrer; Roberta Gualtierotti; Rosa Nieto; Siegfried Goerg; Salvatore Badalamenti; Sara Marsal; Giuseppe Matullo; Serena Pelusi; Simonas Juzenas; Stefano Aliberti; Valter Monzani; Victor Moreno; Tanja Wesse; Tobias L Lenz; Tomas Pumarola; Valeria Rimoldi; Silvano Bosari; Wolfgang Albrecht; Wolfgang Peter; Manuel Romero-Gómez; Mauro D'Amato; Stefano Duga; Jesus M Banales; Johannes R Hov; Trine Folseraas; Luca Valenti; Andre Franke; Tom H Karlsen Journal: N Engl J Med Date: 2020-06-17 Impact factor: 91.245