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All Studies   Meta Analysis       

Oral Fluvoxamine With Inhaled Budesonide for Treatment of Early-Onset COVID-19

Reis et al., Annals of Internal Medicine, doi:10.7326/M22-3305, TOGETHER, NCT04727424
Apr 2023  
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Mortality -200% Improvement Relative Risk Hospitalization 12% Hospitalization or ER >6hr.. 50% primary Budesonide  TOGETHER  EARLY TREATMENT  DB RCT Is early treatment with budesonide + fluvoxamine beneficial for COVID-19? Double-blind RCT 1,476 patients in Brazil (January - July 2022) Lower progression with budesonide + fluvoxamine (p=0.037) c19early.org Reis et al., Annals of Internal Medicine, Apr 2023 Favorsbudesonide Favorscontrol 0 0.5 1 1.5 2+
Budesonide for COVID-19
19th treatment shown to reduce risk in April 2021, now with p = 0.0000011 from 15 studies, recognized in 8 countries.
No treatment is 100% effective. Protocols combine treatments.
5,100+ studies for 109 treatments. c19early.org
The TOGETHER trial has extreme COI, impossible data, blinding failure, randomization failure, uncorrected errors, and many protocol violations. Authors do not respond to these issues and they have refused to release the data as promised. Some issues may apply only to specific arms.
Low-risk (1% hospitalization) outpatient RCT with 738 fluvoxamine + budesonide patients and 738 placebo patients, showing significantly lower hospitalization/ER visits with treatment.
The TOGETHER trial has extreme COI, impossible data, blinding failure, randomization failure, uncorrected errors, and many protocol violations. Authors do not respond to these issues and they have refused to release the data as promised. Some issues may apply only to specific arms. For more details see1-6.
Targeted administration to the respiratory tract provides treatment directly to the typical source of initial SARS-CoV-2 infection and replication, and allows for rapid onset of action, higher local drug concentration, and reduced systemic side effects.
Study covers budesonide and fluvoxamine.
risk of death, 200.0% higher, RR 3.00, p = 1.00, treatment 1 of 738 (0.1%), control 0 of 738 (0.0%), continuity correction due to zero event (with reciprocal of the contrasting arm).
risk of hospitalization, 12.5% lower, RR 0.88, p = 1.00, treatment 7 of 738 (0.9%), control 8 of 738 (1.1%), NNT 738.
hospitalization or ER >6hrs, 50.0% lower, RR 0.50, p = 0.04, treatment 13 of 738 (1.8%), control 27 of 738 (3.7%), NNT 53, adjusted per study, day 28, primary outcome.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Reis et al., 17 Apr 2023, Double Blind Randomized Controlled Trial, placebo-controlled, Brazil, peer-reviewed, 35 authors, study period 15 January, 2022 - 6 July, 2022, average treatment delay 3.0 days, this trial uses multiple treatments in the treatment arm (combined with fluvoxamine) - results of individual treatments may vary, trial NCT04727424 (history) (TOGETHER).
This PaperBudesonideAll
Oral Fluvoxamine With Inhaled Budesonide for Treatment of Early-Onset COVID-19 A Randomized Platform Trial
MD, PhD; Gilmar Reis, Eduardo Augusto, Moreira Santos, MD, PhD; Daniela Silva, Medeiros Carla, MD Silva, PhD Lehana Thabane, PhD Vitoria Helena, Souza Campos, ; Thiago, MD Santiago Ferreira, Castilho Vitor Quirino, Ana Santos, Ribeiro Maria, MD Ana Paula Nogueira, Guimaraes Figueiredo, MD Leonardo Almeida, Monteiro Cançado, MD Savassi, PhD Adhemar Dias, MD, PhD Figueiredo Neto, RN Carina Bitarães, RN Aline Cruz Milagres, MD ; Eduardo Diniz Callegari, Maria Izabel Campos Simplicio, Bscpharm ; Luciene, RN, MPH Barra Ribeiro, Rosemary Oliveira, PhD Ofir Harari, MSc Lindsay A Wilson, PhD, MPH Jamie I Forrest, MSc Hinda Ruton, PhD Sheila Sprague, MSc Paula Mckay, Christina M Guo, MD Gordon H Guyatt, PharmD Craig R Rayner, MD, MPH David R Boulware, MDCM, MPH Nicole Ezer, MD, MPH Todd C Lee, MD, MSc Emily Gibson Mcdonald, MBChB Mona Bafadhel, PhD Christopher Butler, MD Josue Rodrigues Silva, MD, MSc Mark Dybul, MD Edward J Mills
doi:10.7326/M22-3305
Background: Previous trials have demonstrated the effects of fluvoxamine alone and inhaled budesonide alone for prevention of disease progression among outpatients with COVID-19. Objective: To determine whether the combination of fluvoxamine and inhaled budesonide would increase treatment effects in a highly vaccinated population.
