Division of Pharmacy, Centro Hospitalar Conde de São Januário, Health Bureau, Macao SAR Government, China
Correspondence: micmicvongchon@gmail.com
Abstract
Introduction: Cardiovascular diseases (CVDs) are quite prevalent globally, with atherosclerotic being a predominant CVD in Asia. Well-controlled low-density lipoprotein cholesterol (LDL-C) level is crucial in both primary and secondary prevention of these conditions, particularly in patients with chronic kidney disease (CKD). Lipid management in this setting is a major concern for physicians and patients. Here, we report the case of a man with previous hypertension, type 2 diabetes mellitus, dyslipidemia, peripheral artery disease, CKD, heart failure, and coronary artery disease post multiple stent implantations. He was initiated on rosuvastatin treatment, during which he developed rhabdomyolysis, and subsequently received regular hemodialysis. Since the patient was at a very high risk of cardiovascular events and adverse drug reactions, treatment with alirocumab (a proprotein convertase subtilisin / kexin type 9 inhibitor) was initiated for further controlling LDL-C level. Although there is a lack of evidence on the use of alirocumab in patients on hemodialysis, the drug demonstrated a favorable efficacy and safety profile in our patient.
Abstract
The outbreak of Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome (SARS) coronavirus (SARS-CoV-2), has infected and killed millions of people worldwide. It has substantially increased the burden on healthcare system. However, the optimal approach to treatment of COVID-19 is uncertain. “Off-label” use of lopinavir/ritonavir (LPV/r) and interferons, particularly interferon beta (IFN-β), were the most suggested at the early stage. Although the United States National Institutes of Health’s (NIH) COVID-19 guidelines do not recommend the use of both medications for the treatment of COVID-19 in hospitalized patients, their roles in patients with non-severe disease are still unclear. Macau, a famous city for tourism, had 46 COVID-19 confirmed cases as of 2020. In this retrospective review, we summarized clinical and laboratory features of 39 COVID-19 patients admitted in the Centro Hospitalar Conde de São Januário (CHCSJ), of whom all did not receive oxygen therapy or ventilatory support during hospitalization. Of note, 12 (30.8%) of them were asymptomatic. The most common symptoms were fever and cough upon admission. They were all treated with LPV/r ± IFN-β-1b plus supportive care. The mean length of hospitalization was 26.6 (SD ± 12.6) days with LPV/r monotherapy, whereas 27.8 (SD ± 10.1) days with LPV/r/IFN-β-1b combination therapy (p=0.65). The percentage of 28-day negative results for polymerase chain reaction (PCR) test were 67.9% (19 of 28) with monotherapy and 63.6% (7 of 11) with combination therapy (p=0.80). No fatal case was reported and all patients discharged successfully. No beneficial clinical outcome was observed with the addition of IFN-β-1b to LPV/r-based therapy. Further studies are warranted to confirm these findings.