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Impact of Anti-angiogenic Drugs on Severity of COVID-19 in Patients with Non-Small Cell Lung Cancer

Peng et al., Technology in Cancer Research & Treatment, doi:10.1177/15330338241248573
Jan 2024  
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Mortality -79% Improvement Relative Risk Paxlovid for COVID-19  Peng et al.  LATE TREATMENT Is late treatment with paxlovid beneficial for COVID-19? Retrospective 166 patients in China (December 2022 - January 2023) Higher mortality with paxlovid (not stat. sig., p=0.42) c19early.org Peng et al., Technology in Cancer Rese.., Jan 2024 Favorspaxlovid Favorscontrol 0 0.5 1 1.5 2+
Retrospective 166 hospitalized NSCLC patients with COVID-19 showing no significant difference in mortality with paxlovid or azvudine in univariate analysis.
Resistance. Variants may be resistant to paxlovid1-3. Use may promote the emergence of variants that weaken host immunity and potentially contribute to long COVID4.
Confounding by contraindication. Hoertel et al. find that over 50% of patients that died had a contraindication for the use of Paxlovid5. Retrospective studies that do not exclude contraindicated patients may significantly overestimate efficacy.
Black box warning. The FDA notes that "severe, life-threatening, and/or fatal adverse reactions due to drug interactions have been reported in patients treated with paxlovid"6.
AKI. Kamo et al. show significantly increased risk of acute kidney injury.
This study is excluded in the after exclusion results of meta analysis: unadjusted results with no group details.
Study covers paxlovid and azvudine.
risk of death, 79.0% higher, OR 1.79, p = 0.42, treatment 21, control 145, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Peng et al., 31 Jan 2024, retrospective, China, peer-reviewed, 8 authors, study period 12 December, 2022 - 15 January, 2023. Contact: lzh202021@126.com, clmedic@126.com.
This PaperPaxlovidAll
Impact of Anti-angiogenic Drugs on Severity of COVID-19 in Patients with Non-Small Cell Lung Cancer
Sujuan Peng, Hongxiang Huang, Jinhong Chen, Xinjing Ding, Xie Zhu, Yangyang Liu, Li Chen, Zhihui Lu
Technology in Cancer Research & Treatment, doi:10.1177/15330338241248573
Introduction: The 2019 coronavirus disease (COVID-19) pandemic has reshaped oncology practice, but the impact of antiangiogenic drugs on the severity of COVID-19 in patients with non-small cell lung cancer (NSCLC) remains unclear. Patients and Methods: We carried out a retrospective study involving 166 consecutive patients with NSCLC who were positive for COVID-19, aiming to determine the effects of anti-angiogenic drugs on disease severity, as defined by severe/critical symptoms, intensive care unit (ICU) admission/intubation, and mortality outcomes. Risk factors were identified using univariate and multivariate logistic regression models. Results: Of the participants, 73 had been administered anti-angiogenic drugs (termed the anti-angiogenic therapy (AT) group), while 93 had not (non-AT group). Comparative analyses showed no significant disparity in the rates of severe/ critical symptoms (21.9% vs 35.5%, P = 0.057), ICU admission/intubation (6.8% vs 7.5%, P = 0.867), or death (11.0% vs 9.7%, P = 0.787) between these two groups. However, elevated risk factors for worse outcomes included age ≥ 60 (odds ratio (OR): 2.52, 95% confidence interval (CI): 1.07-5.92), Eastern Cooperative Oncology Group performance status of 2 or higher (OR: 21.29, 95% CI: 4.98-91.01), chronic obstructive pulmonary disease (OR: 7.25, 95% CI: 1.65-31.81), hypertension (OR: 2.98, 95% CI: 1.20-7.39), and use of immunoglobulin (OR: 5.26, 95% CI: 1.06-26.25). Conclusion: Our data suggests that the use of anti-angiogenic drugs may not exacerbate COVID-19 severity in NSCLC patients, indicating their potential safe application even during the pandemic period.
Author Contributions ZL and LC researched literature and conceived the study. JC, XD, XZ, and YL were involved in protocol development, gaining ethical approval, patient recruitment, and data analysis. SP and HH wrote the first draft of the manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript. Declaration of Conflicting Interests The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Research Ethics and Patient Consent The studies involving human participants were reviewed and approved by the research ethics committee of the First Affiliated Hospital of Nanchang University, approval/reference number IIT2023131, with an exemption from informed consent. It was performed in line with the guidelines of the Declaration of Helsinki (revised 2013). This was a retrospective clinical study, and statistical analysis of aggregated, deidentified data did not require specific consent. For this study, the raw data were first extracted from HIS, and patients' ORCID iD Zhihui Lu https://orcid.org/0009-0008-2131-4443 Supplemental Material Supplemental material for this article is available online.
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Late treatment
is less effective
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