How to optimize the management of patients with post-infectious asthenia who have undergone COVID-19 at the outpatient stage?


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Abstract

Aim: to study the efficacy and safety of oxyethylammonium methylphenoxyacetate (Trekrezan) in patients with postinfectious asthenia who suffered from COVID-19 on an outpatient basis. Material and methods. The study included 80 people who had COVID-19 on an outpatient basis. Patients were randomized into two groups: main (n=40, mean age 52,14±6,23 years) and control (n=40, mean age 51,62±6,17 years). Patients of the main group received Trekrezan according to the following scheme: on the first day - 3 tablets (600 mg), for the next 7 days - 1 tablet (200 mg) per day. The duration of therapy was 8 days (the total dose of the drug was 2000 mg). Patients in the control group did not receive the drug. Initially and after the study in the main and control groups, testing was carried out using the Asthenic State Scale. Anxiety and depression levels were determined using HADS Scale. Sleep characteristics were scored subjectively. Results. Most of the patients who had COVID-19 presented an average of 7,04±1,06 complaints. In 57 (71,25%) patients included in the study, there were manifestations of moderate asthenia. In the main group of patients, who had a Trekrezan therapy, a distinct positive dynamic was recorded: a decrease in the number of patients with severe asthenia from 8 (20%) to 0 (0%), a decrease in patients with moderate asthenia from 28 (70%) to 0 (0%). At the same time, no such results were observed in the control group: after 8 days of observation, 2 (5%) of 40 patients had signs of severe asthenia, and 16 (40%) of 40 patients had manifestations of moderate asthenia. The drug was well tolerated. There were no side effects. Conclusion. In patients who have suffered from COVID-19 at the outpatient stage, moderate asthenia prevails. Alongside Trekrezan therapy, 80% of patients in the main group have no manifestations of asthenia, while in the control group, half of the patients retain moderate asthenia. Trekrezan can be recommended for the treatment of postinfectious asthenia in patients who have COVID-19.

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About the authors

I. B Zueva

Saint Petersburg Medico-Social Institute

Email: iravit0yandex.ru
195271, Saint Petersburg, 72А Kondratievsky Alley. Tel..: +7 (921) 317-86-94

