Наряду с вакцинацией как основной стратегии борьбы против гриппа, Всемирная организация здравоохранения рекомендует применение противовирусных препаратов, одним из которых является умифеновир. Цель исследования – получение дополнительных сведений о клинической эффективности и безопасности противовирусного препарата Арбидол® (МНН: умифеновир). Материалы и методы. Рандомизированное двойное слепое многоцентровое исследование АРБИТР [A Study of Arbidol (Umifenovir) for Treatment and Prophylaxis of Influenza and Common Cold (ARBITR)] IV фазы проведено с ноября 2011 по апрель 2016 г. на базе 15 исследовательских центров, ведущих амбулаторный прием пациентов в различных регионах Российской Федерации. В общей сложности в исследовании приняли участие 359 пациентов в возрасте от 18 до 65 лет с диагнозом грипп или острая респираторная вирусная инфекция (ОРВИ), у которых от начала заболевания прошло не более 36 ч. Пациентов рандомизировали в две группы: группа пациентов (группа терапии), получавших умифеновир 200 мг 4 раза в сутки в течение 5 дней (n=181), и группа пациентов, получавших плацебо 4 раза в сутки в течение 5 дней (n=178). Первичными (основными) конечными точками исследования приняты общая продолжительность заболевания гриппом/ОРВИ, продолжительность и выраженность основных симптомов гриппа/ОРВИ. В качестве вторичной конечной точки была оценена частота развития осложнений при гриппе/ОРВИ. Безопасность оценивалась путем анализа нежелательных явлений, оценки жизненно важных симптомов, исследования физического состояния пациентов и общеклинических лабораторных показателей. Результаты. В группе пациентов, получавших умифеновир, количество случаев полного выздоровления уже на 4-й день от начала заболевания достоверно отличалось от числа подобных случаев в группе плацебо. Количество случаев полного выздоровления через 96 ч составило 54,1% (98 из 181) и 43,3% (77 из 178) соответственно (p<0,05), а через 108 ч – 64,6% (117 из 181) и 55,1% (98 из 178) соответственно (p<0,05). В группе терапии умифеновиром продолжительность интоксикационного синдрома была достоверно ниже, чем в группе плацебо, и составила 77,76 и 88,91 ч соответственно (p=0,013). Продолжительность всех изучаемых симптомов, обусловливающих интоксикационный синдром, также была ниже в группе, получавшей умифеновир. Так, в группе терапии и группе плацебо данные показатели составили соответственно: длительность лихорадки – 67,96 и 75,32 ч (p=0,037), боль в мышцах – 52,23 и 59,08 ч (p=0,023), головная боль – 52,78 и 63,28 ч (p=0,013), слабость – 76,90 и 88,89 ч (p=0,008). Частота развития осложнений в группе терапии умифеновиром составила 3,8%, в группе плацебо – 5,62%. В группе плацебо отмечено увеличение случаев развития острого трахеобронхита (p<0,02). На протяжении всего исследования умифеновир и плацебо переносились пациентами удовлетворительно, что свидетельствует о благоприятном профиле безопасности. Всего зарегистрировано 42 случая нежелательных явлений у 11 пациентов в группе терапии и у 18 пациентов в группе плацебо, которые не были связаны ни с действием исследуемого препарата, ни с плацебо, а носили случайный характер. Заключение. Результаты исследования указывают на безопасность умифеновира и подтверждают его эффективность по сравнению с плацебо в терапии гриппа и других ОРВИ у взрослых пациентов. Установлено, что противовирусный эффект наиболее выражен в остром периоде заболевания и проявляется сокращением сроков разрешения всех симптомов болезни и снижением тяжести проявлений заболевания.
