Macrolide ineffective in hospitalised COVID-19 patients
Azithromycin does not improve survival or other important clinical outcomes in patients admitted to hospital with COVID-19.
Data from almost 8,000 patients in the UK’s RECOVERY trial found deaths occurred at the same rate in patients treated with azithromycin and those receiving usual care (22% v 22%).
Length of hospital stay (10 v 11 days), the probability of discharge alive at 28 days (69% v 68%) and a composite of progression to mechanical ventilation or death (25% v 26%) were also similar in both groups.
Cause-specific mortality, use of ventilation, successful cessation of invasive mechanical ventilation, or need for renal dialysis or haemofiltration were also similar in both groups.
The researchers concluded azithromycin is not effective in patients admitted to hospital with COVID-19 and its use should be restricted to patients where there is a clear antimicrobial indication.
OSA common in patients with atrial fibrillation
Undiagnosed OSA is highly prevalent in a patients hospitalised with atrial fibrillation (AF) and may be missed because of a relative paucity of symptoms, Australian research shows.
A study of 107 patients with AF at two hospitals investigated the prevalence of OSA as detected by a panel of OSA screening tools and polysomnography.Almost two thirds of patients patients (63%) were newly diagnosed with OSA (32% mild, 19% moderate, 12% severe). However the study investigators, from the Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, found that history and screening questionnaires had limited usefulness in detecting OSA because of the lack of symptoms. The best diagnostic accuracy was obtained with oxygen desaturation index (ODI) derived from a level 3 portable sleep study device
The findings suggested that AF management guidelines should include screening for OSA, concluded the study authors in Journal of Clinical Sleep Medicine.
Asthma medication helpful for early COVID-19
In other COVID-19 news, early treatment with inhaled budesonide appears to reduce the need for hospitalisation in people with COVID-19 disease compared to usual care.
The STOIC (STerOids In COVID-19) study, which includes Australian investigators, found that budesonide administration within seven days of the onset of COVID-19 symptoms also reduced recovery time.
Participants allocated to budesonide had a quicker resolution of fever and other symptoms and had fewer persistent symptoms after 28 days.
Findings from the phase 2 randomised study were published on the medRxiv pre-print server.
Dr Sanjay Ramakrishnan from Edith Cowan University and Associate Professor Dan Nicolau, from Queensland University of Technology, are co-lead investigators on the clinical trial.
They concluded that inhaled budesonide reduced the relative risk of requiring urgent care or hospitalisation by 90 per cent in the 28-day study period.
Low dose as-needed ICS-LABA is well tolerated
No new safety signals have been identified with the use of as-needed budesonide-formoterol as anti-inflammatory reliever therapy for patients with asthma.
Data from the SYGMA 1 and 2 studies was used to compare any adverse effects from the low-dose ICS-LABA with those from daily budesonide maintenance or as-needed terbutaline.
The study found AEs were more frequent with the as-needed terbutaline but similar in both the as-needed and maintenance budesonide-formoterol groups. More patients in the terbutaline group also discontinued treatment due to AEs.
There were no clinically relevant differences between treatment groups in the nature or incidence of individual serious AEs and no treatment-related deaths.
The study was published in Drug Safety.