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

Jiaojiao Pang, Feng Xu, Gianmarco Aondio, Yu Li, Alberto Fumagalli, Ming Lu, 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 Kovacs, Miriam Revera, Hao Wang, Xu Jing, Ying Zhang, Yuguo Chen () and Yihai Cao ()
Additional contact information
Jiaojiao Pang: Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University
Feng Xu: Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University
Gianmarco Aondio: Moriggia-Pelascini Hospital, Gravedona ed Uniti
Yu Li: Qilu Hospital of Shandong University
Alberto Fumagalli: Moriggia-Pelascini Hospital, Gravedona ed Uniti
Ming Lu: Clinical Research Center of Shandong University
Giuseppe Valmadre: Moriggia-Pelascini Hospital, Gravedona ed Uniti
Jie Wei: Renmin Hospital of Wuhan University
Yuan Bian: Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University
Margherita Canesi: Moriggia-Pelascini Hospital, Gravedona ed Uniti
Giovanni Damiani: Moriggia-Pelascini Hospital, Gravedona ed Uniti
Yuan Zhang: Clinical Research Center of Shandong University
Dexin Yu: Qilu Hospital of Shandong University
Jun Chen: Renmin Hospital of Wuhan University
Xiang Ji: Qilu Hospital of Shandong University
Wenhai Sui: The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine
Bailu Wang: Clinical Research Center of Shandong University
Shuo Wu: Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University
Attila Kovacs: Moriggia-Pelascini Hospital, Gravedona ed Uniti
Miriam Revera: Moriggia-Pelascini Hospital, Gravedona ed Uniti
Hao Wang: Qilu Hospital of Shandong University
Xu Jing: Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University
Ying Zhang: Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University
Yuguo Chen: Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University
Yihai Cao: Tumor and Cell Biology, Karolinska Institutet

Nature Communications, 2021, vol. 12, issue 1, 1-10

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 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.

Date: 2021
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DOI: 10.1038/s41467-021-21085-8

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