4.8 Article

Efficacy and tolerability of bevacizumab in patients with severe Covid-19

Journal

NATURE COMMUNICATIONS
Volume 12, Issue 1, Pages -

Publisher

NATURE PORTFOLIO
DOI: 10.1038/s41467-021-21085-8

Keywords

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Funding

  1. National Key R& D Program of China [2020YFC0846600]
  2. Shandong Provincial Key R D Program [2020SFXGFY03]
  3. European Research Council (ERC) advanced grant ANGIOFAT [250021]
  4. Swedish Research Council
  5. Swedish Cancer Foundation
  6. Strategic Research Areas (SFO)-Stem Cell and Regeneration Medicine Foundation
  7. Karolinska Institutet
  8. Swedish Children's Cancer Foundation
  9. Karolinska Institutet Foundation
  10. Karolinska Institutet Distinguished Professor Award
  11. Torsten Soderbergs Foundation
  12. Maud and Birger Gustavsson Foundation
  13. Knut and Alice Wallenberg's Foundation
  14. Novo Nordisk Foundation-Advance grant

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In this single-arm clinical trial, the authors show that treatment of COVID-19 patients with bevacizumab, an anti-vascular endothelial growth factor drug, can improve PaO2/FiO(2) ratios and oxygen-support status. Relative to an external control group, bevacizumab shows clinical efficacy by improving oxygenation.
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 (PaO2/FiO(2)) >100mmHg and <= 300mmHg, and diffuse pneumonia confirmed by chest imaging. Followed up for 28 days. Among these, bevacizumab plus standard care markedly improves the PaO2/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 72h 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. In this single-arm clinical trial, the authors show that treatment of COVID-19 patients with bevacizumab, an anti-vascular endothelial growth factor drug, can improve PaO2/FiO(2) ratios and oxygen-support status. Relative to an external control group, bevacizumab shows clinical efficacy by improving oxygenation.

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