Çocuklarda COVID-19 Tedavisi

Yıl 2020, COVID-19, 9 - 14, 24.07.2020

Belgin Gülhan , Aslınur Özkaya Parlakay

https://doi.org/10.12956/tchd.762827

Öz

COVID-19 için halen spesifik etkili bir tedavi yoktur. Özellikle yetişkin hastalarda yayınlanmış ve devam etmekte olan birçok çalışma bulunmaktadır. Pediatrik hastalarda tedavi seçenekleri yetişkin hastalarda kullanılan ajanlara göre belirlenmektedir. Coronavirüs hastalığı 2019 (COVID-19) neredeyse çoğu çocukta hafif olarak geçirilmesine rağmen, hastaların küçük bir kısmında ciddi veya kritik hastalık gelişebilmektedir. Çocuklarda semptomlar ve hastalık seyri hafif olduğundan destekleyici tedavi tedavinin temelini oluşturur. Çocuklarda COVID-19'u tedavi etmek için kullanılabilecek, randomize kontrollü çalışması olan herhangi bir ilaç bulunmamaktadır. Bununla birlikte, kliniği ağır olan vakalarda, yetişkinlerde kullanılan ilaçlar vaka bazında değerlendirilirmekte ve kullanılabilmektedir. Çocuklarda COVID-19 için potansiyel tedavilerin güvenliğini ve etkinliğini daha iyi tanımlamak için iyi tasarlanmış kontrollü klinik çalışmalara artan bir ihtiyaç vardır.

Anahtar Kelimeler

çocuk, COVID-19, tedavi

Treatment of children with COVID-19

Öz

Currently, there is not any specific effective treatment for COVID-19. There are many studies published and ongoing especially on adult patients. Treatment options in pediatric patients are determined according to the agents used in adult patients. Although coronavirus disease 2019 (COVID-19) is mild in nearly all children, a small proportion of pediatric patients develop severe or critical illness. Supportive therapy forms the basis of the treatment as the symptoms and disease course in children are mild. There are currently no randomized controlled trials of drugs that can be used to treat COVID-19 in children. However, in severe clinical cases, the drugs used in adults are evaluated and used on a case-by-case basis. There is a growing need for well-designed controlled clinical trials to better define the safety and efficacy of potential treatments for COVID-19 in children.