In spite of vaccination was recommended by the World Health Organization, the main strategy of influenza is antiviral drugs treatment, one of which is umifenovir. Aim. The aim of the study is to obtain additional data on safety and therapeutic efficacy of the antiviral drug Arbidol (umifenovir) in patients with a diagnosis of influenza and common cold. Materials and methods. Double-blind, randomized, placebo-controlled clinical study investigating efficacy and safety of Arbidol (umifenovir) in Treatment and Prophylaxis of Influenza and Common Cold (ARBITR) IV phase started in November 2011 and completed in April 2016 on the basis of 15 research centers in various regions of the Russian Federation. A total of 359 patients, aged 18 to 65 years with influenza or acute respiratory tract infection, of no more than 36 hours' duration were enrolled in the study. Patients were randomized into two groups: a group of patients (therapy group) treated by Arbidol (umifenovir) at a dosage of 800 mg/day (2 capsules) for 5 days (n=181), and a group of patients receiving placebo 4 times a day for 5 days (n=178). The primary outcome measures of the study were the duration of clinical illness among patients with common cold and influenza/ARVI, the duration and severity of the main symptoms. Number of clinical complications associated with influenza and common cold was assessed as a secondary outcome. Safety was assessed by analyzing number of adverse events that are probably or definitely related to Arbidol, assessing vital signs, examining the physical condition of patients and general clinical laboratory parameters. Results. In the group treated by umifenovir, the number of full recover patients on the 4th day from the disease onset were significantly differed from the number of such cases in the placebo group. The number of cases of complete recovery after 96 hours was 98 patients (54.1%) and 77 (43.3%), p<0.05, and after 108 hours – 117 (64.6%) and 98 (55.1%), p<0.05. Duration of intoxication was reduced with umifenovir compared to placebo, amounted to 77.76 and 88.91 hours, respectively, p=0.013. The duration of all intoxication syndrome symptoms was also lower in the group receiving umifenovir. Thus, in the therapy group and placebo group, these parameters were respectively: fever duration – 67.96 and 75.32 hours (p=0.037), muscle pain – 52.23 and 59.08 hours (p=0.023), headache – 52.78 and 63.28 hours (p=0.013), weakness – 76.90 and 88.89 hours (p=0.008). The incidence of complications in the umifenovir group was 3.8%, in the placebo group 5.62%. Cases of acute tracheobronchitis was an increase in the placebo group (p<0.02). Umifenovir and placebo were well tolerated. A total of 42 cases of adverse events were registered in 11 patients in the treatment group and in 18 patients in the placebo group, which were not associated with umifenovir or placebo. Conclusion. The results of this study indicate umifenovir safety and confirm its effectiveness to the treatment of influenza and other acute respiratory viral infections in adult patients. It was found that effect of umifenovir in the treatment of influenza in adults is most pronounced in the acute stage of the disease and appears in the reduction of time to resolution of all symptoms of the disease, reducing the severity of symptoms of the disease.
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________________________________________________
1. Monto AS. Epidemiology of viral respiratory infections. Am J Med. 2002 Apr 22;112(Suppl 6A):4S-12S.
2. Cox NJ, Subbarao K. Global epidemiology of influenza: past and present. Annu Rev Med. 2000;51:407-21.
3. World Health Organization. Influenza (seasonal). 2016. http://www.who.int/mediacentre/factsheets/fs211/en/ Accessed 12.12.2017.
4. Khasanova RR. Dynamics of mortality fr om respiratory diseases and influenza in modern Russia. Problems of risk analysis. 2017;14(5):72-81 (In Russ.)].
5. Maltezou HC, Tsiodras S. Antiviral agents for influenza: molecular targets, concerns of resistance, and new treatment options. Curr Drug Targets. 2009 Oct;10(10):1041-8.
6. World Health Organization. Influenza: BRaVe call to action. 2013. http://www.who.int/influenza/patient_care/clinical/call_to_action/en/ Accessed 12.12.2017.