Author contributions are available at Annals.org.
References
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'sequence': 'additional', 'affiliation': []}, { 'given': 'Silvia Helena Sousa Pietra', 'family': 'Pedroso', 'sequence': 'additional', 'affiliation': []}, {'given': 'Snaydia Viegas', 'family': 'Resende', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Wellington da Silva', 'family': 'Rocha', 'sequence': 'additional', 'affiliation': []}, {'given': 'Thamiris Caldeira', 'family': 'Alves', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Aline Lúcia de Jesus', 'family': 'Martins', 'sequence': 'additional', 'affiliation': []}, {'given': 'Amanda Gouvêa', 'family': 'Mesquita', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Amanda Larissa Alves', 'family': 'Mendes', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Anna Beatriz Oliveira', 'family': 'Mendes', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Anna Clara de Jesus', 'family': 'Oliveira', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Carolina Couto de Azevedo', 'family': 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'sequence': 'additional', 'affiliation': []}, {'given': 'Isabela Canabrava', 'family': 'Soares', 'sequence': 'additional', 'affiliation': []}, { 'given': 'João Victor Barbosa', 'family': 'Silveira', 'sequence': 'additional', 'affiliation': []}, {'given': 'Joselaine Gomes de', 'family': 'Souza', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Juliana Marques Santos', 'family': 'Ferreira', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Kênia Sthéfhane Guimarães', 'family': 'Gonçalves', 'sequence': 'additional', 'affiliation': []}, {'given': 'Laura Campos', 'family': 'Oliveira', 'sequence': 'additional', 'affiliation': []}, {'given': 'Layane Maria de', 'family': 'Almeida', 'sequence': 'additional', 'affiliation': []}, {'given': 'Letícia Campos', 'family': 'Siqueira', 'sequence': 'additional', 'affiliation': []}, {'given': 'Letícia de Fátimas', 'family': 'Costa', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Lorena Gabrielle Miranda', 'family': 'Maciel', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Lorena Giovanna Silva', 'family': 'Peixoto', 'sequence': 'additional', 'affiliation': []}, {'given': 'Lorena Mesquita', 'family': 'Alves', 'sequence': 'additional', 'affiliation': []}, {'given': 'Luana Rosa', 'family': 'Rodrigues', 'sequence': 'additional', 'affiliation': []}, {'given': 'Luisa Andrade de', 'family': 'Almeida', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Marcela Luíza Amaral Resende', 'family': 'Lara', 'sequence': 'additional', 'affiliation': []}, {'given': 'Luíza Lanna França', 'family': 'Reis', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Maria Eduarda Gomes', 'family': 'Horácio', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Maria Eduarda Martins', 'family': 'Soares', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Maria Luiza Magalhães', 'family': 'Parreiras', 'sequence': 'additional', 'affiliation': []}, {'given': 'Mariana Campos', 'family': 'Siqueira', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Mariana Cristina Flores', 'family': 'Mariano', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Marina Guimarães', 'family': 'Bragatto', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Matheus Andrade Almeida e', 'family': 'Silva', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Mayra Estefane Silva dos', 'family': 'Santos', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Mirele Augusta Batista', 'family': 'Ribeiro', 'sequence': 'additional', 'affiliation': []}, {'given': 'Nayara Santos', 'family': 'Drumond', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Pedro Hosken Fernandes', 'family': 'Guimarães', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Pollyana Maria Silva', 'family': 'Diniz', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Roberta Dumont Paiva', 'family': 'Lopes', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Rosemary Muniz de', 'family': 'Oliveira', 'sequence': 'additional', 'affiliation': []}, {'given': 'Stephanny Kelvyn', 'family': 'Bessa', 'sequence': 'additional', 'affiliation': []}, {'given': 'Sheila Soares', 'family': 'Anselmo', 'sequence': 'additional', 'affiliation': []}, {'given': 'Tainara Silva', 'family': 'Vieira', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Tatiana Aparecida Gomes da', 'family': 'Silva', 'sequence': 'additional', 'affiliation': []}, {'given': 'Thais Campos', 'family': 