Anahtar Kelimeler

children, COVID-19, treatment

Kaynakça

• 1. World Health Organisation. Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts. Interim guidance 17 March 2020. Web cite: https://www.who.int/publications/i/item/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts. (Achived at June 30, 2020)
• 2. Day M. Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists. BMJ 2020; 368:m1086. doi: 10.1136/bmj.m1168.
• 3. Chen Z, Fu J, Shu Q, Chen Y, Hua C, Li FB, et al. Diagnosis and treatment recommendations for pediatric respiratory infection caused by the 2019 novel coronavirus. World J Pediatr 2020;16:240-6.
• 4. Centers for Disease Control and Prevention. Interim Infection Prevention and Control Recommendations for Patients with Confirmed 2019 Novel Coronavirus (2019-nCoV) or Patients Under Investigation for 2019-nCoV in Healthcare Settings. https://www.cdc.gov/coronavirus/2019-nCoV/hcp/infection-control.html (Accessed on April 15, 2020).
• 5. Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB. Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19) A Review. JAMA 2020 Apr 13. doi: 10.1001/jama.2020.6019.
• 6. Chih-Chia Lua, Mei-Yu Chena, Yuh-Lih Changa. Potential therapeutic agents against COVID-19: What we know so far. J Chin Med Assoc 2020;83:534-6.
• 7. Zhai P, Ding Y , Wu X, Long J, Zhong Y, Li Y. The epidemiology, diagnosis and treatment of COVID-19. Int J Antimicrob Agents 2020;55:105955.
• 8. Gao J, Tian Z, Yang X. Breakthrough: chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends 2020; 14:72-3.
• 9. Yao X, Ye F, Zhang M, Cui C, Huang B, Niu P, et al. In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Clin Infect Dis 2020; Mar 9;ciaa237. doi: 10.1093/cid/ciaa237.
• 10. WHO. “Solidarity” clinical trial for COVID-19 treatments: Update on hydroxychloroquine. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19-treatments (Accessed on June 18, 2020).
• 11. Geleris J, Sun Y, Platt J, Zucker J, Baldwin M, Hripcsak G, et al. Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19. N Engl J Med 2020;382:2411-8.
• 12. Mahévas M, Tran VT, Roumier M, Chabrol A, Paule R, Guillaud C, et al. Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data. BMJ 2020;369:m1844. doi:10.1136/bmj.m1844
• 13. FDA web site: https://www.fda.gov/drugs/drug-safety-and-availability/fda-cautions-against-use-hydroxychloroquine-or-chloroquine-covid-19-outside-hospital-setting-or.(Achieved on 2020 June, 30)
• 14. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020;323:1061-9.
• 15. Roden DM, Harrington RA, Poppas A, Russo AM. Considerations for Drug Interactions on QTc in Exploratory COVID-19 Treatment. Circulation 2020; 141:e906-7.
• 16. Turkish Ministry of Health, General Directorate of Public Health. COVID-19 (SARS-CoV-2 ENFEKSİYONU) REHBERİ. Web site: https://covid19bilgi.saglik.gov.tr/depo/rehberler/COVID-19_Rehberi.pdf (Achieved at June 30, 2020)
• 17. Hurst M, Faulds D. Lopinavir. Drugs. 2000;60:1380‐1.
• 18. Chu CM, Cheng VC, Hung IF, Wong MM, Chan KH, Chan KS, et al. Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findings. Thorax 2004;59:252-6.
• 19. Sheahan TP, Sims AC, Leist SR, Schafer A, Won J, Brown AJ, et al. Comparative therapeutic efficacy of remdesivir and combination lopinavir, ritonavir, and interferon beta against MERS‐CoV. Nat Commun 2020;11:222. doi: 10.1038/s41467-019-13940-6.
• 20. Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis 2020;20:689-96.
• 21. Ye XT, Luo YL, Xiia SC, Sun QF, Ding JG, Zhou Y, et al. Clinical efficacy of lopinavir/ritonavir in the treatment of Coronavirus disease 2019. Eur Rev Med Pharmacol Sci 2020;24:3390 6.
• 22. Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A trial of lopinavir-rito navir in adults hospitalized with severe Covid-19. N Engl J Med 2020;382:1787-99.
• 23. Alhazzani W, Moller MH, Arabi MY, Loeb M, Gong MN, Fan E, et al. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med 2020;46:854-87.
• 24. Sanders JM, Monogue ML, Jodlowski TZ. Cutrell JB. Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19) A Review. JAMA 2020. doi:10.1001/jama.2020.6019.
• 25. FurutaY, KomenoT, NakamuraT. Favipiravir (T 705), a broad spectrum inhibitor of viral RNA polymerase. Proc Jpn Acad Ser B Phys Biol Sci 2017;93:449 63.
• 26. Cai Q, Yang M, Liu D, Chen J, Shu D, Xia J et al. Experimental Treatment with Favipiravir for COVID-19: An Open-Label Control Study. Engineering 2020Mar 18. doi: https://doi.org/10.1016/j.eng.2020.03.007.
• 27. Chen C, Yi Z, Huang J, Yin P, Cheng Z, Wu J, et al. Favipiravir versus Arbidol for COVID-19: a randomized clinical trial. medRxiv 2020. doi: 10.1101/2020.03.17.20037432.