7. Ison MG. Finding the right combination antiviral therapy for influenza. Lancet Infect Dis. 2017 Dec;17(12):1221-2. doi: 10.1016/S1473-3099(17)30537-6. Epub 2017 Sep 22
8. Oshansky CM, Thomas PG. The human side of influenza. J Leukocyte Biology. 2012;92(1):83-96. doi: 10.1189/jlb.1011506
9. Ramos I, Fernandez-Sesma A. Innate Immunity to H5N1 Influenza Viruses in Humans. Viruses. 2012;4(12):3363-88. doi: 10.3390/v4123363
10. Teijaro JR, Walsh KB, Long JP, Tordoff KP, Stark GV, Eisfeld AJ, et al. Protection of ferrets from pulmonary injury due to H1N1 2009 influenza virus infection: immunopathology tractable by sphingosine-1-phosphate 1 receptor agonist therapy. Virology. 2014 Mar;452-453:152-7. doi: 10.1016/j.virol.2014. 01.003. Epub 2014 Jan 31
11. Webster RG, Govorkova EA. Continuing challenges in influenza. Annals of the New York Academy of Sciences. 2014;1323(1):115-39. doi: 10.1111/nyas.12462
12. Osterholm MT, Kelley NS, Sommer A, Belongia EA. Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. Lancet Infect Dis. 2012 Jan;12(1):36-44. doi: 10.1016/S1473-3099(11)70295-X
13. Guidance for Industry Antiviral Product Development -Conducting and Submitting Virology Studies to the Agency. U.S. Department of Health and Human Services Food and Drug Administration Center for Drug Evaluation and Research (CDER). June 2006. https://www.fda.gov/ohrms/dockets/98fr/05d-0183-gdl0002-01.pdf
14. Beigel JH. Antiviral compounds in the pipeline to tackle H1N1 influenza infection. Drugs of the future. 2010;35(5):385-92. doi: 10.1358/dof.2010.035. 05.1487081
15. Intharathep P, Laohpongspaisan C, Rungrotmongkol T, Loisruangsin A, Malaisree M, Decha P, Aruksakunwong O, Chuenpennit K, Kaiyawet N, Sompornpisut P, Pianwanit S, Hannongbua S. How amantadine and rimantadine inhibit proton transport in the M2 protein channel. J Mol Graph Model. 2008 Oct;27(3):342-8. doi: 10.1016/j.jmgm.2008.06.002
16. Van der Vries E, van den Berg BW, Schutten M. Fatal oseltamivir-resistant influenza virus infection. New England J Medicine. 2008;359(10):1074-6. doi: 10.1056/NEJMc0803120
17. Gubareva LV, et al. Selection of influenza virus mutants in experimentally infected volunteers treated with oseltamivir. J Infectious Diseases. 2001;183:523-31. doi: 10.1086/318537
18. Yacine A, Boivin G. A Review of Clinical Influenza A and B Infections With Reduced Susceptibility to Both Oseltamivir and Zanamivir. Open forum infectious diseases. Oxford University Press. 2017;4(3):1-10. https://doi.org/10. 1093/ofid/ofx105
19. Trebbien R, Pedersen SS, Vorborg K, Franck KT, Fischer TK. Development of oseltamivir and zanamivir resistance in influenza A(H1N1)pdm09 virus, Denmark, 2014. Eurosurveillance. 2017;22(3):30445. doi: 10.2807/1560-7917.ES.2017.22.3.30445
20. Zeng LY, Yang J, Liu S. Investigational hemagglutinin-targeted influenza virus inhibitors. Expert Opin Investig Drugs. 2017 Jan;26(1):63-73. doi: 10.1080/13543784.2017.1269170
21. Boriskin YS, Leneva IA, Pécheur EI, Polyak SJ. Arbidol: a broad-spectrum antiviral compound that blocks viral fusion. Curr Med Chem. 2008;15(10):997-1005. doi: 10.2174/092986708784049658
22. Nasser ZH, Swaminathan K, Müller P, Downard KM. Inhibition of influenza hemagglutinin with the antiviral inhibitor arbidol using a proteomics based approach and mass spectrometry. Antiviral Res. 2013;100(2):399-406. doi: 10.1016/j.antiviral.2013.08.021
23. Blaising J, Polyak SJ, Pécheur EI. Arbidol as a broad-spectrum antiviral: an update. Antiviral Res. 2014;107:84-94. doi: 10.1016/j.antiviral.2014.04.006
24. Kadama RU and Wilson IA. Structural basis of influenza virus fusion inhibition by the antiviral drug Arbidol. Proc Natl Acad Sci USA. 2017;114(2):206-14. doi: 10.1073/pnas.1617020114
25. Leneva IA, Russell RJ, Boriskin YS, Hay AJ. Characteristics of arbidol-resistant mutants of influenza virus: implications for the mechanism of anti-influenza action of arbidol. Antiviral Res. 2009,81(2):132-40. doi: 10.1016/j. antiviral.2008.10.009
26. Lvov DK, Burtseva EI, Shchelkanov MYu, et al. Peculiarities of the flu epidemic in certain territories of Russia in the epidemic season 2012-2013 the Dominance of strains of influenza virus A(H1N1)pdm09 in Europe. Questions of Virology. 2014;2:5-10 (In Russ.).
