新冠病毒治疗药物奈玛特韦片/利托那韦片的作用机制和临床研究情况

目的 分析奈玛特韦片/利托那韦片(Paxlovid^TM,帕克洛维)的作用机制和临床研究情况,为其合理用药提供参考。方法 系统检索美国食品药品监督管理局(FDA)官方网站、Pubmed、Embase、中国期刊全文数据库(CNKI)、中国生物医学文献数据(CBM)、万方数据库(Wanfang)中奈玛特韦片/利托那韦片相关文献,汇总相关的基本信息、作用机制、药动学、药效学、临床疗效评价、安全性、药物相互作用、特殊人群用药等。结果与结论 奈玛特韦片/利托那韦片通过作用于SARS-CoV-2主要蛋白酶,抑制该酶介导的蛋白质前体加工,从而阻止病毒复制。基于目前的试验结果,奈玛特韦片/利托那韦片干预可大大降低轻、中症COVID-19成年患者的住院率及病死率。对于该药是否适用于所有COVID-19患者的临床治疗,还需要更多研究论证。     

[Translated article] Practical Guide to New Treatments for SARS-CoV-2 Infection in Dermatology Patients Being Treated With Common Immunomodulators

Immunosuppressants and immunomodulators are widely used in dermatology. Some of these drugs, however, can increase the risk of severe COVID-19. New antivirals against SARS-CoV-2 have been shown to reduce progression to COVID-19 pneumonia in susceptible patients, but their availability is limited. On May 23, 2022, the Spanish Agency for Medicines and Medical Devices (AEMPS) updated its priority eligibility criteria for SARS-CoV-2 antiviral therapy. In this practical guide, we review the indications for these new drugs and provide guidance on which patients with mild to moderate COVID might benefit from their use in dermatology.     

Guía práctica de las nuevas alternativas terapéuticas frente a SARS-CoV-2 en pacientes con inmunomoduladores de uso frecuente en dermatología

Immunosuppressants and immunomodulators are widely used in dermatology. Some of these drugs, however, can increase the risk of severe COVID-19. New antivirals against SARS-CoV-2 have been shown to reduce progression to COVID-19 pneumonia in susceptible patients, but their availability is limited. On May 23, 2022, the Spanish Agency for Medicines and Medical Devices (AEMPS) updated its priority eligibility criteria for SARS-CoV-2 antiviral therapy. In this practical guide, we review the indications for these new drugs and provide guidance on which patients with mild to moderate COVID might benefit from their use in dermatology.     

Etiopathogenic theories about long COVID

The main etiopathogenic theories of long coronavirus disease (COVID) are listed and a conjunction of them is carried out with the objective of deciphering the pathophysiology of the entity, finally the main lines of treatment existing in real life are discussed (Paxlovid, use of antibiotics in dysbiosis, triple anticoagulant therapy, temelimab).     

The efficacy of Paxlovid against COVID-19 is the result of the tight molecular docking between Mpro and antiviral drugs (nirmatrelvir and ritonavir)

PurposeCurrently, a number of medications for coronavirus disease 2019 (COVID-19) treatment are tested in clinical trials; however, credible clinical studies are becoming increasingly difficult to come by. Paxlovid is a ritonavir-boosted nirmatrelvir drug that the U.S. Food and Drug Administration (FDA) authorized for the treatment of COVID-19.This study aimed to demonstrate the interaction of nirmatrelvir and ritonavir on the active site of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) main protease (M^pro).Materials and methodsTo locate the optimal docking between M^pro and antiviral drugs, and to conduct dynamic simulations between atoms in the fusion areas, various bioinformatics and mathematical equations were applied.ResultsAccording to the docking data, nirmatrelvir has a stronger interaction with M^pro than ritonavir, which has more multiple bonds. Molecular docking of antiviral drugs such as Paxlovid has a significant impact on the treatment of COVID-19 virus.ConclusionsAccording to this study, Paxlovid may work on new strains, including Omicron, because the M^pro mutation P132H in the Omicron variant has no direct effect on the protein.