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Potential Drug Interaction Between Warfarin, COVID-19 Treatment Reported

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A probable drug interaction was observed in 2 patients taking warfarin who were initiated on remdesivir and dexamethasone for the treatment of COVID-19, according to a case series recently published in the Journal of Pharmacy Practice.

The patients, a 71-year-old man and a 62 year-old-man, both on long-term warfarin therapy, presented to the emergency department with symptoms of COVID-19. Per the report, each patient’s international normalized ratio (INR) was within their specific goal and both denied any diet, lifestyle, or medication changes prior to admission.

“During admission, both patients experienced a marked elevation in INR within 24 to 48 hours of the initiation of remdesivir with dexamethasone for COVID-19 pneumonia directed therapy,” the authors reported. After several days of modification to their warfarin doses, both patients were stable enough for discharge and were counseled to continue monitoring per the instructions of their outpatient pharmacist.


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Although the exact mechanism of action resulting in the interaction between dexamethasone, remdesivir, and warfarin is unknown, the authors concluded that there is potential for interaction based on a calculated Drug Interaction Probability Scale score of 5. “This probable interaction is demonstrated by marked INR elevations within 24 to 48 hours of initiation of the combination in 2 cases with patients with historically stable INR history,” the authors stated.

Reference

Landayan RP, Saint-Felix S, Williams A. Probable interaction between warfarin and the combination of remdesivir with dexamethasone for coronavirus disease 2019 (COVID-19) treatment: A 2 case report. J. Pharm. Pract. [Published online April 5, 2021]. doi: 10.1177/08971900211008623

This article originally appeared on MPR

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Source: https://www.medicalbag.com/home/medicine/warfarin-remdesivir-dexamethasone-drug-interaction-cases/

Covid19

Novavax Says Its COVID Vaccine Is Extremely Effective

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Novavax says its vaccine is 100% effective against the original strain of the coronavirus and had 93% efficacy against more worrisome variants. Alastair Grant/AP hide caption

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Alastair Grant/AP

The first results from a large efficacy study of a new kind of COVID-19 vaccine are now out, and they are good. Very good.

According to Novavax, the vaccine’s manufacturer, it had a 100% efficacy against the original strain of the coronavirus and 93% efficacy against more worrisome variants that have subsequently appeared.

In addition to efficacy, the PREVENT-19 (the PRE-fusion protein subunit Vaccine Efficacy Novavax Trial COVID-19) trial showed the Novavax vaccine was safe for users. Like other COVID-19 vaccines, it caused headaches, chills and muscle aches after injection, but few of these side effects were considered serious or severe.

The study involved 29,960 volunteers in the United States and Mexico. In the study, two-thirds of the volunteers received two shots of the vaccine and one-third received two shots of a placebo.

A total of 77 cases of COVID-19 occurred during the study: 63 in the placebo group and 14 in the vaccine group. According to the Novavax statement describing the results, none of the cases of COVID-19 in the vaccine group were related to the original strain of the virus, hence the 100% efficacy against the original strain.

The breakthrough cases were all caused by the newer, more worrisome variants, and all of the breakthroughs in the vaccine group were mild. By contrast, 10 in the placebo group were considered moderate and four severe. Novavax’s statement did not specify which variants in particular were prevented.

The company says it intends to file for authorization from regulators in the U.S., Europe and the United Kingdom later this summer. Novavax says it will be able to deliver 100 million doses per month by the end of September and 150 million doses per month by the end of the year.

The Novavax vaccine is what’s known as a protein subunit vaccine. All COVID-19 vaccines are based on something called the coronavirus spike protein. That’s the protein that prompts the immune system to make antibodies to the virus.

The vaccines made by Moderna and Pfizer-BioNTech deliver the genetic instructions for the spike protein in the form of messenger-RNA, and the cells of the person receiving the vaccine make the spike protein. The Johnson & Johnson vaccine delivers those instructions using a viral vector, again relying on the vaccine recipient’s cells to make the protein.

Novavax, on the other hand, makes the protein in cell cultures grown in giant bioreactors in manufacturing facilities and delivers the fully formed vaccine along with a substance for priming the immune system in its vaccine.

