BC 045 – Efficacité du molnupiravir dans le traitement ambulatoire de la COVID-19 (étude MOVe-OUT)

BaladoCritique - club de lecture médical

Dans cette 45e baladodiffusion, le Dr Luc Lanthier discute de l’efficacité du molnupiravir, un nouvel agent antiviral, comme traitement des sujets ambulatoires avec COVID-19, en plus de réviser la littérature médicale de novembre et décembre 2021.

Quiz clinique (5 min 06), étude principale (5 min 28), critique (20 min 55), autres articles (40 min 53), réponse au quiz clinique (46 min 05)

Référence principale

Jayk Bernal A, Gomes da Silva MM, Musungaie DB, Kovalchuk E, Gonzalez A, Delos Reyes V, et al. Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients. N Engl J Med. 2021. doi: 10.1056/NEJMoa2116044. PubMed PMID: 34914868.

Articles associés

Arribas JR, Bhagani S, Lobo SM, Khaertynova I, Mateu L, Fishchuk R, et al. Randomized Trial of Molnupiravir or Placebo in Patients Hospitalized with Covid-19. NEJM Evidence. 2021. doi: 10.1056/EVIDoa2100044.

Whitley R. Molnupiravir – A Step toward Orally Bioavailable Therapies for Covid-19. N Engl J Med. 2021. doi: 10.1056/NEJMe2117814. PubMed PMID: 34914869.

https://www.covid19treatmentguidelines.nih.gov/about-the-guidelines/whats-new/

Rubino DM, Greenway FL, Khalid U, O’Neil PM, Rosenstock J, Sørrig R, Wadden TA, Wizert A, Garvey WT; STEP 8 Investigators. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes: The STEP 8 Randomized Clinical Trial. JAMA. 2022;327(2):138-150. PubMed PMID: 35015037.

Autres articles d’intérêt

Novembre

Ingason AB, Hreinsson JP, Agustsson AS, Lund SH, Rumba E, Palsson DA, et al. Rivaroxaban Is Associated With Higher Rates of Gastrointestinal Bleeding Than Other Direct Oral Anticoagulants : A Nationwide Propensity Score-Weighted Study. Ann Intern Med. 2021;174(11):1493-502. PubMed PMID: 34633836.

Nazarzadeh M, Bidel Z, Canoy D, Copland E, Wamil M, Majert J, et al. Blood pressure lowering and risk of new-onset type 2 diabetes: an individual participant data meta-analysis. Lancet. 2021;398(10313):1803-10. PubMed PMID : 34774144.

Neuman MD, Feng R, Carson JL, Gaskins LJ, Dillane D, Sessler DI, et al. Spinal Anesthesia or General Anesthesia for Hip Surgery in Older Adults. N Engl J Med. 2021;385(22):2025-35. PubMed PMID: 34623788.

Tascilar K, Hagen M, Kleyer A, Simon D, Reiser M, Hueber AJ, et al. Treatment tapering and stopping in patients with rheumatoid arthritis in stable remission (RETRO): a multicentre, randomised, controlled, open-label, phase 3 trial. Lancet Rheumatology. 2021;3(11):e767-e77.

Thomas SJ, Moreira ED, Jr., Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine through 6 Months. N Engl J Med. 2021;385(19):1761-73. PubMed PMID: 34525277.

Walter EB, Talaat KR, Sabharwal C, Gurtman A, Lockhart S, Paulsen GC, et al. Evaluation of the BNT162b2 Covid-19 Vaccine in Children 5 to 11 Years of Age. N Engl J Med. 2022;386(1):35-46. PubMed PMID: 34752019.

Munch MW, Myatra SN, Vijayaraghavan BKT, Saseedharan S, Benfield T, et al. Effect of 12 mg vs 6 mg of Dexamethasone on the Number of Days Alive Without Life Support in Adults With COVID-19 and Severe Hypoxemia: The COVID STEROID 2 Randomized Trial. JAMA. 2021;326(18):1807-17. PubMed PMID: 34673895.

Gupta A, Gonzalez-Rojas Y, Juarez E, Crespo Casal M, Moya J, Falci DR, et al. Early Treatment for Covid-19 with SARS-CoV-2 Neutralizing Antibody Sotrovimab. N Engl J Med. 2021;385(21):1941-50. PubMed PMID: 34706189.

