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本文引用的文献

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Tocilizumab in Hospitalized Patients with Severe Covid-19 Pneumonia.托珠单抗治疗重症 COVID-19 肺炎住院患者。
N Engl J Med. 2021 Apr 22;384(16):1503-1516. doi: 10.1056/NEJMoa2028700. Epub 2021 Feb 25.
2
Association of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers With the Risk of Hospitalization and Death in Hypertensive Patients With COVID-19.血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂与 COVID-19 合并高血压患者住院和死亡风险的关系。
J Am Heart Assoc. 2021 Jul 6;10(13):e018086. doi: 10.1161/JAHA.120.018086. Epub 2021 Feb 24.
3
Effect of Hydroxychloroquine in Hospitalized Patients with Covid-19.羟氯喹治疗 COVID-19 住院患者的疗效。
N Engl J Med. 2020 Nov 19;383(21):2030-2040. doi: 10.1056/NEJMoa2022926. Epub 2020 Oct 8.
4
Therapeutic versus prophylactic anticoagulation for severe COVID-19: A randomized phase II clinical trial (HESACOVID).治疗性与预防性抗凝治疗重症 COVID-19:一项随机 II 期临床试验(HESACOVID)。
Thromb Res. 2020 Dec;196:359-366. doi: 10.1016/j.thromres.2020.09.026. Epub 2020 Sep 21.
5
Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.羟考酮治疗对严重 COVID-19 患者死亡率和器官支持的影响:REMAP-CAP COVID-19 皮质类固醇随机临床试验。
JAMA. 2020 Oct 6;324(13):1317-1329. doi: 10.1001/jama.2020.17022.
6
Effect of Dexamethasone on Days Alive and Ventilator-Free in Patients With Moderate or Severe Acute Respiratory Distress Syndrome and COVID-19: The CoDEX Randomized Clinical Trial.地塞米松对中重度 COVID-19 相关急性呼吸窘迫综合征患者存活天数和无呼吸机天数的影响:CoDEX 随机临床试验。
JAMA. 2020 Oct 6;324(13):1307-1316. doi: 10.1001/jama.2020.17021.
7
Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: A Meta-analysis.COVID-19 重症患者全身使用皮质类固醇与死亡率的关联:一项荟萃分析。
JAMA. 2020 Oct 6;324(13):1330-1341. doi: 10.1001/jama.2020.17023.
8
Effect of Hydrocortisone on 21-Day Mortality or Respiratory Support Among Critically Ill Patients With COVID-19: A Randomized Clinical Trial.COVID-19 重症患者中氢化可的松对 21 天死亡率或呼吸支持的影响:一项随机临床试验。
JAMA. 2020 Oct 6;324(13):1298-1306. doi: 10.1001/jama.2020.16761.
9
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J Am Coll Cardiol. 2020 Oct 20;76(16):1815-1826. doi: 10.1016/j.jacc.2020.08.041. Epub 2020 Aug 26.
10
Tocilizumab in patients with severe COVID-19: a retrospective cohort study.托珠单抗治疗重症新型冠状病毒肺炎患者:一项回顾性队列研究
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COVID-19 期间的药物使用:近期证据回顾。

Medication use during COVID-19: Review of recent evidence.

机构信息

Medical student in the Faculty of Medicine at the University of British Columbia in Vancouver.

Assistant Professor in the Leslie Dan Faculty of Pharmacy at the University of Toronto in Ontario.

出版信息

Can Fam Physician. 2021 Mar;67(3):171-179. doi: 10.46747/cfp.6703171.

DOI:10.46747/cfp.6703171
PMID:33727376
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7963004/
Abstract

OBJECTIVE

To keep health care providers, in response to the ongoing coronavirus disease 2019 (COVID-19) pandemic, informed about the medications that have been proposed to treat the disease and the evidence supporting their use.

QUALITY OF EVIDENCE

A narrative review of medications most widely used to treat COVID-19 was conducted, outlining the best available evidence for each pharmacologic treatment to date. Searches were performed in PubMed, EMBASE, and MEDLINE using key words and , as well as related terms. Relevant research studies conducted in human populations and cases specific to patients with COVID-19 were included, as were relevant hand-searched papers and reviews. Only articles in English and Chinese were included.

MAIN MESSAGE

While current management of patients with COVID-19 largely involves supportive care, without a widely available vaccine, practitioners have also resorted to repurposing medications used for other indications. This has caused considerable controversy, as many of these treatments have limited clinical evidence supporting their use and therefore pose implications for patient safety, drug access, and public health. For instance, medications such as hydroxychloroquine and chloroquine, lopinavir-ritonavir, nonsteroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers gained widespread media attention owing to hype, misinformation, or misinterpretation of research evidence.

CONCLUSION

Given the severity of the pandemic and the potential broad effects of implementing safe and effective treatment, this article provides a narrative review of the current evidence behind the most widely used medications to treat COVID-19 in order to enable health care practitioners to make informed decisions in the care of patients with this life-threatening disease.

摘要

目的

使医疗保健提供者能够了解针对当前正在流行的 2019 冠状病毒病(COVID-19)提出的治疗该疾病的药物以及支持其使用的证据。

证据质量

对用于治疗 COVID-19 的最广泛使用的药物进行了叙述性综述,概述了迄今为止每种药物治疗的最佳现有证据。在 PubMed、EMBASE 和 MEDLINE 中使用关键词 和 ,以及相关术语进行了搜索。纳入了在人类人群中进行的相关研究以及针对 COVID-19 患者的具体病例研究,还纳入了相关的手工搜索论文和综述。仅纳入了英文和中文的文章。

主要信息

尽管目前 COVID-19 患者的管理主要涉及支持性护理,但由于尚未广泛提供疫苗,从业者也转而重新使用用于其他适应证的药物。这引起了相当大的争议,因为这些治疗方法中的许多方法的临床证据有限,因此对患者安全、药物获取和公共卫生构成了影响。例如,羟氯喹和氯喹、洛匹那韦-利托那韦、非甾体抗炎药、血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂等药物由于炒作、错误信息或对研究证据的错误解释而引起了广泛的媒体关注。

结论

鉴于大流行的严重程度以及实施安全有效的治疗方法的潜在广泛影响,本文对用于治疗 COVID-19 的最广泛使用的药物的现有证据进行了叙述性综述,以便医疗保健从业者能够在治疗这种危及生命的疾病时做出明智的决策。