The Novavax vaccine was one of the vaccines chosen for development as part of Operation Warp Speed. The U.S. government is providing $1.75 billion to the company to support the vaccine’s development.

It’s not clear at this point whether the Food and Drug Administration is prepared to continue to grant emergency use authorizations for COVID-19 vaccines. The FDA may require Novavax to go through the standard licensure process, which can take considerably longer than an EUA.

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Source: https://www.npr.org/sections/coronavirus-live-updates/2021/06/14/1006094476/novavax-says-its-covid-vaccine-is-extremely-effective-efficacy

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Specific antibodies may be effective against multiple coronavirus types

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coronavirus antibody

Patients who have been exposed to a coronavirus may produce a versatile, cross-reactive coronavirus antibody; this may be useful for the eventual development of a broad-acting vaccine.

There are seven human coronavirus types, of which, four cause the common cold, named OC43, HKU1, 229E, and NL63. Most people become infected with at least one of these four coronaviruses at some point in their lives. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is another member of the coronavirus family that causes COVID-19. Infection with the cold-causing coronaviruses may lead to immune memory. This could potentially impact on the immune response to COVID-19.

Research published in Nature Communications compared blood samples of patients collected before the pandemic with those who tested positive for COVID-19. By doing this, the researchers were able to find antibody types that cross reacted with other coronaviruses and SARS-CoV-2.

Cross-reactive coronavirus antibody produced during SARS-CoV-2 infection

It was discovered that a cross-reactive coronavirus antibody is triggered as a direct result of a COVID-19 infection. Dr Raiees Andrabi, a senior author of the paper, stated, “We were able to determine that this type of cross-reactive antibody is likely produced by a memory B cell that’s initially exposed to a coronavirus that causes the common cold, and is then recalled during a COVID-19 infection.”

Memory B cells are long-lived, as they can circulate throughout the body for decades in order to recognise and fight pathogens that they have previously encountered. Memory B cells offer protection against reinfection by rapidly producing specific antibodies. Although the study found evidence of pre-existing cross-reactive memory B cells that were triggered during SARS-CoV-2 infection, there was only weak evidence of pre-existing SARS-CoV-2 cross-reactive serum antibodies in pre-pandemic patient samples. However, the researchers were able to identify one cross-reactive neutralizing antibody specific to the S2 subunit of the spike (S) protein.

How does this antibody work?

The researchers used electron microscopy to visualise how the cross-reactive antibody had the ability to neutralize a range of coronaviruses, including SARS-CoV-2. They found that the antibody typically bound to the S protein of the virus. This area did not seem to vary in different coronavirus strains.

Ge Song, the first author of the paper, stated, “The study highlights how important it is to fully understand the nature of pre-existing immunity, especially in regard to coronaviruses. Earlier exposure to a coronavirus, even a virus that causes mild colds, impacts the nature and level of antibodies produced when more serious coronavirus threats emerge.”

Significance of the study

Since immunological memory forms the basis of vaccination, the findings of this study could potentially lead to the creation of a vaccine or antibody treatment that works against most or all coronaviruses. Pre-existing immunity to endemic coronaviruses should be further investigated to evaluate antibody responses to SARS-CoV-2.

Co-author Dr Dennis Burton explained, “Another deadly coronavirus will likely emerge again in the future – and when it does, we want to be better prepared. Our identification of a cross-reactive antibody against SARS-CoV-2 and the more common coronaviruses is a promising development on the way to a broad-acting vaccine or therapy.”

References:

Song, G., et al. (2021). Cross-reactive serum and memory B-cell responses to spike protein in SARS-CoV-2 and endemic coronavirus infection. Nature Communications, 12(1), 1-10. Retrieved from: https://www.nature.com/articles/s41467-021-23074-3

Versatile coronavirus antibody may be starting point for broader-acting vaccines (2021). EurekAlert! Retrieved from: https://www.eurekalert.org/pub_releases/2021-05/sri-vca052721.php

Quast, I. and Tarlinton, D. (2021). B cell memory: understanding COVID-19. Immunity, 54(2), 205-210. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7826135/

Image by mattthewafflecat from Pixabay 

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Source: https://medicalnewsbulletin.com/specific-antibodies-may-be-effective-against-all-coronavirus-types/

