新型冠状病毒肺炎疫情应对的循证药学实践

Evidence-based Pharmaceutical Practice Responding for Novel Coronavirus Pneumonia Epidemic

目的:为在新型冠状病毒肺炎(COVID-19)疫情应对中开展循证药学信息支持的药学工作实践提供参考。方法:检索PubMed、中国知网以及万方数据库,检索时间截至2020年2月12日,同时检索药品说明书、UpToDate数据库。收集COVID-19的药物治疗进展、禁止与洛匹那韦/利托那韦合用的药物信息和药物不良反应信息,并进行总结和评价。结果和结论:共有14篇文献介绍了针对COVID-19的化学药物治疗,主要包括抗病毒药(如干扰素α/干扰素α-2β、洛匹那韦/利托那韦等)、免疫调节药(如糖皮质激素、丙种球蛋白)、抗疟药(如磷酸氯喹)等7类20种化学药。现有的药物治疗证据主要来自体外细胞试验或正在进行的临床随机对照试验,证据级别和推荐强度较低(按牛津证据级别评价为5级、推荐意见强度为D级)。对于国家卫生健康委员会诊疗方案中推荐可以试用的药物洛匹那韦/利托那韦,该药为细胞色素P450(CYP)3A抑制剂,可增加部分抗心律失常药物、抗肿瘤靶向药物、抗菌药物等的血药浓度,应禁止与阿夫唑嗪、伊伐布雷定、胺碘酮等药物合用;该药十分常见的不良反应主要累及消化系统(腹泻、味觉障碍、呕吐等)、呼吸系统(上呼吸道感染)、内分泌和代谢系统(高胆固醇血症等)、皮肤及附属物(皮疹),临床需加强监测。

OBJECTIVE:To provide reference for related pharmacy work for developing evidence-based pharmacy information support to respond for novel coronavirus pneumonia(COVID-19) epidemic. METHODS:The PubMed,CNKI and Wanfang database were consulted to obtain treatment progress of COVID-19,prohibited for use with lopinavir/ritonavir and adverse drug reactionas until February 12,2020;so were package insert and UpToDate at the same time. Those information were summarized and evaluated. RESULTS & CONCLUSIONS:Totally 14 literatures introduced chemical drugs for COVID-19,involving 7 categories, 20 kinds of chemical drugs as antiviral drugs(interferon α/interferon α-2β, lopinavir/litonavir, etc.),immunomodulatory agents(such as glucocorticoid,gamma globulin),antimalarial drugs(such as chloroquine phosphate). The existing evidence of drug treatment mainly comes from in vitro cell test or currently progressing RCT,with low-level evidence and recommendation intensity(Oxford evidence level is level 5,recommendation intensity is level D). For lopinavir/ritonavir that recommended in the diagnosis and treatment recommendations for COVID-19 published by the National Health Commission,it is a CYP3 A inhibitor,which resulted in increased plasma concentrations of some medications such as antiarrhythmic drugs,antitumor targeted drugs and antibacterial drugs,and should not be used in combination with drugs such as afzosin,ivabradine,amiodarone,etc. Its common adverse reactions mainly involved igestive system(diarrhea,taste disorders,vomiting,etc.),respiratory system(upper respiratory tract infection),endocrine and metabolic system(hypercholesterolemia,etc.),skin and its appendents(skin rash),which should be monitored clinically.