News Scan for Jun 07, 2022

News brief

Electronic algorithms show promise for identifying antibiotic overuse

Electronic algorithms developed by an antibiotic stewardship team at the University of Pennsylvania were highly accurate in detecting inappropriate antibiotic prescribing for bronchitis and pharyngitis, scientists reported yesterday in Open Forum Infectious Diseases.

Using ICD-10 diagnostic codes, the team of clinicians, pharmacists, and researchers identified adult patients in the University of Pennsylvania Health System who were treated for acute bronchitis and pharyngitis from Mar 15, 2017, to Mar 14, 2018. They then randomly selected 300 patients each with bronchitis and pharyngitis—two conditions for which antibiotic prescribing is common and often inappropriate—and compared assessment of antibiotic prescribing based on manual chart review (the gold standard) with the assessment of electronic algorithms constructed for each diagnosis using electronic health record data.

The criteria for appropriate prescribing, choice of antibiotic, and duration were based on established guidelines.

Of 300 subjects with bronchitis, 167 (55.7%) received an antibiotic inappropriately based on manual chart review. The electronic algorithm demonstrated 100% sensitivity and 95.3% specificity for detection of inappropriate prescribing. Of 300 subjects with pharyngitis, 94 (31.3%) had an incorrect prescribing decision. Among 29 subjects with a positive rapid streptococcal antigen test, 27 (93.1%) received an appropriate antibiotic and 29 (100%) received the correct duration. The electronic algorithm also demonstrated very high sensitivity and specificity for all outcomes.

The study authors say the findings highlight the potential for using electronic health records to reduce the workload of antibiotic stewardship programs (ASPs).

"The results suggest our electronic algorithms for these two common outpatient clinical conditions can be used to efficiently and accurately identify instances of inappropriate antibiotic prescribing," they wrote. "These algorithms could provide longitudinal data on patterns of inappropriate antibiotic use and be reported at the level of the health system, the practice, and/or the individual provider to better inform and support ASP targets and initiatives."
Jun 6 Open Forum Infect Dis abstract

Moderna launches phase 3 trial of mRNA flu vaccine

Moderna today announced the launch of a phase 3 trial of its mRNA seasonal flu vaccine, which has a goal of immunizing about 6,000 adult participants in the Southern Hemisphere, which is entering its flu season.

In a statement, the company said the vaccine candidate, one of several respiratory disease vaccines in development, encodes for the hemagglutinin glycoprotein of the four flu virus strains recommended by the World Health Organization. It added that the surface glycoprotein is an important target for generating broad protection against flu and is the primary target for current flu vaccines.

For the study, researchers will compare the safety and immunogenicity of a single dose of the mRNA vaccine with a single dose of a licensed seasonal flu vaccine.

Stéphane Bancel, MBA, MS, Moderna's chief executive officer, said the speed and flexibility of the mRNA vaccine manufacturing process make it well positioned to address unmet needs for seasonal flu. He said Moderna's flu vaccine is a key part of its respiratory vaccine strategy, which also includes the development of combination products that target multiple viruses in a single vaccine, such as SARS-CoV-2 and respiratory syncytial virus (RSV). Besides a flu vaccine, the company is also working on a bivalent SARS-CoV-2 booster that covers the Omicron variant and vaccines for RSV and cytomegalovirus.

The company said it is planning for a confirmatory efficacy study for its mRNA flu vaccine as early as the 2022-23 Northern Hemisphere flu season, if needed.
Jun 7 Moderna press release

COVID-19 Scan for Jun 07, 2022

News brief

Those who believe in COVID-19 conspiracies may be at risk for depression

People who believe in conspiracies about the COVID-19 pandemic are at an increased risk of experiencing anxiety and depression, according to new research presented at the European Congress of Psychiatry and published in Frontiers in Psychiatry.

The research was based on survey results of 700 volunteers who answered a newly created COVID-19 Conspiratorial Beliefs Scale developed by researchers at several Polish universities. Participants also took the Hospital Anxiety and Depression Scale survey, as well as the Generic Conspiracist Beliefs Scale (covering topics such as aliens from other planets) to compare results.

The main COVID-19 conspiracy theories believed by participants were that SARS-CoV-2 tests were unreliable; governments deliberately spread false information about COVID-19, and vitamins and minerals supplementation could cure COVID-19 infections.

The researchers found belief in COVID-19 conspiracies was higher in those who believe in other conspiracies, and belief in COVID-19 conspiracies was correlated with increased levels of anxiety and depression. It was unclear, however, if anxiety and depression caused someone to believe in conspiracies, or whether conspiracy belief led to mental health problems.

"The tendency to believe in false convictions regarding COVID-19 may be detrimental to our psychological functioning as it is associated with increased symptoms of anxiety and depression," the authors concluded.

In a European Psychiatric Association press release, lead study author Paweł Debski, MD, of the Medical University of Silesia in Katowice, Poland, said, "COVID has only struck us in the last couple of years, and developing the tools to evaluate the mental health effects takes time.… Our next steps are to see whether beliefs are related to specific psychological traits, and whether any pro-health messages can help."
Jun 6 Front Psychiatry study
Jun 6 European Psychiatric Association press release

Molnupiravir cut need for higher levels of care in non-severe COVID-19

Nonhospitalized, unvaccinated COVID-19 patients who received Merck's antiviral molnupiravir had less need for respiratory support and fewer acute-care visits than those given a placebo, finds the secondary analysis of the phase 2/3 randomized, controlled MOVe-OUT trial published today in the Annals of Internal Medicine.

Scientists from Merck led the study of 1,433 adults diagnosed as having mild or moderate COVID-19 and one or more risk factors for severe disease at 107 sites around the world. Participants were randomly assigned in a 1:1 ratio to receive either 800 milligrams of molnupiravir within 5 days of symptom onset or placebo every 12 hours for 5 days.

The molnupiravir group had faster normalization of C-reactive protein level (an indicator of inflammation) and oxygen saturation than placebo recipients (3 vs 10 days). Molnupiravir recipients also had less need for respiratory support (relative risk reduction [RRR], 34.3%; 95% confidence interval [CI], 4.3% to 54.9%).

The RRRs were 23.6% (95% CI, -20.7% to 51.6%) for conventional oxygen therapy, 26.1% (95% CI, -112% to 74.2%) for use of a high-flow heated and humidified device, 75.4% (95% CI, -120% to 97.2%) for noninvasive mechanical ventilation, and 64.1% (95% CI, -12.1% to 88.5%) for invasive mechanical ventilation—all considered to be not statistically significant.

Hospitalized molnupiravir recipients were released a median of 3 days before placebo recipients and had fewer all-cause acute-care visits (7.2% vs 10.6%; RRR, 32.1% [95% CI, 4.4% to 51.7%]) and acute-care visits for COVID-19 (6.6% vs 10.0%; RRR, 33.8% [95% CI, 5.6% to 53.6%]).

In the final analysis of all participants but the three who were hospitalized after receiving the first dose of the study drug, molnupiravir was tied to a meaningful decrease in the risk of hospitalization or death (6.8% vs 9.6%). No serious adverse events were reported by day 29.

"Meaningful benefits of molnupiravir to patients and health care systems may exceed the previously demonstrated benefits of reducing hospitalizations or death due to disease progression as well as alleviating symptoms in high-risk patients," the researchers wrote.
Jun 7 Ann Intern Med study