Abstract

A STUDY ON ASSESSING THE EFFECTIVENESS OF COVID-19 TREATMENT IN PATIENTS WITH COMORBID CONDITIONS

M. Prathibha*, S. Meghna, C. Sarvari and N. Roma

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Abstract

Background: Corona virus disease (COVID-19) caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is a current global pandemic that is in various waves across the nations. Many facets contribute to a higher risk of mortality from Coronavirus disease (COVID-19), including male gender, increased age, hypertension, diabetes mellitus, cardiovascular diseases, chronic obstructive pulmonary disease, and chronic kidney disease. Remdesivir (antiviral agent) was the first and only drug approved by the FDA on October 22, 2020, for treatment of COVID-19. Besides that, EUAs have been given for vaccines, monoclonal-directed antibodies, convalescent plasma, and various other drugs around the globe. The mortality rate of COVID-19 in India is almost half of the global rate. Given the magnitude of the pandemic there must be room for phased improvements which may save many lives, while we arrive at a beneficial antiviral agent, potential targeted immunotherapy or an effective vaccine. Aim and Objectives: To assess the impact of comorbid conditions in the decline of viral load by antiviral drugs in the treatment of COVID-19 by assessing the therapeutic efficacy of antivirals in patients with comorbid conditions, assessing the type and frequency of comorbid conditions and evaluating the risk of serious outcomes in patients with COVID-19 by stratifying their co-morbid status. Methodology: A retrospective observational study was carried out with 100 patients for a period of 6 months. First, the patients were categorized upon demographic details and comorbidities. Second, patients were evaluated for clinical status improvement using the ORDINAL SCALE. Third, comorbid stratification was done using the CHARLSON COMORBIDITY INDEX. Fourth, response to antiviral drugs for COVID treatment was analyzed using EFFICACY INDEX used by C Carson et al. Fifth, the treatment outcome of antivirals was analyzed based upon efficacy/mortality using RATIO BASED ANALYSIS. At last, Patient Information Leaflets were prepared to be given to the patients. Results and Discussion: Hypertension was the highest found comorbidity followed by Diabetes Mellitus and, the least found comorbidity was cardiovascular disease. While assessing risk of serious outcome 34% of patients required hospitalization with oxygen and 8% patients were fatal during hospitalization. Comorbidity stratification showed majority of patients at 98% survival rate and 2% at the least rate of survival, mostly geriatrics and male. The most given antiviral drug to patients was Remdesivir at 56%, followed by Umifenovir at 19% and Favipiravir at 15%. The least favorable choice was Lopinavir/Ritonavir at 2%. The major antiviral therapeutic response was MARKED at 70%, followed by WORSE at 18%. This shows that the efficacy of given antivirals is far greater than their inefficacy when used judiciously. In Cardiovascular disease comorbidity, Remdesivir showed MARKED efficacy, hence it could be a significant choice of antiviral in treating COVID-19 with CVS disease. In Chronic Kidney Disease comorbidity, Oseltamivir and Remdesivir both showed MARKED efficacy, hence these could be significant choices of antivirals in treating COVID-19 with CKD disease. In Chronic Obstructive Pulmonary Disease comorbidity, Umifenovir showed MODERATE efficacy, which suggests its judicious use as an antiviral for the treatment of COVID-19 with COPD disease, but Remdesivir reported two deaths hence, Remdesivir must be used with caution. In Diabetes Mellitus comorbidity, Acyclovir was the only drug with MARKED efficacy, which could be a significant choice of antiviral. Interestingly, Remdesivir was the most given drug to patients with Diabetes Mellitus comorbidity, with an efficacy/mortality ratio of 3:1, hence it should be given judiciously. Umifenovir had the worst efficacy/mortality ratio of 3:2, caution must be exercised. In Hypertension comorbidity, Favipiravir was the most given antiviral drug with MARKED efficacy which could be a significant choice. Acyclovir and Lopinavir/Ritonavir also showed MARKED efficacy, they too could be considered as significant choices. Remdesivir showed an efficacy/mortality ratio of 2:1 which suggests the need of exercising caution while treating COVID in patients with Hypertension. According to Ratio Based Analysis, all drugs showed favorable efficacy in their respective comorbidities except Remdesivir in COPD, T2DM & HTN and Umifenovir in T2DM. Hence caution and judicious use must be exercised. Conclusion: In summary, Hypertension followed by Diabetes Mellitus were the most found comorbidities putting them at more risk of contracting COVID and more prone to disease progression in comparison with other comorbidities. In Cardiovascular disease comorbidity, Remdesivir was found to be effective. In Chronic Kidney disease comorbidity, Oseltamivir and Remdesivir both were found to be effective. In Chronic Obstructive Pulmonary disease comorbidity, Umifenovir was found to be most effective. In Diabetes Mellitus comorbidity, Acyclovir was found to be most effective. In Hypertension comorbidity, Acyclovir, Lopinavir/Ritonavir and Favipiravir were found to be most effective. Hence drugs with better efficacy outcomes should be judiciously considered over conventional choices of antiviral drugs in treating COVID-19 with comorbidities. This would help decrease risk of infection/ rate of hospitalizations, escalation of complications, lower the rate of morbidity and mortality, improve hospital care, tap into tailored pharmacotherapy for each comorbidity, establish evidence based medicine for COVID treatment guidelines and improve the overall QoL. However, a study as this must be undertaken on a large adult population to confirm the antiviral efficacy and rule out any adverse effect, antiviral induced complications for the safety and benefit of all.

Keywords: COVID-19, SARS COV-2, Hypertension, Diabetes Mellitus, Chronic Obstructive Pulmonary Disease, Chronic Kidney Disease, Cardiovascular Disorders, CVS, CKD, COPD, T2DM, HTN, Comorbidities, Ordinal scale, Charlson Comorbidity Index, Efficacy Index, WHO, EUA,