Korley FK, Durkalski-Mauldin V, Yeatts SD, Schulman K, Davenport RD, Dumont LJ, et al. Early Convalescent Plasma for High-Risk Outpatients with Covid-19. N Engl J Med. 2021;385(21):1951-60. PubMed PMID: 34407339.

Décembre

Pitt B, Filippatos G, Agarwal R, Anker SD, Bakris GL, Rossing P, et al. Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes. N Engl J Med. 2021;385(24):2252-63. PubMed PMID: 34449181.

Agarwal R, Sinha AD, Cramer AE, Balmes-Fenwick M, Dickinson JH, Ouyang F, et al. Chlorthalidone for Hypertension in Advanced Chronic Kidney Disease. N Engl J Med. 2021;385(27):2507-19. PubMed PMID: 34739197.

Wang Y, Meng X, Wang A, Xie X, Pan Y, Johnston SC, et al. Ticagrelor versus Clopidogrel in CYP2C19 Loss-of-Function Carriers with Stroke or TIA. N Engl J Med. 2021;385(27):2520-30. PubMed PMID: 34708996.

Ray WA, Chung CP, Stein CM, Smalley W, Zimmerman E, Dupont WD, et al. Association of Rivaroxaban vs Apixaban With Major Ischemic or Hemorrhagic Events in Patients With Atrial Fibrillation. JAMA. 2021;326(23):2395-404. PubMed PMID: 34932078.

Sabatine MS, Bergmark BA, Murphy SA, O’Gara PT, Smith PK, Serruys PW, et al. Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis. Lancet. 2021;398(10318):2247-57. PubMed PMID : 34793745.

Singh AK, Carroll K, McMurray JJV, Solomon S, Jha V, Johansen KL, et al. Daprodustat for the Treatment of Anemia in Patients Not Undergoing Dialysis. N Engl J Med. 2021;385(25):2313-24. PubMed PMID: 34739196.

Kalinsky K, Barlow WE, Gralow JR, Meric-Bernstam F, Albain KS, Hayes DF, et al. 21-Gene Assay to Inform Chemotherapy Benefit in Node-Positive Breast Cancer. N Engl J Med. 2021;385(25):2336-47. PubMed PMID: 34914339.

Self WH, Sandkovsky U, Reilly CS, Vock DM, Gottlieb RL, Mack M, et al. Efficacy and safety of two neutralising monoclonal antibody therapies, sotrovimab and BRII-196 plus BRII-198, for adults hospitalised with COVID-19 (TICO): a randomised controlled trial. Lancet Infectious Diseases. 2021. doi: 10.1016/s1473-3099(21)00751-9.

Marconi VC, Ramanan AV, de Bono S, Kartman CE, Krishnan V, Liao R, et al. Efficacy and safety of baricitinib for the treatment of hospitalised adults with COVID-19 (COV-BARRIER): a randomised, double-blind, parallel-group, placebo-controlled phase 3 trial. Lancet Respiratory Medicine. 2021;9(12):1407-18. PubMed PMID : 34480861.

Weinreich DM, Sivapalasingam S, Norton T, Ali S, Gao H, Bhore R, et al. REGEN-COV Antibody Combination and Outcomes in Outpatients with Covid-19. N Engl J Med. 2021;385(23):e81. doi: 10.1056/NEJMoa2108163. PubMed PMID: 34587383.

Spyropoulos AC, Goldin M, Giannis D, Diab W, Wang J, Khanijo S, et al. Efficacy and Safety of Therapeutic-Dose Heparin vs Standard Prophylactic or Intermediate-Dose Heparins for Thromboprophylaxis in High-risk Hospitalized Patients With COVID-19: The HEP-COVID Randomized Clinical Trial. JAMA Intern Med. 2021;181(12):1612-20. PubMed PMID: 34617959.

Gottlieb RL, Vaca CE, Paredes R, Mera J, Webb BJ, Perez G, et al. Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients. N Engl J Med. 2021. Epub 2021/12/23. doi: 10.1056/NEJMoa2116846. PubMed PMID: 34937145.

Colchicine in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet Respiratory Medicine. 2021;9(12):1419-26. PubMed PMID : 34672950.

Abani O, Abbas A, Abbas F, Abbas M, Abbasi S, Abbass H, et al. Aspirin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet. 2022;399(10320):143-151. PubMed PMID : 34800427.

Ali K, Berman G, Zhou H, Deng W, Faughnan V, Coronado-Voges M, et al. Evaluation of mRNA-1273 SARS-CoV-2 Vaccine in Adolescents. N Engl J Med. 2021;385(24):2241-51. Epub 2021/08/12. PubMed PMID: 34379915.

