Latest COVID-19 research details local vaccine reactions, ineffective outpatient treatments

Local reactions to the Moderna mRNA COVID-19 vaccine were described in a case series published as a letter by the New England Journal of Medicine on March 3. Twelve patients had large local reactions, with a median onset on day 8 after the first dose, resolving a median of six days later. Five of the reactions were grade 3 plaques. All the patients received second doses; six patients had no local reaction, three had similar recurrent reactions, and three had lower-grade reactions. “We hope this letter encourages additional reporting and communication regarding the epidemiologic characteristics, causes, and implications of these delayed cutaneous reactions, since this information might allay the concerns of patients, encourage completion of vaccination, and minimize the unnecessary use of antibiotic agents,” the authors said. In other vaccine news, the CDC recently updated its guidance to address the Janssen (Johnson & Johnson) vaccine and revise some contraindications for the mRNA vaccines.

Ivermectin did not improve outcomes in patients with mild COVID-19, according to a study published by JAMA on March 4. Patients in Colombia were randomized to ivermectin, 300 μg/kg for five days (n=200) or placebo (n=200). The median time to resolution of symptoms was 10 days in the ivermectin group compared with 12 days in the placebo group (hazard ratio for resolution of symptoms, 1.07; 95% CI, 0.87 to 1.32). “The findings do not support the use of ivermectin for treatment of mild COVID-19, although larger trials may be needed to understand the effects of ivermectin on other clinically relevant outcomes,” the study authors said, noting that “the relatively young and healthy study population rarely developed complications, rendering the study underpowered to detect such effects.”

Azithromycin was also ineffective for outpatients, according to a study published by The Lancet on March 4. The British trial randomized patients with suspected COVID-19 who were ages 65 years and older or 50 years and older with at least one comorbidity to azithromycin, 500 mg, (n=540), usual care (n=875), or other intervention (n=850). It found little evidence of a meaningful benefit with azithromycin on the outcome of recovery time and no difference on the outcome of hospitalization or death. “In conclusion, our findings show that azithromycin should not be used routinely to treat COVID-19 in the community in older adults, in the absence of additional indications,” the authors concluded, noting the importance of the results for antibiotic stewardship.

The NIH recently halted trials of three other potential COVID-19 treatments due to futility. One study had tested convalescent plasma in patients who came to an ED with mild to moderate symptoms. The other two were trials of monoclonal antibody treatments in hospitalized patients, part of the ACTIV-3 clinical trial.

Several recent studies looked at the effect of the pandemic on alcohol consumption. Alcohol withdrawal was more common among hospitalized patients after COVID-19 hit, according to a research letter published by JAMA Network Open on March 3. Sales of both alcohol and tobacco were higher in April to June 2020 than in the same period in 2019, according to a letter published March 2 by Annals of Internal Medicine. It found a 34% increase in alcohol sales in the U.S., which the authors noted was too high to be attributed to bar and restaurant closures alone. Another letter published by Annals of Internal Medicine the same day similarly found an increase in alcohol sales in Ontario from $1.617 billion in March to June 2019 to $1.885 billion in March to June 2020. The authors said that clinicians should caution patients about the risks of alcohol consumption during the pandemic and that public health measures should focus on the treatment needs of patients with alcohol use disorders.