'Siqueira', 'sequence': 'additional', 'affiliation': []}, {'given': 'Vânia Regina', 'family': 'Carmo', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Vitor Augusto Lima do', 'family': 'Vale', 'sequence': 'additional', 'affiliation': []}, {'given': 'Vitor Vilaça', 'family': 'Oliveira', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Wedsley Sander Lopes dos', 'family': 'Santos', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Aline Daniele de Almeida', 'family': 'Abreu', 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'family': 'Rodrigues', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Mateus de Oliveira', 'family': 'Ferreira', 'sequence': 'additional', 'affiliation': []}, {'given': 'Murilo Passinati', 'family': 'Perez', 'sequence': 'additional', 'affiliation': []}, {'given': 'Natalia Batista', 'family': 'Zanetti', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Rafaela Ribeiro de', 'family': 'Almeida', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Sarah Jeniffer da Silva', 'family': 'Jamar', 'sequence': 'additional', 'affiliation': []}, {'given': 'Sofia Caporalli', 'family': 'Barbosa', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Sofia Vianna Von Bentzeen', 'family': 'Rios', 'sequence': 'additional', 'affiliation': []}, {'given': 'Stella Silva', 'family': 'Rosa', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Thomaz Takashi Ferreira', 'family': 'Morimoto', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Verônica de Araújo Libânio', 'family': 'costa', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Vitor Augusto Alves da', 'family': 'Silva', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Amanda Cypestre Alves', 'family': 'Batista', 'sequence': 'additional', 'affiliation': []}, {'given': 'Ana Flávia Gomes', 'family': 'Viana', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Ângela Rodrigues Vieira', 'family': 'Santos', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Anna Luiza Ribeiro', 'family': 'Flores', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Arthur Guimarães Rodrigues', 'family': 'Dutra', 'sequence': 'additional', 'affiliation': []}, {'given': 'Bruna Luiza', 'family': 'Maia', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Clarisse Lourdes Nadú de', 'family': 'Almeida', 'sequence': 'additional', 'affiliation': []}, {'given': 'Daniel Domingues', 'family': 'Barbosa', 'sequence': 'additional', 'affiliation': []}, {'given': 'Daniela Carla', 'family': 'Medeiros', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Daniele Saionara da', 'family': 'Silva', 'sequence': 'additional', 'affiliation': []}, {'given': 'Diuly Ane Faria', 'family': 'Rezende', 'sequence': 'additional', 'affiliation': []}, {'given': 'Felipe Menezes', 'family': 'Andrade', 'sequence': 'additional', 'affiliation': []}, {'given': 'Fernanda Rúbia', 'family': 'Batista', 'sequence': 'additional', 'affiliation': []}, {'given': 'Gabriela Ferreira', 'family': 'Reis', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Giovane Carvalho Constantino Ferreira de', 'family': 'Paula', 'sequence': 'additional', 'affiliation': []}, {'given': 'Geovani de Araújo', 'family': 'Júnior', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Henrique Amaral Fonseca', 'family': 'Pires', 'sequence': 'additional', 'affiliation': []}, {'given': 'Jéssica Aguilar', 'family': 'Silva', 'sequence': 'additional', 'affiliation': []}, {'given': 'Isabela Lovatti', 'family': 'Rovetta', 'sequence': 'additional', 'affiliation': []}, {'given': 'Júlia Silva', 'family': 'Rangel', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Júlia Lima Soares de', 'family': 'Paula', 'sequence': 'additional', 'affiliation': []}, {'given': 'Juliana Oliveira', 'family': 'Costa', 'sequence': 'additional', 'affiliation': []}, {'given': 'Lucas Júnio da', 'family': 'Silva', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Luiz Gustavo Fernandes', 'family': 'Dias', 'sequence': 'additional', 'affiliation': []}, {'given': 'Lívia Francino', 'family': 'Oliveira', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Lucas Rodrigues Pereira', 'family': 'Barros', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Lucas de Souza Gontijo', 'family': 'Pessoa', 'sequence': 'additional', 'affiliation': []}, {'given': 'Lucas Klier', 'family': 'Silva', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Maria Luisa Lara Lanza', 'family': 'Stabile', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Mariana da Rocha Assis', 'family': 