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

Nat Commun. 2021 Feb 5;12(1):814. doi: 10.1038/s41467-021-21085-8.

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 O2 ratio (PaO2/FiO2) >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 PaO2/FiO2 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.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Angiogenesis Inhibitors / therapeutic use
  • Bevacizumab / therapeutic use*
  • Body Temperature / drug effects
  • COVID-19 / drug therapy*
  • COVID-19 / virology
  • China
  • Female
  • Fever / prevention & control
  • Humans
  • Italy
  • Male
  • Middle Aged
  • SARS-CoV-2 / drug effects*
  • SARS-CoV-2 / physiology
  • Treatment Outcome

Substances

  • Angiogenesis Inhibitors
  • Bevacizumab

Associated data

  • ClinicalTrials.gov/NCT04275414
  • figshare/10.6084/m9.figshare.13482810
  • figshare/10.6084/m9.figshare.13482834