• 28. Madelain V, Nguyen TH, Olivo A, Lamballerine X, Gudj J, Taburet AM, et al. Ebola virus infection: review of the pharmacokinetic and pharmacodynamic properties of drugs considered for testing in human efficacy trials. Clin Pharmacokinet 2016; 55:907– 23.
• 29. Nguyen TH, Guedj J, Anglaret X, Laouenan C, Madelain V, Taburet AM, et al. Favipiravir pharmacokinetics in Ebolainfected patients of the JIKI trial reveals concentrations lower than targeted. PLoS Negl Trop Dis 2017; 11:e0005389.
• 30. COVID-19 (SARS-Cov2 Enfeksiyonu) tedavisinde kullanılacak ilaçlara ilişkin bilgilendirme; Favipiravir 200 mg tablet. Web site: https://dosyamerkez.saglik.gov.tr/Eklenti/37219,favipiravir-200-mg-tablet--guncelleme-tarihi-14042020pdf.pdf?0. (achieved at 30.6.2020)
• 31. European Medicines Agency, Committee for Medicinal Products for Human Use (CHMP) assessment report, Procedure no: EMEA/H/A-5(3)/1410, 03.02.2016.
• 32. Bouazza N, Treluyer JM, Foissac F, Mentré F, Taburet AM, Guedj J, et al. Favipiravir for children with Ebola. Lancet 2015;385:603–4.
• 33. Y Tayama , K Miyake, K Sugihara, S Kitamura, M Kobayashi, S Morita, et al. Developmental changes of aldehyde oxidase activity in young Japanese children. Clin Pharmacol Ther 2007;81:567–72.
• 34. Sissoko D, Laouenan C, Folkesson E, M'Lebing AB, Beavogui AH, Baize S,et al. Experimental Treatment with Favipiravir for Ebola Virus Disease (the JIKI Trial): A Historically Controlled, Single-Arm Proof-of-Concept Trial in Guinea. PLoS Med 2016;13:e1001967. doi: 10.1371/journal.pmed.1001967.
• 35. de Wit E, Feldmann F, Cronin J, Jordan R, Okumura A, Thomas T, et al. Prophylactic and therapeutic remdesivir (GS-5734) treatment in the rhesus macaque model of MERS-CoV infection. Proc Natl Acad Sci U S A 2020;117:6771-6.
• 36. Sheahan TP, Sims AC, Graham RL, Menachery VD, Gralinski LE, Case JB, et al. Broad-spectrum antiviral GS-5734 inhibits both epidemic and zoonotic coronaviruses. Sci Transl Med 2017;9:eaal3653. doi: 10.1126/scitranslmed.aal3653.
• 37. Sheahan TP, Sims AC, Leist SR, Schafer A, Won J, Brown AJ, et al. Comparative therapeutic efficacy of remdesivir and combination lopinavir, ritonavir, and interferon beta against MERS-CoV. Nat Commun 2020;11:222. doi: 10.1038/s41467-019-13940-6.
• 38. Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res 2020;30: 269-71.
• 39. Mulangu S, Dodd LE, Davey RT Jr, Tshiani Mbaya O, Proschan M, Mukadi D,et al. A randomized, controlled trial of Ebola virus disease therapeutics. N Engl J Med 2019;381:2293-303.
• 40. European Medicines Agency. Summary on compassionate use: Remdesivir Gilead. April 3, 2020 (https://www.ema.europa.eu/en/ documents/other/summary-compassionate -use-remdesivir-gilead_en.pdf).
• 41. Grein J, Ohmagari N, Shin D, Diaz G, Asperges E, Castagna A, et al. Compassionate Use of Remdesivir for Patients with Severe Covid-19.N Engl J Med 2020;382:2327-36.
• 42. Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, et al. Remdesivir for the Treatment of Covid-19 - Preliminary Report. N Engl J Med 2020;NEJMoa2007764. doi:10.1056/NEJMoa2007764
• 43. Wang Y, Zhang D, Du G, Zhao J, Jin Y, Fu S, et al. Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial [published correction appears in Lancet 2020;395:1569-78.
• 44. Li L, Zhang W, Hu Y, Tong X, Zheng S, Yang Z, et al. Effect of Convalescent Plasma Therapy on Time to Clinical Improvement in Patients With Severe and Life-threatening COVID-19: A Randomized Clinical Trial. JAMA 2020;e2010044. doi:10.1001/jama.2020.10044
• 45. Valk SJ, Piechotta V, Chai KL, Doree C, Monsef I, Wood EM, et al. Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19: a rapid review. Cochrane Database Syst Rev 2020;5:CD013600. doi:10.1002/14651858.CD013600
• 46. Qin C, Zhou L, Hu Z, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis 2020;ciaa248. doi:10.1093/cid/ciaa248
• 47. Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan China. Intensive Care Med 2020;46:846-8.
• 48. Chen X, Zhao B, Qu Y,Chen Y, Xiong J, Feng Y, et al. Detectable serum SARS-CoV-2 viral load (RNAaemia) is closely correlated with drastically elevated interleukin 6 (IL-6) level in critically ill COVID-19 patients. Clin Infect Dis 2020;ciaa449. doi:10.1093/cid/ciaa449.
• 49. Kewan T, Covut F, Jaghbeer MJ, Rose L, Gopalakrishna KV, Akbik B. Tocilizumab for treatment of patients with severe COVID19: A retrospective cohort study. ECLINM (2020), https://doi.org/10.1016/j.eclinm.2020.100418.
• 50. Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 2020;395:1033-3.
• 51. Colaneri M, Bogliolo L, Valsecchi P, Sacchi P, Zuccaro V, Brandolino F, et al. Tocilizumab for Treatment of Severe COVID-19 Patients: Preliminary Results from SMAtteo COvid19 REgistry (SMACORE). Microorganisms 2020;8:695. doi:10.3390/microorganisms8050695