Evaluation of anakinra in the management of patients with COVID-19 infection: A randomized clinical trial

Background: The global COVID-19 pandemic led to substantial clinical and economic outcomes with catastrophic consequences. While the majority of cases has mild to moderate disease, minority of patients progress into severe disease secondary to the stimulation of the immune response. The hyperinflammatory state contributes towards progression into multi-organ failure which necessitates suppressive therapy with variable outcomes. This study aims to explore the safety and efficacy of anakinra in COVID-19 patients with severe disease leading to cytokine release syndromes. Methods: In this open-label, multi-center, randomized clinical trial, patients with confirmed COVID-19 infection with evidence of respiratory distress and signs of cytokine release syndrome were randomized in 1:1 ratio to receive either standard of care (SOC) or anakinra (100 mg subcutaneously every 12 h for 3 days then 100 mg subcutaneously once daily for 4 days) in addition to SOC. The primary outcome was treatment success at day 14 as defined by the WHO clinical progression score of ≤3. Primary analysis was based upon intention-to-treat population, with value of p of <0.05. Results: Out 327 patients screened for eligibility, 80 patients were recruited for the study. The mean age was 49.9 years (SD = 11.7), with male predominance at 82.5% (n = 66). The primary outcome was not statistically different (87.5% (n = 35) in anakinra group vs. 92.5% (n = 37) in SOC group, p = 0.712; OR = 1.762 (95%CI: 0.39–7.93). The majority of reported adverse events were mild in severity and not related to the study treatment. Elevated aspartate aminotransferase was the only significant adverse event which was not associated with discontinuation of therapy. Conclusion: In patients with severe COVID-19 infection, the addition of anakinra to SOC treatment was safe but was not associated with significant improvement according to the WHO clinical progression scale. Further studies are warranted to explore patients’ subgroups characteristics that might benefit from administered therapy. Clinical Trial Registration: Trial registration at ClinicalTrials.gov, identifier: NCT04643678.This study was funded by the Medical Research Center at Hamad Medical Corporation, Qatar (MRC-01-20-1095)

HIV case reporting and HIV treatment outcomes in Qatar

AimThe aim of the paper is to provide an overview of available HIV case reporting and treatment data for in Qatar for the period 2015–2020.MethodsHIV case reporting data were analyzed by sex and mode of transmission. To construct HIV care continuum from the data available, we obtained information on the total number of HIV diagnosed patients on antiretroviral treatment (ART) between January 1st 2015 and December 31st 2020, number of patients on ART who had an HIV viral load test and the number who were virally suppressed (defined as having the viral load of less than 1,000 copies/mL).ResultsA total of 515 HIV cases were reported to the Ministry of Public Health since beginning of reporting in 1986, and that included Qatari nationals and expatriate residents diagnosed in Qatar. There was an increase in the annual number of newly reported HIV cases from 16 cases in 2015 (of these, 14 were males) to 58 cases in 2020 (of these, 54 were males). The total number of HIV diagnosed people on ART increased from 99 in 2015 to 213 in 2020. During 2020 the overall viral load testing coverage and viral load suppression among those tested for viral load in men were 72.5% and 93.1%, respectively, while in women these values were 60.4% and 84.4%, respectively.ConclusionDue to increase in newly reported HIV cases, there is a need to develop an effective HIV strategic information system in Qatar and data-driven and targeted national HIV response

Clinical manifestations and outcome of Mpox infection in Qatar: An observational study during the 2022 outbreak

Mpox emerged in May 2022 as a global outbreak, mostly in hitherto non-endemic countries. To describe the epidemiological and clinical characteristics of mpox in Qatar, data were retrospectively retrieved for all laboratory-confirmed mpox cases diagnosed in Qatar between May and November 2022. Twelve cases were identified; of which 10 were males, and the median age was 33.5 years (IQR 24.5–37.5). Recent sexual exposure was reported in 9 patients, 6 of which were outside Qatar. Seven individuals reported exclusive heterosexual contact. Pleomorphic skin lesions were present in all cases, with anogenital involvement in 11. Fever (7/12) and lymphadenopathy (4/12) were relatively common. All cases were HIV-negative. The majority of cases had an uncomplicated and self-limiting clinical illness. In conclusion, the majority of early mpox infections in Qatar were purportedly acquired through heterosexual contact, primarily among middle-aged men. The clinical course was mostly uneventful. In the absence of active case finding and the mild and self-limiting nature of the clinical illness, undetected community transmission cannot be ruled out

Psychological impact of the COVID-19 pandemic within institutional quarantine and isolation centres and its sociodemographic correlates in Qatar: A cross-sectional study