Yu. V Kim

Acad. I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Healthcare of Russia

197022, Saint Petersburg, 6-8 Lva Tolstogo Str

M. Yu Suslova

Saint Petersburg Medico-Social Institute

195271, Saint Petersburg, 72А Kondratievsky Alley

References

  1. Kingstone T., Taylor A.K., O'Donnell C.A. et al. Finding the «right» GP: A qualitative study of the experiences of people with long-COVID. BJGP Open. 2020; 4(5): bjgpopen20X101143. doi: 10.3399/bjgpopen20X101143.
  2. Wiersinga W.J., Rhodes A., Cheng A.C. et al. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): A review. JAMA. 2020; 324(8): 782-93. doi: 10.1001/jama.2020.12839.
  3. National Institute of Health Director's blog. Post-covid syndrome. Available at https://directorsblog.nih.gov/tag/post-covid-syndrome/(date of access - 10.07.2021).
  4. Greenhalgh T., Knight M., A'Court M. et al. Management of post acute COVID-19 in primary care. BMJ. 2020; 370: m3026. doi:10.1136/ bmj.m3026.
  5. Tenforde M., Kim S., Lindsell C. et al. Symptom duration and risk factors for delayed return to usual health among outpatients with COVID-19 in a Multistate Health Care Systems Network - United States, March-June 2020. MMWR Morb Mortal Wkly Rep. 2020; 69(30): 993-98. doi: 10.15585/mmwr.mm6930e1.
  6. Covid-19-long-term-health-effects. Available at: https://www.gov.uk/government/publications/covid-19-long-term-health-effects/covid-19-long-term-health-effects (date of access - 10.07.2021).
  7. Moldofsky H., Patcai J. Chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome; a case-controlled study. BMC Neurol. 2011; 11: 37. doi: 10.1186/1471-2377-11-37.
  8. Huang C., Huang L., Wang Y. et al. 6-month consequences of COVID-19 in patients discharged from hospital: A cohort study. Lancet. 2021; 397(10270): 220-32. doi: 10.1016/S0140-6736(20)32656-8.
  9. Simani L., Ramezani M., Darazam I.A. et al. Prevalence and correlates of chronic fatigue syndrome and post-traumatic stress disorder after the outbreak of the COVID-19. J Neurovirol. 2021; 27(1): 154-59. doi: 10.1007/s13365-021-00949-1.
  10. Carfi A., Bernabei R., Landi F., for the Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent symptoms in patients after acute COVID-19. JAMA. 2020; 324(6): 603-05. doi: 10.1001/jama.2020.12603.
  11. Moreno-Perez O., Merino E., Leon-Ramirez J.M. et al. Post-acute COVID-19 syndrome. Incidence and risk factors: A Mediterranean cohort study. J Infect. 2021; 82(3): 378-83. doi: 10.1016/j.jinf.2021.01.004.
  12. Liang L., Yang B., Jiang N. et al. Three-month follow-up study of survivors of coronavirus disease 2019 after discharge. J Korean Med Sci. 2020; 35: e418. doi: 10.3346/jkms.2020.35.e418.
  13. Halpin S.J., McIvor C., Whyatt E.G. et al. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A crosssectional evaluation. J Med Virol. 2021; 93(2): 1013-22. doi: 10.1002/jmv.26368.
  14. Carvalho-Schneider C., Laurent E., Lemaignen A. et al. Follow-up of adults with noncritical COVID-19 two months after symptom onset. Clin Microbiol Infect. 2021; 27(2): 258-63. doi: 10.1016/j.cmi.2020.09.052.
  15. Garrigues E., Janvier P., Kherabi Y. et al. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. J Infect. 2020; 81(6): e4-e6. doi: 10.1016/j.jinf.2020.08.029.
  16. Davis H.E., Assaf G.S., McCorkell L. et al. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. 2020. doi: 10.1101/2020.12.24.20248802. Available at: https://www.medrxiv.org/content/10.1101/2020.12.24.20248802v2 (date of access - 10.07.2021).
  17. Инструкция по медицинскому применению лекарственного препарата Трекрезан. РУ: ЛСР-008909/09. Доступ: http://grls. rosminzdrav.ru/ (дата обращения - 10.07.2021). @@Instruction for medical use Trekrezan. РУ: ЛСР-008909/09. Marketing authorization: ЛСР-008909/09. Available at: http://grls.rosminzdrav.ru/ (date of access - 10.07.2021).
  18. Тест-опросник для диагностики астении. Шкала астенического состояния (ШАС) Л. Д. Малковой. Доступ: http://psycabi.net/ testy/129-test-dlya-diagnostiki-astenii-shkala-astenicheskogosostoyaniyashas-l-d-malkovoj (дата обращения - 10.07.2021). @@Test questionnaire for the diagnosis of asthenia. Asthenic State Scale by L.D. Malkova. Available at: http://psycabi.net/testy/129-test-dlya-diagnostiki-astenii-shkala-astenicheskogosostoyaniyashas-l-d-malkovoj (date of access - 10.07.2021) (In Russ.).
  19. Вейн A.M. Медицина сна. Избранные лекции по неврологии. М.: Эйдос Медиа. 2006: с. 12-20. [Vane A.M. Sleep medicine. Selected lectures on neurology. Moscow: Eidos Media. 2006: pp. 12-20 (In Russ.)].
  20. Mahase E. Covid-19: What do we know about «long Covid»? BMJ. 2020; 370: m2815. doi: 10.1136/bmj.m2815.
  21. Xiao S., Luo D., Xiao Y. Survivors of COVID-19 are at high risk of posttraumatic stress disorder. Glob Health Res Policy. 2020; 5: 29. doi: 10.1186/s41256-020-00155-2.
  22. Sudre C.H., Murray B., Varsavsky T. et al. Attributes and predictors of long COVID. Nat Med. 2021; 27(4): 626-31. doi: 10.1038/s41591-021-01292-y.
  23. Barsky A.J., Peekna H.M., Borus J.F. Somatic symptom reporting in women and men. J Gen Intern Med. 2001; 16(4): 266-75. doi: 10.1046/j.1525-1497.2001.00229.x.
  24. Luers J.C., Rokohl A.C., Loreck N. et al. Olfactory and Gustatory Dysfunction in Coronavirus Disease 2019 (COVID-19). Clin Infect Dis. 2020; 71(16): 2262-64. doi: 10.1093/cid/ciaa525.