'Pinto', 'sequence': 'additional', 'affiliation': []}, {'given': 'Nicholas Vanzin', 'family': 'Cunha', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Paloma Alister Vilela da', 'family': 'Silva', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Rafael Silva Rodrigues', 'family': 'Soares', 'sequence': 'additional', 'affiliation': []}, {'given': 'Thais Gomes de', 'family': 'Oliveira', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Victor Oliveira de', 'family': 'Araújo', 'sequence': 'additional', 'affiliation': []}, {'given': 'Wesley Costa', 'family': 'Arcanjo', 'sequence': 'additional', 'affiliation': []}, {'given': 'Alice Pinheiro', 'family': 'Vanetti', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Ana Carolina Araújo Lage', 'family': 'Santos', 'sequence': 'additional', 'affiliation': []}, {'given': 'Ariade Gomes', 'family': 'Freitas', 'sequence': 'additional', 'affiliation': []}, {'given': 'Felipe Viana', 'family': 'Santos', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Fernanda Freitas', 'family': 'Pinheiro', 'sequence': 'additional', 'affiliation': []}, {'given': 'Fernanda Perez', 'family': 'Rocha', 'sequence': 'additional', 'affiliation': []}, {'given': 'Filipe Viana', 'family': 'Santos', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Giulia de Jesus', 'family': 'Marcolino', 'sequence': 'additional', 'affiliation': []}, {'given': 'Humberto Drumond', 'family': 'Filho', 'sequence': 'additional', 'affiliation': []}, {'given': 'Isabela Gontijo', 'family': 'Mendonça', 'sequence': 'additional', 'affiliation': []}, {'given': 'Isadora Gomides', 'family': 'Faria', 'sequence': 'additional', 'affiliation': []}, { 'given': 'José Victor Mendes', 'family': 'Milhomem', 'sequence': 'additional', 'affiliation': []}, {'given': 'Larissa Milagres', 'family': 'Mol', 'sequence': 'additional', 'affiliation': []}, {'given': 'Letícia de 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'Lara Silveira', 'family': 'Marques', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Larissa Martins do', 'family': 'Nascimento', 'sequence': 'additional', 'affiliation': []}, {'given': 'Larissa Oliveira', 'family': 'Moreira', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Lorena Luiza Soares de', 'family': 'Oliveira', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Lucas Eduardo Lessa', 'family': 'Mussi', 'sequence': 'additional', 'affiliation': []}, {'given': 'Lucas Medeiros', 'family': 'Ruas', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Luiza Nogueira Assis', 'family': 'Barbosa', 'sequence': 'additional', 'affiliation': []}, {'given': 'Luiz Otávio de', 'family': 'Sousa', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Marcelo Rodrigues da Costa', 'family': 'Fernandes', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Maria Eduarda Guimarães de', 'family': 'Souza', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Maria Thereza Figueiredo Bélem', 'family': 'Calazans', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Mariana Rodrigues Marinho de', 'family': 'Bastos', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Pedro Henrique Arcanjo', 'family': 'Alvarenga', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Quimberli Vassinave', 'family': 'Cujuí', 'sequence': 'additional', 'affiliation': []}, {'given': 'Rafaela Valadares', 'family': 'Diniz', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Rafael Cota Andrade Ferreira de', 'family': 'Souza', 'sequence': 'additional', 'affiliation': []}, {'given': 'Rita de Cássia', 'family': 'Silva', 'sequence': 'additional', 'affiliation': []}, {'given': 'Vinícius Alves', 'family': 'Corrêa', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Vinícius Carvalho de', 'family': 'Oliveira', 'sequence': 'additional', 'affiliation': []}, {'given': 'Vitória Aparecida', 'family': 'Cunha', 'sequence': 'additional', 'affiliation': []}, {'given': 'Viviane Costa', 'family': 'Santos', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Ana Paula Figueiredo Guimarães de', 'family': 'Almeida', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Ana Paula Guimarães Alves de', 'family': 'Carvalho', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Antônio Henrique Batista', 'family': 'Jorge', 'sequence': 'additional', 'affiliation': []}, {'given': 'Artur Pimenta', 'family': 'Ribeiro', 'sequence': 'additional', 'affiliation': []}, {'given': 'Elisângela Santos', 'family': 'Sena', 'sequence': 'additional', 'affiliation': []}, {'given': 'Cleide Rocha', 'family': 