Setting The State of Qatar has had one of the highest COVID-19 infection rates globally and has used state-managed quarantine and isolation centres to limit the spread of infection. Quarantine and isolation have been shown to negatively affect the mental health of individuals. Qatar has a unique population, with around 90% of the population being economic migrants and a majority being blue-collar workers and labourers. Objectives This study was carried out to evaluate the psychological impact of institutional isolation and quarantine during the COVID-19 pandemic outbreak in Qatar. The study also explored the sociodemographic correlates of this psychological impact. Design, participants and intervention A cross-sectional study involving 748 consenting individuals in institutional quarantine and isolation in Qatar during the months of June and July 2020 was carried out. Relevant sociodemographic data along with depressive and anxiety symptomatology scores were collected from consenting adults at these facilities. Results 37.4% (n=270) of respondents reported depressive symptoms and 25.9% (n=189) reported anxiety symptoms. The scores were higher for individuals in isolation facilities and higher for migrants from poor socioeconomic group (p<0.001 for both). Within this group, although worries about infection were widely reported, lack of contact with the family was cited as one of the most important sources of distress. Respondents reported that contact with the family and reliable information were important factors that helped during the duration of isolation and quarantine. Conclusions Our study reported significantly elevated scores for depression and anxiety during institutional quarantine, which is in keeping with emerging evidence. However, in contrast to other studies reporting mostly from native populations, this study of a population with an overwhelming majority of immigrants highlights the special mental health needs of this specific group and can inform future healthcare policies.Scopu

Adding colchicine to tocilizumab in hospitalized patients with severe COVID-19 pneumonia: An open-label randomized controlled trial

Introduction: Colchicine acts upstream in the cytokines cascade by inhibiting the nod-like receptor protein 3 (NLRP3) inflammasome while interleukin 6 (IL-6) receptor antagonists, such as tocilizumab, block the end result of the cytokines cascade. Hence, adding colchicine to tocilizumab with the aim of blocking the early and end products of the cytokines cascade, might reduce the risk of developing cytokine storm. Methods and analysis: We aim to conduct an open-label randomized controlled trial to evaluate the efficacy and safety of adding colchicine to tocilizumab among patients with severe COVID-19 pneumonia to reduce the rate of invasive mechanical ventilation and mortality. We will include patients with severe COVID-19 pneumonia who received tocilizumab according to our local guidelines. Enrolled patients will be then randomized in 1:1 to colchicine versus no colchicine. Patients will be followed up for 30 days. The primary outcome is the rate of invasive mechanical ventilation and will be determined using Cox proportional hazard model. Discussion: Given colchicine's ease of use, low cost, good safety profile, and having different anti-inflammatory mechanism of action than other IL-6 blockade, colchicine might serve as a potential anti-inflammatory agent among patients with severe COVID-19 pneumonia. This study will provide valuable insights on the use of colchicine in severe COVID-19 when added to IL-6 antagonists. Ethics and dissemination: The Medical Research Center and Institutional Review Board at Hamad Medical Corporation in Qatar approved the study protocol (MRC-01-21-299). Results of the analysis will be submitted for publication in a peer-reviewed journal. 2022 Lippincott Williams and Wilkins. All rights reserved.Scopu

Soluble ACE2 and angiotensin II levels are modulated in hypertensive COVID-19 patients treated with different antihypertension drugs.

This study examines the effect of antihypertensive drugs on ACE2 and Angiotensin II levels in hypertensive COVID-19 patients. Hypertension is a common comorbidity among severe COVID-19 patients. ACE2 expression can be modulated by antihypertensive drugs such as ACEis and ARBs, which may affect COVID-19's prognosis. BB and CCB reduce mortality, according to some evidence. Their effect on circulating levels of ACE2 and angiotensin II, as well as the severity of COVID-19, is less well studied. The clinical data were collected from 200 patients in four different antihypertensive medication classes (ACEi, ARB, BB, and CCB). Angiotensin II and ACE2 levels were determined using standard ELISA kits. ACE2, angiotensin II, and other clinical indices were evaluated by linear regression models. Patients on ACEi ( = 57), ARB ( = 68), BB ( = 15), or CCB ( = 30) in this study had mild ( = 76), moderate ( = 76), or severe ( = 52) COVID-19. ACE2 levels were higher in COVID-19 patients with severe disease ( = 0.04) than mild ( = 0.07) and moderate ( = 0.007). The length of hospital stay is correlated with ACE2 levels ( = 0.3,  = 0.003). Angiotensin II levels decreased with severity ( = 0.04). Higher ACE2 levels are associated with higher CRP and D-dimer levels. Elevated Angiotensin II was associated with low levels of CRP, D-dimer, and troponin. ACE2 levels increase with disease severity in patients taking an ARB ( = 0.01), patients taking ACEi, the degree of disease severity was associated with a decrease in angiotensin II. BB patients had the lowest disease severity. We found different levels of soluble ACE2, and angiotensin II are observed among COVID-19 patients taking different antihypertensive medications and exhibiting varying levels of disease severity. COVID-19 severity increases with elevated ACE2 levels and lower angiotensin II levels indicating that BB treatment reduces severity regardless of levels of ACE2 and angiotensin II.Open Access funding is provided by the Qatar National Library. This report was made possible by an RRC award [RRC-2-076] from the Qatar National Research Fund (a member of The Qatar Foundation). The statements made herein are solely the responsibility of the authors. We would like to acknowledge Qatar BioBank for helping with the logistics of the collected samples, Prof. Nahla Afifi, Dr. Marwa A. El Deeb, and Ms. Sidra Abdulshakoor. The publication of this paper is covered by Qatar National Library