27. Huang L, Zhang L, Liu Y, Luo R, Zeng L, Telegina I, Vlassov V. Arbidol for preventing and treating influenza in adults and children. Cochrane Database of Systematic Reviews. 2015;1. doi: 10.1002/14651858.CD011489
28. Bulgakova VA, Uchaikin VF, Shamsheva OV, Osipova EA, Bevz AY, Prostyakov IV, Maleev VV. Pharmacologic and Epidemiologic Study of the Course of Influenza and Other Acute Respiratory Viral Infections in Postpandemic Season in Children Younger than 18 years. J Pediatric Infectious Diseases. 2015;10(03):68-75. doi: 10.1055/s-0036-1571306
29. Leneva IA, Burtseva EI, Yatsyshina SB, Fedyakina IT, Kirillova ES, Selkova EP, Osipova E, Maleev VV. Virus susceptibility and clinical effectiveness of anti-influenza drugs during the 2010-2011 influenza season in Russia. Int J Infect Dis. 2016;43:77-84. doi: 10.1016/j.ijid.2016.01.001
30. Brooks MJ, Sasadeusz JJ, Tannock GA. Antiviral chemotherapeutic agents against respiratory viruses: wh ere are we now and what’s in the pipeline. Curr Opin Pulmonary Med. 2004;10:197.
31. Megan J. Brooks, Elena I. Burtseva, et al. Antiviral Activity of Arbidol, a Broad-Spectrum Drug for Use Against Respiratory Viruses, Varies According to Test Conditions. J Med Virol. 2012 Jan;84(1):170-81.
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1 ФБУН «Центральный научно-исследовательский институт эпидемиологии» Роспотребнадзора (ЦНИИ эпидемиологии), Москва, Россия;
2 ФГАУ «Национальный медицинский исследовательский центр здоровья детей» Минздрава России (НМИЦЗД), Москва, Россия;
3 ФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» Минобороны России, Санкт-Петербург, Россия;
4 ФГБОУ ВПО «Московский государственный университет им. М.В. Ломоносова», биологический факультет, Москва, Россия;
5 ФБУН «Московский научно-исследовательский институт эпидемиологии и микробиологии им. Г.Н. Габричевского» Роспотребнадзора, Москва, Россия;
6 ФГБОУ ВО «Смоленский государственный медицинский университет» Минздрава России, Смоленск, Россия;
7 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России (МГМСУ), Москва, Россия;
8 ФГБНУ «Научно-исследовательский институт вакцин и сывороток им. И.И. Мечникова», Москва, Россия
1 Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare, Moscow, Russia;
2 Children’s Health Research Centre, Ministry of Health of Russia, Moscow, Russia;
3 S.M. Kirov Military Medical Academy, Ministry of Defense of the Russian Federation, Saint Petersburg, Russia;
4 M.V. Lomonosov Moscow State University, Moscow, Russia;
5 G.N. Gabrichevsky Moscow Research Institute of Epidemiology and Microbiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare, Moscow, Russia;
6 Smolensk State Medical University, Ministry of Health of Russia, Smolensk, Russia;
7 A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia;
8 I.I. Mechnikov Research Institute of Vaccines and Sera, Moscow, Russia