Bevacizumab in Severe or Critical Patients With COVID-19 Pneumonia
Condition: Coronavirus Infections
MeSH terms: COVID-19; Coronavirus Infections
Study type: Interventional
Phase: Phase 2

Summary: 
      The novel identified coronavirus (SARS-CoV-2) in 2019 causes an nationwide outbreak as well
      as public health crisis in China, and expands globally. Pulmonary edema is one of the most
      detrimental symptoms and usually presents in severe and critical coronavirus disease
      (COVID-19), resulting in dyspnea, acute lung injury (ALI) ,acute respiratory distress
      syndrome (ARDS), and even death. Recent evidence revealed higher levels of blood Vascular
      Endothelial Growth Factor (VEGF) in COVID-19 patients compared with healthy controls. VEGF is
      considered as the most potent vascular permeability inducers. Numerous studies have revealed
      that VEGF was a key factor and a potential therapeutic target in ALI and ARDS. Bevacizumab,
      an anti-VEGF drug, approved by the FDA on February 26, 2004 and widely used in clinical
      oncotherapy, is a promising drug for ALI/ARDS in COVID-19 through suppression of pulmonary
      edema.
    

Detailed description: 
      In December 2019, a new identified coronavirus (SARS-CoV-2) outbreak in Wuhan, causes public
      health crisis in China and spreads worldwide. On February 11,2020, the World Health
      Organization officially named the disease caused by the new coronavirus "COVID-19". The
      Chinese Government takes stronger and harsher measures to control the progression of its
      outbreak. Meanwhile, five editions of "Diagnosis and Treatment for Novel Coronavirus-Infected
      Pneumonia" has been timely and continuously issued, which play extremely important roles in
      guiding the clinical management of COVID-19 nationwide in China.

      The symptoms of human infection with SARS-CoV-2 are generally fever, fatigue, dry cough and
      dyspnea. Noteworthy, a considerable percentage of COVID-19 cases have rapidly progressed to
      severe and critical type, among which acute lung injury (ALI) and acute respiratory distress
      syndrome (ARDS) are the most common complications, resulting in a large number of pneumonia
      hospitalized patients requiring supplemental oxygen, mechanical ventilation, or even
      ECMO.Pulmonary edema is a detrimental feature as well as a key causal factor of ALI/ARDS.

      Vascular Endothelial Growth Factor (VEGF) is considered as the most potent vascular
      permeability inducers. Recent evidence has revealed higher VEGF levels in COVID-19 patients
      compared with healthy controls. The rise of VEGF levels may be caused by hypoxia, severe
      inflammation, and upregulation of the infected respiratory tract epithelium itself. Numerous
      studies have confirmed a key role of VEGF as potential therapeutic target in acute lung
      injury (ALI) and acute respiratory distress syndrome (ARDS) due do increase vascular
      permeability and induce pulmonary edema.

      Thus, Bevacizumab, an anti-VEGF medication, may offer a unique approach to treat ALI/ARDS
      caused by COVID-19. Bevacizumab is a humanized monoclonal antibody with long half-life. It
      has been approved by the FDA on February 26, 2004 and widely used in clinical oncotherapy,
      with the pharmacokinetics and pharmacodynamics having been widely understood. Therefore,
      Bevacizumab is a promising drug for the treatment of ALI/ARDS as well as reduction of
      mortality in severe and critical COVID-19 patients through suppression of pulmonary edema.
    

Intervention name(s): Bevacizumab Injection
Intervention type(s): Drug
Intervention description(s): Bevacizumab 500mg + normal saline (NS) 100ml, ivdrip ≥90min
Intervention MeSH terms: Bevacizumab
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: COVID-19; Bevacizumab; pneumonia