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[艾尔戈非龙与奥司他韦治疗流感:多中心随机对照临床试验结果]

[Ergoferon and oseltamivir in treatment of influenza: results of multicentre randomized comparative clinical trial].

作者信息

Aver'ianov A V, Babkin A P, Bart B Ia, Volchetskiĭ A L, Minina E S, Kozyrev O A, Kostinov M P, Petrov D V, Sel'kova E P, Putilovskiĭ M A, Nechaev V B, Epshteĭn O I, Andrianova E N

出版信息

Antibiot Khimioter. 2012;57(7-8):23-30.

Abstract

The narrow range of choice and virus resistance to the most common drugs require search and introduction of new drugs with proven efficacy and safety for the treatment of influenza. Ergoferon is a new combined medicine containing release active antibodies to interferon-gamma (anti-IFNgamma), CD4-coreceptor and histamine. The formulation influences various links of antiviral defense and provides antiinflammatory effect. The efficacy of the drug is related to its production process during which multiple reduction of the initial concentration of every component leads to release of special release activity. Previous experimental studies showed that anti-IFNgamma had antiviral activity against pandemic influenza virus A (H1N1) 2009 comparable to that ofoseltamivir (suppression of virus replication in the lung tissue, increase of the lifespan and reduction of the laboratory animals mortality). The aim of the multicentre randomized clinical trial was to compare (versus oseltamivir) the efficacy and safety of ergoferon in the treatment of influenza in adults. 213 patients with flu-like symptoms were examined in 8 medical centres of Russia during two epidemiological seasons (2010-11 and 2011-12). The inclusion criteria were: the first 48 hours after the onset; fever > or =37.8 degrees C, at least one common symptom and at least one respiratory symptom. Influenza was confirmed in 52 patients by QuickVue rapid diagnosis. 23 patients received ergoferon according to the treatment scheme and 29 received oseltamivir (daily dose 150 mg). Duration of the treatment was 5 days. The patients were followed up for 7 days. The primary endpoint was the percentage of the patients with the body temperature normalization for 2-5 days of the treatment. The maximum efficacy of ergoferon was observed on the second day of the treatment: almost half (48%) of the initially febrile patients had normal body temperature (versus 28% in the patients treated with oseltamivir). The comparison of the two groups of the patients by the morning and evening measurements of the body temperature every five days of the treatment by Cochran-Mantel-Haenszel revealed a significant difference between the two groups (chi2 = 7.1; p = 0.008). The average duration of the fever in the group of ergoferon was 2.3 +/- 1.2 days, in the group of oseltamivir--2.6 +/- 1.3 days (the efficacy of oseltamivir in the present study was comparable with the previously published data). The percentage of the patients treated with antipyretics because of hyperthermia on the second day of the treatment lowered 3 times and amounted to 17% (versus 41% in the oseltamivir group). The severity of common and respiratory symptoms (nose/throat/chest) significantly decreased on the third day of the treatment in both groups, the majority of the patients had either minimum severity or no signs of influenza. The clinical improvement was associated with positive changes in the life quality. No cases of the disease aggravation were recorded. Complications requiring antibiotic treatment or hospitalization were not observed during the followup. There were no adverse events recorded due to the drug use. No deviations in the laboratory indices were stated. Ergoferon is a new safe drug for the treatment of influenza. Its clinical efficacy was comparable to that of oseltamivir. The therapeutic effects of the drug were evident from: significant reduction of the disease severity, duration of febricity and general toxicity and respiratory flu symptoms, lower percentage of the patients with fever for 2 days. The febrile period in most of the patients did not exceed 2 days.

摘要

可供选择的药物种类有限,且病毒对最常用药物具有耐药性,因此需要寻找并引入经证实具有疗效和安全性的新型药物来治疗流感。埃尔戈非龙是一种新型复方药物,含有针对γ干扰素(抗IFNγ)、CD4共受体和组胺的释放活性抗体。该制剂影响抗病毒防御的各个环节,并具有抗炎作用。药物的疗效与其生产过程有关,在此过程中每种成分的初始浓度多次降低会导致特殊释放活性的释放。先前的实验研究表明,抗IFNγ对2009年甲型H1N1大流行性流感病毒具有抗病毒活性,与奥司他韦相当(抑制肺组织中的病毒复制、延长寿命并降低实验动物死亡率)。这项多中心随机临床试验的目的是比较(与奥司他韦相比)埃尔戈非龙治疗成人流感的疗效和安全性。在两个流行季节(2010 - 11年和2011 - 12年)期间,俄罗斯的8个医疗中心对213名有流感样症状的患者进行了检查。纳入标准为:发病后的前48小时;体温≥37.8℃,至少一种常见症状和至少一种呼吸道症状。通过QuickVue快速诊断在52名患者中确诊为流感。23名患者按照治疗方案接受埃尔戈非龙治疗,29名患者接受奥司他韦治疗(每日剂量150毫克)。治疗持续时间为5天。对患者进行了7天的随访。主要终点是治疗2 - 5天体温恢复正常的患者百分比。在治疗的第二天观察到埃尔戈非龙的最大疗效:几乎一半(48%)最初发热的患者体温恢复正常(而接受奥司他韦治疗的患者为28%)。通过 Cochr an - Mantel - Haenszel在治疗的每五天早晚测量体温对两组患者进行比较,发现两组之间存在显著差异(χ2 = 7.1;p = 0.008)。埃尔戈非龙组发热的平均持续时间为2.3±1.2天,奥司他韦组为2.6±1.3天(本研究中奥司他韦的疗效与先前发表的数据相当)。治疗第二天因高热使用退烧药的患者百分比降低了3倍,降至17%(奥司他韦组为41%)。两组患者在治疗第三天常见和呼吸道症状(鼻/喉/胸部)的严重程度均显著降低,大多数患者症状严重程度最低或无流感迹象。临床改善与生活质量的积极变化相关。未记录到疾病加重的病例。在随访期间未观察到需要抗生素治疗或住院的并发症。未记录到因使用该药物引起的不良事件。未提及实验室指标有偏差。埃尔戈非龙是一种治疗流感的新型安全药物。其临床疗效与奥司他韦相当。该药物的治疗效果体现在:疾病严重程度、发热持续时间、全身毒性和呼吸道流感症状显著降低,发热2天的患者百分比降低。大多数患者的发热期不超过2天。

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