COVID-19 Internal Medicine Units (Clinica Medica, Medicina Interna Universitaria, Medicina Ospedaliera 2), Azienda Ospedaliero-Universitaria "S. Anna", Ferrara, Italy.
Eur Rev Med Pharmacol Sci. 2020 Aug;24(15):8219-8225. doi: 10.26355/eurrev_202008_22511.
At the end of 2019, the Novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), spread rapidly from China to the whole world. Circadian rhythms can play crucial role in the complex interplay between viruses and organisms, and temporized schedules (chronotherapy) have been positively tested in several medical diseases. We aimed to compare the possible effects of a morning vs. evening antiviral administration in COVID patients.
We retrospectively evaluated all patients admitted to COVID internal medicine units with confirmed SARS-CoV-2 infection, and treated with darunavir-ritonavir (single daily dose, for seven days). Age, sex, length of stay (LOS), pharmacological treatment, and timing of antiviral administration (morning or evening), were recorded. Outcome indicators were death or LOS, and laboratory parameters, e.g., variations in C-reactive protein (CRP) levels, ratio of arterial oxygen partial pressure (PaO2, mmHg) to fractional inspired oxygen (FiO2) (PaO2/FiO2), and leucocyte count.
The total sample consisted of 151 patients, 33 (21.8%) of whom were selected for antiviral treatment. The mean age was 61.8±18.3 years, 17 (51.5%) were male, and the mean LOS was 13.4±8.6 days. Nine patients (27.3%) had their antiviral administration in the morning, and 24 (72.7%) had antiviral administration in the evening. No fatalities occurred. Despite the extremely limited sample size, morning group subjects showed a significant difference in CRP variation, compared to that in evening group subjects (-65.82±33.26 vs. 83.32±304.89, respectively, p<0.032). No significant differences were found for other parameters.
This report is the first study evaluating temporized morning vs. evening antiviral administration in SARS-CoV-2 patients. The morning regimen was associated with a significant reduction in CRP values. Further confirmations with larger and multicenter samples of patients could reveal novel potentially useful insights.
2019 年底，新型严重急性呼吸综合征冠状病毒-2（SARS-CoV-2）从中国迅速传播到全世界。昼夜节律在病毒与生物体的复杂相互作用中起着至关重要的作用，时间疗法（chronotherapy）已在多种医学疾病中得到积极验证。我们旨在比较 COVID 患者中早晨与晚上抗病毒治疗的可能效果。
我们回顾性评估了所有因确诊 SARS-CoV-2 感染而入住 COVID 内科病房的患者，并接受了达芦那韦-利托那韦（每日一次剂量，连用七天）治疗。记录了年龄、性别、住院时间（LOS）、药物治疗以及抗病毒治疗（早晨或晚上）的时间。主要观察终点为死亡或 LOS，以及实验室参数，如 C 反应蛋白（CRP）水平的变化、动脉血氧分压（PaO2，mmHg）与吸入氧分数（FiO2）的比值（PaO2/FiO2）和白细胞计数。
总样本包括 151 例患者，其中 33 例（21.8%）接受了抗病毒治疗。患者平均年龄为 61.8±18.3 岁，17 例（51.5%）为男性，平均 LOS 为 13.4±8.6 天。9 例（27.3%）患者的抗病毒治疗时间在早晨，24 例（72.7%）患者的抗病毒治疗时间在晚上。无死亡病例发生。尽管样本量极小，但与晚上组相比，早晨组的 CRP 变化差异有统计学意义（-65.82±33.26 与 83.32±304.89，p<0.032）。其他参数未发现显著差异。
本报告是第一项评估 SARS-CoV-2 患者定时清晨与傍晚抗病毒治疗的研究。清晨方案与 CRP 值的显著降低相关。进一步用更大样本量和多中心的 COVID 患者验证可能会揭示新的有用见解。
