Precision medicine for COVID-19: a call for better clinical trials

The agents have variable mechanism of actions, ranging from inhibition of entry of viral particles into the cells and inhibition of various enzymes associated with viral replication to an improvement of the host immune response to the virus [3]. Homogeneity in selecting patients can be guided not on...

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Bibliographic Details
Published in:Critical care (London, England) England), 2020-06, Vol.24 (1), p.282-282, Article 282
Main Authors: Shrestha, Gentle Sunder, Paneru, Hem Raj, Vincent, Jean-Louis
Format: Article
Language:English
Subjects:
Clinical trials
Clinical Trials as Topic - standards
Coronavirus Infections - epidemiology
Coronavirus Infections - therapy
Coronaviruses
COVID-19
Critical care
Darunavir
Design
Disease transmission
Humans
Monoclonal antibodies
Pandemics
Patients
Pneumonia
Pneumonia, Viral - epidemiology
Pneumonia, Viral - therapy
Precision Medicine
Sarilumab
Sepsis
Vaccines
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Summary:The agents have variable mechanism of actions, ranging from inhibition of entry of viral particles into the cells and inhibition of various enzymes associated with viral replication to an improvement of the host immune response to the virus [3]. Homogeneity in selecting patients can be guided not only by advanced molecular testing for biomarkers but also by the simple tools like clinical features of patients including clinical stage of disease, vital signs measurement, laboratory data, ventilator settings, and other types of organ dysfunction. SEE PDF] Some examples of precision medicine-guided trial designs may be, and not limited to: * Trial of hydroxychloroquine in individuals at high risk of acquiring infection, but not yet infected, those without cardiovascular disease, with normal QTc, avoiding concurrent medications that can prolong QT interval, cautiously selected dosing, dose adjusted to renal function, avoiding and rapidly correcting dyslectrolytemia [3, 7]. * Trial of anti-inflammatory agents like corticosteroids or anti-cytokine agents like tocilizumab in patients with or at risk of endothelial dysfunction or endotheliitis or in patients with an elevated level of interleukin-6 [3, 8]. * Trial of anticoagulation in patients with sepsis-induced coagulopathy or marked elevation of d-dimer and without contraindication for anticoagulation [1, 9].
ISSN:1364-8535
1466-609X
1364-8535
1366-609X
DOI:10.1186/s13054-020-03002-5