Understanding the Potential Impact of Different Drug Properties on Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Transmission and Disease Burden: A Modelling Analysis

被引：6

作者：

Whittaker, Charles ^{[1
]}

Watson, Oliver J. ^{[1
]}

Alvarez-Moreno, Carlos ^{[2
]}

Angkasekwinai, Nasikarn ^{[3
]}

Boonyasiri, Adhiratha ^{[4
]}

Carlos Triana, Luis ^{[5
]}

Chanda, Duncan ^{[6
,7
]}

Charoenpong, Lantharita ^{[8
]}

Chayakulkeeree, Methee ^{[3
]}

Cooke, Graham S. ^{[9
,10
]}

Croda, Julio ^{[11
,12
,13
]}

Cucunuba, Zulma M. ^{[1
,14
]}

Djaafara, Bimandra A. ^{[1
,15
]}

Estofolete, Cassia F. ^{[16
]}

Grillet, Maria-Eugenia ^{[17
]}

Faria, Nuno R. ^{[1
,18
,19
,20
]}

Figueiredo Costa, Silvia ^{[21
]}

Forero-Pena, David A. ^{[22
]}

Gibb, Diana M. ^{[23
]}

Gordon, Anthony C. ^{[24
]}

Hamers, Raph L. ^{[15
,25
]}

Hamlet, Arran ^{[1
]}

Irawany, Vera ^{[26
]}

Jitmuang, Anupop ^{[3
]}

Keurueangkul, Nukool ^{[27
]}

Kimani, Teresia Njoki ^{[28
]}

Lampo, Margarita ^{[29
]}

Levin, Anna S. ^{[30
]}

Lopardo, Gustavo ^{[31
]}

Mustafa, Rima ^{[32
]}

Nayagam, Shevanthi ^{[1
]}

Ngamprasertchai, Thundon ^{[33
]}

Njeri, Ng'ang'a Irene Hannah ^{[34
]}

Nogueira, Mauricio L. ^{[16
]}

Ortiz-Prado, Esteban ^{[35
]}

Perroud, Mauricio W., Jr. ^{[36
]}

Phillips, Andrew N. ^{[37
]}

Promsin, Panuwat ^{[38
]}

Qavi, Ambar ^{[39
]}

Rodger, Alison J. ^{[37
]}

Sabino, Ester C. ^{[40
]}

Sangkaew, Sorawat ^{[41
]}

Sari, Djayanti ^{[42
]}

Sirijatuphat, Rujipas ^{[3
]}

Sposito, Andrei C. ^{[43
]}

Srisangthong, Pratthana ^{[44
]}

Thompson, Hayley A. ^{[1
]}

Udwadia, Zarir ^{[45
]}

Valderrama-Beltran, Sandra ^{[46
]}

Winskill, Peter ^{[1
]}

机构：

[1] Imperial Coll London, MRC Ctr Global Infect Dis Anal, London, England

[2] Univ Nacl Colombia, Clin Univ Colombia, Clin Colsanitas, Fac Med, Bogota, Colombia

[3] Mahidol Univ, Siriraj Hosp, Fac Med, Div Infect Dis & Trop Med,Dept Med, Bangkok, Thailand

[4] Mahidol Univ, Siriraj Hosp, Fac Med, Bangkok, Thailand

[5] Pontificia Univ Javeriana, Hosp Univ San Ignacio, Bogota, Colombia

[6] Univ Teaching Hosp, Adult Infect Dis Ctr, Lusaka, Zambia

[7] Univ Zambia, Dept Internal Med, Sch Med, Lusaka, Zambia

[8] Bamrasnaradura Infect Dis Inst, Minist Publ Hlth, Dept Dis Control, Nonthaburi, Thailand

[9] Imperial Coll London, Dept Infect Dis, London, England

[10] Imperial Coll NHS Trust, NIHR Biomed Res Ctr, London, England

[11] Fundacao Oswaldo Cruz, Campo Grande, MS, Brazil

[12] Univ Fed Mato Grosso do Sul, Sch Med, Campo Grande, Brazil

[13] Yale Sch Publ Hlth, New Haven, CT USA

[14] Pontificia Univ Javeriana, Fac Med, Dept Epidmiol Clin & Bioestadist, Bogota, Colombia

[15] Eijkman Oxford Clin Res Unit, Jakarta, Indonesia

[16] Fac Med Sao Jose Rio Preto FAMERP, Sao Jose Do Rio Preto, Brazil

[17] Univ Cent Venezuela, Fac Ciencias, Inst Zool & Ecol Trop, Caracas, Venezuela

[18] Univ Sao Paulo, Dept Molestias Infecciosas & Parasitarias, Sao Paulo, Brazil