'Veloso', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Gonçalvino Eleutério', 'family': 'Murta', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Inara Maria Gomes', 'family': 'Cardoso', 'sequence': 'additional', 'affiliation': []}, {'given': 'João Warley', 'family': 'Alves', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Jorge Fernando Rocha', 'family': 'Veloso', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Joyce Souto Barbosa Pimenta de', 'family': 'Figueiredo', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Karolina Campos Sampaio', 'family': 'Lopes', 'sequence': 'additional', 'affiliation': []}, {'given': 'Larissa Vieira', 'family': 'Souza', 'sequence': 'additional', 'affiliation': []}, {'given': 'Loren Montanha', 'family': 'Costa', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Ludimila Pereira de', 'family': 'Souza', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Maria de Fátima César', 'family': 'Lima', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Maria Izabel Silveira', 'family': 'Gonçalves', 'sequence': 'additional', 'affiliation': []}, {'given': 'Marizete Gislaine', 'family': 'Mendes', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Mayra Darlliane Loiola', 'family': 'Silva', 'sequence': 'additional', 'affiliation': []}, {'given': 'Raissa Rocha e', 'family': 'Fonseca', 'sequence': 'additional', 'affiliation': []}, {'given': 'Samuel de Paiva', 'family': 'Oliveira', 'sequence': 'additional', 'affiliation': []}, {'given': 'Thiago Rodrigues', 'family': 'Ferro', 'sequence': 'additional', 'affiliation': []}, {'given': 'Aline', 'family': 'Cruz Milagres', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Ana Carolina Aguiar', 'family': 'Estevam', 'sequence': 'additional', 'affiliation': []}, {'given': 'Ana Martins de', 'family': 'Oliveira', 'sequence': 'additional', 'affiliation': []}, { 'given': 'André Henrique de Sousa', 'family': 'Oliveira', 'sequence': 'additional', 'affiliation': []}, {'given': 'Carina', 'family': 'Bitarães', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Carla Stefany Oliveira', 'family': 'França', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Hayka K. Rodrigues', 'family': 'Freire', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Laís Aparecida dos Reis', 'family': 'Gama', 'sequence': 'additional', 'affiliation': []}, {'given': 'Laylla Michelle', 'family': 'Pereira', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Luciléia Alcântara Gomes e', 'family': 'Silva', 'sequence': 'additional', 'affiliation': []}, {'given': 'Patrícia Santana', 'family': 'Assis', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Regiane Aparecida de', 'family': 'Andrade', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Thaís de Paula Ferreira da', 'family': 'Silva', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Thiago de Alcântara', 'family': 'César', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Adriana Marcos Mendes', 'family': 'Rabelo', 'sequence': 'additional', 'affiliation': []}, {'given': 'Aline do Carmo', 'family': 'Rosa', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Ana Paula 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'family': 'Borges', 'sequence': 'additional', 'affiliation': []}, {'given': 'Igor Brandão', 'family': 'Rocha', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Jéssica Genoveva Boline Passarelli Capaz Pinto da', 'family': 'Silva', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Jorge Carlos do Amaral', 'family': 'Júnior', 'sequence': 'additional', 'affiliation': []}, { 'suffix': 'II', 'given': 'José Pio', 'family': 'Marques', 'sequence': 'additional', 'affiliation': []}, {'given': 'Laura Lima', 'family': 'Vargas', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Lorena Cristina Ferreira', 'family': 'Batista', 'sequence': 'additional', 'affiliation': []}, {'given': 'Luiz Eduardo Coelho', 'family': 'Fava', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Luiza de Azevedo Freitas', 'family': 'Giles', 'sequence': 'additional', 'affiliation': []}, {'given': 'Marina Lacerda', 'family': 'Marques', 'sequence': 'additional', 'affiliation': []}, { 'given': 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'http://dx.doi.org/10.7326/M22-3305', 'relation': {}, 'ISSN': ['0003-4819', '1539-3704'], 'subject': ['General Medicine', 'Internal Medicine'], 'container-title-short': 'Ann Intern Med', 'published': {'date-parts': [[2023, 5]]}}
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