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June 18 Web Event: Asian Immigrant Experiences with Racism, Immigration-related Fears, and the COVID-19 Pandemic

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While the country has collectively experienced health and economic difficulties with the COVID-19 pandemic, certain groups have experienced a disproportionate impact. The Asian American community has had to cope with the burden of pandemic-related racism and, as one of the fastest growing immigrant communities in the nation, immigration-related fears due to policy and regulatory action of recent years. Yet, there is often limited data and focus on the experiences of the expanding Asian immigrant community. KFF is hosting a June 18 public web event to highlight and discuss the complex set of challenges facing Asian immigrants and strategies to address them.

The one-hour interactive web event begins at 12 p.m. ET on Friday, June 18, featuring remarks from U.S. Congresswoman Judy Chu, who has been a leading voice on many of the issues to be discussed and chairs the Congressional Asian Pacific American Caucus. Findings from a new KFF survey of Asian American patients from four community health centers will be released at the event with a panel discussion and audience questions to follow.

Welcome and Keynote Remarks

  • KFF Executive Vice President for Health Policy Larry Levitt (moderator)
  • U.S. Congresswoman and Chair of Congressional Asian Pacific American Caucus The Honorable Judy Chu
  • Chief Program Director of Blue Shield of California Foundation Carolyn Wang Kong

Presentation of Survey Findings

  • KFF Vice President and Director of the Racial Equity and Health Policy Program Samantha Artiga

Panel Discussion

  • Director of Policy and Advocacy at the Association of Asian Pacific Community Health Organizations (AAPCHO) Adam Carbullido
  • Vice President of Strategic Initiatives at International Community Health Services Sunshine Monastrial
  • Chief Deputy of Administration at Asian Health Services Thu Quach

The one-hour event will conclude with a question-and-answer session.

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Source: https://www.kff.org/racial-equity-and-health-policy/event/june-18-web-event-asian-immigrant-experiences-with-racism-immigration-related-fears-and-the-covid-19-pandemic/

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G-7 Leaders Are Set To Pledge 1 Billion Coronavirus Vaccines To Other Countries

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President Biden and British Prime Minister Boris Johnson speak during a bilateral meeting ahead of the G-7 summit on Thursday in Carbis Bay, England. Patrick Semansky/AP hide caption

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Patrick Semansky/AP

World leaders of the Group of Seven are expected to announce today a commitment to share 1 billion of their COVID-19 vaccine resources with the lower income countries struggling to control the spread of the virus.

On Thursday, President Biden announced plans for the U.S. to donate 500 million doses of the Pfizer COVID-19 vaccine globally. The first 200 million are expected to be distributed this year and the rest will follow in 2022.

“Our values call on us to do everything that we can to vaccinate the world against COVID-19,” Biden said of the decision. “It’s also in America’s self-interest. As long as the virus rages elsewhere, there’s a risk of new mutations that could threaten our people.”

Canada, France, Germany, Italy, Japan, the United Kingdom and the U.S. make up the G-7.

The move by the wealthy democracies to share their vaccine stockpiles comes as high vaccination levels in those countries have led to a decline in infections, hospitalizations, and deaths. Enough improvements have been made in the U.S. and U.K. for coronavirus-related protocols to ease.

But in South Asia and Latin America, countries are still struggling to contain the virus.

In late May, the World Health Organization urged wealthier countries to contribute more to COVAX and requested at least 1 billion excess doses by the end of 2021. The COVAX program distributes mass quantities of vaccines to countries based on their populations.

“By donating vaccines to COVAX alongside domestic vaccination programmes, the most at-risk populations can be protected globally, which is instrumental to ending the acute phase of the pandemic, curbing the rise and threat of variants, and accelerating a return to normality,” WHO said in a statement in May.

Biden and the other G-7 leaders are in the U.K. for the first meeting in about two years. The meeting is set to open today at Carbis Bay, a seaside resort in Cornwall in southwest England.

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Source: https://www.npr.org/sections/coronavirus-live-updates/2021/06/11/1005437511/g-7-leaders-to-pledge-1-billion-vaccines-to-countries-struggling-with-covid-19

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