Arbel R, Hammerman A, Sergienko R, Friger M, Peretz A, Netzer D, et al. BNT162b2 Vaccine Booster and Mortality Due to Covid-19. N Engl J Med. 2021;385(26):2413-20. PubMed PMID: 34879190.

Dunkle LM, Kotloff KL, Gay CL, Anez G, Adelglass JM, Barrat Hernandez AQ, et al. Efficacy and Safety of NVX-CoV2373 in Adults in the United States and Mexico. N Engl J Med. 2021. Epub 2021/12/16. doi: 10.1056/NEJMoa2116185. PubMed PMID: 34910859.

Falsey AR, Sobieszczyk ME, Hirsch I, Sproule S, Robb ML, Corey L, et al. Phase 3 Safety and Efficacy of AZD1222 (ChAdOx1 nCoV-19) Covid-19 Vaccine. N Engl J Med. 2021;385(25):2348-60. PubMed PMID: 34587382.

Ehrmann S, Li J, Ibarra-Estrada M, Perez Y, Pavlov I, McNicholas B, et al. Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial. Lancet Respiratory Medicine. 2021;9(12):1387-95. PubMed PMID : 34425070.

Lazarus R, Baos S, Cappel-Porter H, Carson-Stevens A, Clout M, Culliford L, et al. Safety and immunogenicity of concomitant administration of COVID-19 vaccines (ChAdOx1 or BNT162b2) with seasonal influenza vaccines in adults in the UK (ComFluCOV): a multicentre, randomised, controlled, phase 4 trial. Lancet. 2021;398(10318):2277-87. PubMed PMID : 34774197.

Levin EG, Lustig Y, Cohen C, Fluss R, Indenbaum V, Amit S, et al. Waning Immune Humoral Response to BNT162b2 Covid-19 Vaccine over 6 Months. N Engl J Med. 2021;385(24):e84. PubMed PMID: 34614326.

Reis G, Dos Santos Moreira-Silva EA, Silva DCM, Thabane L, Milagres AC, Ferreira TS, et al; TOGETHER investigators. Effect of early treatment with fluvoxamine on risk of emergency care and hospitalisation among patients with COVID-19: the TOGETHER randomised, platform clinical trial. Lancet Glob Health. 2022 Jan;10(1):e42-e51. PubMed PMID: 34717820.

Guides de pratique

Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;144(22):e368-e454. PubMed PMID: 34709928.

Kanwal F, Shubrook JH, Adams LA, Pfotenhauer K, Wai-Sun Wong V, Wright E, et al. Clinical Care Pathway for the Risk Stratification and Management of Patients With Nonalcoholic Fatty Liver Disease. Gastroenterology. 2021;161(5):1657-69. PubMed PMID: 34602251.

Ruetzler K, Smilowitz NR, Berger JS, Devereaux PJ, Maron BA, Newby LK, et al. Diagnosis and Management of Patients With Myocardial Injury After Noncardiac Surgery: A Scientific Statement From the American Heart Association. Circulation. 2021;144(19):e287-e305. PubMed PMID: 34601955.

Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med. 2021;49(11):e1063-e143. PubMed PMID: 34605781.

Stevens SM, Woller SC, Baumann Kreuziger L, Bounameaux H, Doerschug K, Geersing GJ, et al. Executive Summary: Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report. Chest. 2021;160(6):2247-59. PubMed PMID: 34352279.

Capsule méthodologique

Bassler D, Briel M, Montori VM, Lane M, Glasziou P, Zhou Q, et al. Stopping randomized trials early for benefit and estimation of treatment effects: systematic review and meta-regression analysis. JAMA. 2010;303(12):1180-7. PubMed PMID: 20332404.

https://first10em.com/ebm-masterclass-what-exactly-is-a-p-value/

Références du quiz clinique

Clase CM, Carrero JJ, Ellison DH, Grams ME, Hemmelgarn BR, Jardine MJ, et al; Conference Participants. Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2020;97(1):42-61. PubMed PMID: 31706619.

Hyperkalemia in CKD: Mind the Gap Segment | Core IM Podcast

Palmer BF, Carrero JJ, Clegg DJ, Colbert GB, Emmett M, Fishbane S, et al. Clinical Management of Hyperkalemia. Mayo Clin Proc. 2021;96(3):744-62. PubMed PMID: 33160639.