[19] Univ Sao Paulo, Inst Med Trop, Fac Med, Sao Paulo, Brazil

[20] Univ Oxford, Dept Zool, Oxford, England

[21] Univ Sao Paulo, Hosp Clin, Fac Med, Sao Paulo, Brazil

[22] Biomed Res & Therapeut Vaccines Inst, Ciudad Bolivar, Ciudad Bolivar, Venezuela

[23] UCL, MRC Clin Trials Unit, London, England

[24] Imperial Coll London, Div Anaesthet Pain Med & Intens Care, London, England

[25] Univ Oxford, Vtr Tropical Med & Global Hlth, Nuffield Dept Med, Oxford, England

[26] Univ Indonesia, Fatmawati Gen Hosp, Fac Med, Jakarta, Indonesia

[27] Samutprakan Hosp, Bangkok, Thailand

[28] Kenyan Minist Hlth, Nairobi, Kenya

[29] Inst Venezolano Invest Cient, Caracas, Venezuela

[30] Univ Sao Paulo, Fac Med, Dept Infect Dis, Sao Paulo, Brazil

[31] Hosp Bernardo Houssay, Buenos Aires, DF, Argentina

[32] Imperial Coll London, Dept Epidemiol & Biostat, London, England

[33] Mahidol Univ, Fac Trop Med, Dept Clin Trop Med, Bangkok, Thailand

[34] Kenyan Minist Hlth, Kiambu Cty, Kenya

[35] Univ Amer, OneHlth Global Res Grp, Quito, Ecuador

[36] Univ Estadual Campinas, Sch Med Sci, Campinas, Brazil

[37] UCL, Inst Global Hlth, London, England

[38] Mahidol Univ, Siriraj Hosp, Fac Med, Crit Care Div,Dept Med, Bangkok, Thailand

[39] Imperial Coll London, Sch Public Hlth, London, England

[40] Univ Sao Paulo, Fac Med, Inst Med Trop, Sao Paulo, Brazil

[41] Imperial Coll London, Fac Med, Dept Infect Dis, Sect Adult Infect Dis, London, England

[42] Publ Hlth & Nursing Univ Gadjah Mada, Publ Hosp Dr Sardjito, Fac Med, Dept Anesthesiol & Intens Theraphy, Yogyakarta, Indonesia

[43] Univ Estadual Campinas, Atherosclerosis & Vasc Biol Lab, Campinas, Brazil

[44] Bangkok Christian Hosp, Bangkok, Thailand

[45] Hinduja Hosp & Res Ctr, Mumbai, Maharashtra, India

[46] Pontificia Univ Javeriana, Hosp Univ San Ignacio, Sch Med, Div Infect Diseases, Bogota, Colombia

来源：

CLINICAL INFECTIOUS DISEASES | 2022年 / 75卷 / 01期

基金：

美国国家卫生研究院; 英国医学研究理事会; 英国惠康基金; 比尔及梅琳达.盖茨基金会;

关键词：

SARS-CoV-2; COVID-19; epidemiology; therapeutics; modelling; COVID-19; ACCESS; CARE;

D O I：

10.1093/cid/ciab837

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Coronavirus disease 2019 (COVID-19) drug development to date has focused on reducing deaths among hospitalized patients, but greater public-health impact could come from drugs delivered to outpatients early in the course of disease, and that prevent hospitalization and/or onwards transmission. Background The public health impact of the coronavirus disease 2019 (COVID-19) pandemic has motivated a rapid search for potential therapeutics, with some key successes. However, the potential impact of different treatments, and consequently research and procurement priorities, have not been clear. Methods Using a mathematical model of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission, COVID-19 disease and clinical care, we explore the public-health impact of different potential therapeutics, under a range of scenarios varying healthcare capacity, epidemic trajectories; and drug efficacy in the absence of supportive care. Results The impact of drugs like dexamethasone (delivered to the most critically-ill in hospital and whose therapeutic benefit is expected to depend on the availability of supportive care such as oxygen and mechanical ventilation) is likely to be limited in settings where healthcare capacity is lowest or where uncontrolled epidemics result in hospitals being overwhelmed. As such, it may avert 22% of deaths in high-income countries but only 8% in low-income countries (assuming R = 1.35). Therapeutics for different patient populations (those not in hospital, early in the course of infection) and types of benefit (reducing disease severity or infectiousness, preventing hospitalization) could have much greater benefits, particularly in resource-poor settings facing large epidemics. Conclusions Advances in the treatment of COVID-19 to date have been focused on hospitalized-patients and predicated on an assumption of adequate access to supportive care. Therapeutics delivered earlier in the course of infection that reduce the need for healthcare or reduce infectiousness could have significant impact, and research into their efficacy and means of delivery should be a priority.

引用

页码：E224 / E233

页数：10

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