Efficacy and tolerability of bevacizumab in patients with severe Covid-19
Jiaojiao Pang, Feng Xu, Gianmarco Aondio, Yu Li, Alberto Fumagalli, Ming Lü, Giuseppe Valmadre, Jie Wei, Yuan Bian, Margherita Canesi, Giovanni Damiani, Yuan Zhang, Dexin Yu, Jun Chen, Xiang Ji, Wenhai Sui, Bailu Wang, Shuo Wu, Attila Kovács, Miriam Revera, Hao Wang, Jing Xu, Ying Zhang, Yuguo Chen, Yihai Cao
Abstract
Abstract On the basis of Covid-19-induced pulmonary pathological and vascular changes, we hypothesize that the anti-vascular endothelial growth factor (VEGF) drug bevacizumab might be beneficial for treating Covid-19 patients. From Feb 15 to April 5, 2020, we conducted a single-arm trial (NCT04275414) and recruited 26 patients from 2-centers (China and Italy) with severe Covid-19, with respiratory rate ≥30 times/min, oxygen saturation ≤93% with ambient air, or partial arterial oxygen pressure to fraction of inspiration O 2 ratio (PaO 2 /FiO 2 ) >100 mmHg and ≤300 mmHg, and diffuse pneumonia confirmed by chest imaging. Followed up for 28 days. Among these, bevacizumab plus standard care markedly improves the PaO 2 /FiO 2 ratios at days 1 and 7. By day 28, 24 (92%) patients show improvement in oxygen-support status, 17 (65%) patients are discharged, and none show worsen oxygen-support status nor die. Significant reduction of lesion areas/ratios are shown in chest computed tomography (CT) or X-ray within 7 days. Of 14 patients with fever, body temperature normalizes within 72 h in 13 (93%) patients. Relative to comparable controls, bevacizumab shows clinical efficacy by improving oxygenation and shortening oxygen-support duration. Our findings suggest bevacizumab plus standard care is highly beneficial for patients with severe Covid-19. Randomized controlled trial is warranted.