  25. Lechien J.R., Chiesa-Estomba C.M., De Siati D.R. et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol. 2020; 277(8): 2251-61. doi: 10.1007/s00405-020-05965-1.
  26. Зарубина И.В., Ходченкова И.П., Шабанов П.Д. Метаболические эффекты трекрезана при доброкачественной гиперплазии предстательной железы у крыс и ее осложнении простатитом. Клиническая патофизиология. 2006; 2: 32-35. @@Zarubina I.V., Khodchenkova I.P., Shabanov P.D. Metabolic effects of Trerezan in benign prostatic hyperplasia in rats and its complication with prostatitis. Klinicheskaya patofiziologiya = Clinical Pathophysiology. 2006; 2: 32-35 (In Russ.).
  27. Шабанов П.Д., Ганапольский В.П., Зарубина И.В. с соавт. Метаболический активатор трекрезан: изучение метеоадаптогенных и иммуномодулирующих свойств. Нейронауки. 2006; 3(5): 43-48. @@Shabanov P.D., Ganapolsky V.P., Zhumasheva A.B. et al. Metabolic activator Trekrezan: study of meteoadaptogenic and immunomodulatory properties. Neyronauki = Neurosciences. 2006; 3(5): 43-48 (In Russ.).
  28. Жумашева А.Б., Болехан А.В., Шабанов П.Д. Иммуномодулирующие свойства трекрезана. Психофармакология и биологическая наркология. 2009; 3: 2555-2559. @@Zhumasheva A.B., Bolekhan A.V., Shabanov P.D. Immunomodulating properties of Trekrezan. Psikhofarmakologiya i biologicheskaya narkologiya = Psychopharmachology and Biological Narcology. 2009; 3: 2555-2559 (In Russ.).
  29. Ходченкова И.П., Зарубина И.В., Шабанов П.Д. Эффекты трекрезана при доброкачественной гиперплазии предстательной железы у крыс и ее осложнении простатитом. Инфекционные болезни: проблемы здравоохранения и военной медицины: материалы научно-практической конференции. СПб. 2006; с. 312-313. @@Hodchenkova I.P., Zarubina I.V., Shabanov P.D. Effects of Trekrezan in benign prostatic hyperplasia in rats and its complication with prostatitis. Abstracts of scientific-practical conference «Infectious diseases: problems of health and military medicine». Saint Petersburg. 2006; pp. 312-313 (In Russ.)
  30. Шабанов П. Д., Зарубина И. В., Новиков В. Е., Цыган В. Н. Метаболические корректоры гипоксии. СПб.: Информ-Навигатор. 2010; 916 с. @@Shabanov P.D., Zarubina I.V., Novikov V.E., Tsygan V.N. Metabolic hypoxia correctors. Saint Petersburg; Inform-Navigator. 2010; 916 pp. (In Russ.).
  31. Зарубина И.В., Болехан А.В., Шабанов П.Д. Сравнение энергостабилизирующих и иммунотропных свойств трекрезана и поли-оксидония при бронхолегочном воспалении у крыс. Экспериментальная и клиническая фармакология. 2006; 5: 50-54. @@Zarubina I.V., Bolekhan A.V., Shabanov P.D. Comparative study of the energy-stabilizing and immunotropic properties of Trekrezan and Polyoxidon on a bronchopulmonary inflammation model in rats. Eksperimental'naya i klinicheskaya farmakologiya = Experimental and Clinical Pharmacology. 2006; 5: 50-54 (In Russ.). doi: https://doi.org/10.30906/0869-2092-2006-69-5-50-54.
  32. Зарубина И.В., Рылеев А.Ю., Жумашева А.Б. с соавт. Эффективны ли иммуномодуляторы при бронхолегочном воспалении у крыс? Психофармакология и биологическая наркология. 2005; 3: 1017-1022. @@Zarubina I.V., Ryleev A.Yu., Zhumasheva A.B. et al. Are immunomodulators effective in bronchopulmonary inflammation in rats? Psikhofarmakologiya i biologicheskaya narkologiya = Psychopharmachology and Biological Narcology. 2005; 3: 1017-1022 (In Russ.).
  33. Чеснокова Н.П., Понукалина Е.В., Бизенкова М.Н. Лекция 13. Молекулярно-клеточные механизмы цитотоксического действия гипоксии. Научное обозрение. Медицинские науки. 2017; 2: 60-63. @@Chesnokova N.P., Ponukalina E.V., Bizenkova M.N. Lecture 13. Molecular-cellular mechanisms of the cytotoxic action of hypoxia. Nauchnoe obozrenie. Meditsinskie nauki = Scientific Review. Medical Sciences. 2017; 2: 60-63 (In Russ.).
  34. Зарубина И.В., Антоненкова Е.В., Болехан А.В., Мокренко Е.В. Влияние иммуномодуляторов в разных комбинациях на люцигенин зависимую хемилюминесценцию в альвеолярных и перитонеальных макрофагах крови. Обзоры по клинической фармакологии и лекарственной терапии. 2014; 1: 15-18. @@Zarubina I.V., Antonenkova E.V., Bolechan A.V., Mokrenko E.V. Effect of immune modulators in different combinations on luceginine-dependent chemical luminescence in the blood alveolar and peritoneal macrophages. Obzory po klinicheskoy farmakologii i lekarstvennoy terapii = Reviews on Clinical Pharmacology and Drug Therapy. 2014; 1: 15-18 (In Russ.).
  35. Шабанов П.Д., Ганапольский В.П., Жумашева А.Б., Елистратов А.А. Трекрезан как метаболический активатор, обладающий свойствами метеоадаптогена, психоэнергизатора и иммуномодулятора (теоретическое и экспериментальное обоснование). Вестник Российской военно-медицинской академии. 2006; 1: 53-57. @@Shabanov P.D., Ganapolsky V.P., Zhumasheva A.B., Elistratov A.A. Trekrezan as a metabolic activator with the properties of a meteoadaptogen, psychoenergizer and immunomodulator (theoretical and experimental justification). Vestnik Rossiyskoy voyenno-meditsinskoy akademii = Bulletin of the Russian Military Medical Academy. 2006; 1: 53-57 (In Russ.).
  36. Казимировская В.Б., Дьяков В.М., Воронков М.Г, Ковальчук С.Ф. Трекрезан: токсикология, фармакология, результаты клинических испытаний. Иркутск. 1996; 224 с. @@Kazimirovskaya V.B., Dyakov V.M., Voronkov M.G., Kovalchuk S.F. Trekrezan: toxicology, pharmacology, results of clinical trials. Irkutsk. 1996; 224 p. (In Russ.).

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