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Efficacy and tolerability of bevacizumab in patients with severe Covid-19 #MMPMID33547300
Pang J; Xu F; Aondio G; Li Y; Fumagalli A; Lu M; Valmadre G; Wei J; Bian Y; Canesi M; Damiani G; Zhang Y; Yu D; Chen J; Ji X; Sui W; Wang B; Wu S; Kovacs A; Revera M; Wang H; Jing X; Zhang Y; Chen Y; Cao Y
Nat Commun 2021[Feb]; 12 (1): 814 PMID33547300show ga
On the basis of Covid-19-induced pulmonary pathological and vascular changes, we hypothesize that the anti-vascular endothelial growth factor (VEGF) drug bevacizumab might be beneficial for treating Covid-19 patients. From Feb 15 to April 5, 2020, we conducted a single-arm trial (NCT04275414) and recruited 26 patients from 2-centers (China and Italy) with severe Covid-19, with respiratory rate >/=30 times/min, oxygen saturation =93% with ambient air, or partial arterial oxygen pressure to fraction of inspiration O(2) ratio (PaO(2)/FiO(2)) >100 mmHg and =300 mmHg, and diffuse pneumonia confirmed by chest imaging. Followed up for 28 days. Among these, bevacizumab plus standard care markedly improves the PaO(2)/FiO(2) ratios at days 1 and 7. By day 28, 24 (92%) patients show improvement in oxygen-support status, 17 (65%) patients are discharged, and none show worsen oxygen-support status nor die. Significant reduction of lesion areas/ratios are shown in chest computed tomography (CT) or X-ray within 7 days. Of 14 patients with fever, body temperature normalizes within 72 h in 13 (93%) patients. Relative to comparable controls, bevacizumab shows clinical efficacy by improving oxygenation and shortening oxygen-support duration. Our findings suggest bevacizumab plus standard care is highly beneficial for patients with severe Covid-19. Randomized controlled trial is warranted.