Randomised Controlled Trial of Intravenous Nafamostat Mesylate in COVID Pneumonitis: Phase 1b/2a Experimental Study to Investigate Safety, Pharmacokinetics and Pharmacodynamics
| العنوان: | Randomised Controlled Trial of Intravenous Nafamostat Mesylate in COVID Pneumonitis: Phase 1b/2a Experimental Study to Investigate Safety, Pharmacokinetics and Pharmacodynamics |
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| المؤلفون: | Oliver Koch, Andrew Duncan, Jean Antonelli, Timothy S. Walsh, Annya Bruce, Kay Russell, Colin Ferrett, Colin Church, James S. O. McCullagh, Jürgen Schwarze, Cecilia Boz, Giulia Rinaldi, Sinéad Plant, Gareth Hardisty, Anne Moore, Ahsan R. Akram, Kourosh Honarmand Ebrahimi, Sarah McNamara, Feng Li, Kevin G. Blyth, K. Dhaliwal, David H. Dockrell, Asta Valanciute, Ross Mills, Bethany Mills, Claire L. Mackintosh, Daniel C. Anthony, Tom Quinn, Steve P. Rannard, John Norrie, Irene Young, Keith Finlayson, Kate Templeton, Alastair F. Nimmo, Richard A. O’Connor, Erin Gaughan, Emma Scholefield, James W. Dear, Richard Parker, Andrew Owen, Philip Emanuel, Manu Shankar-Hari, Grant C. Churchill, Adam Marshall, Nik Hirani, Islom B. Nazarov, Matthew Burgess, Emily Gwyer Findlay, Sunny Jabball |
| المصدر: | Quinn, T, Gaughan, E E, Bruce, A, Antonelli, J, O'Connor, R A, Li, F, McNamara, S, Koch, O, Mackintosh, C, Dockrell, D, Walsh, T, Blyth, K G, Church, C, Schwarze, J, Boz, C, Valanciute, A, Burgess, M, Emanuel, P, Mills, B, Rinaldi, G, Hardisty, G, Mills, R, Gwyer Findlay, E L, Jabbal, S, Duncan, A, Plant, S, Marshall, A D L, Young, I, Russell, K, Scholefield, E, Nimmo, A F, Nazarov, I B, Churchill, G C, McCullagh, J S O, Ebrahimi, K H, Ferrett, C, Templeton, K E, Rannard, S, Owen, A, Moore, A, Finlayson, K, Shankar-Hari, M, Akram, A R, Parker, R A, Dear, J W, Hirani, N & Dhaliwal, K 2022, ' Randomised Controlled Trial of Intravenous Nafamostat Mesylate in COVID pneumonitis: Phase 1b/2a Experimental Study to Investigate Safety, Pharmacokinetics and Pharmacodynamics ', EBioMedicine . https://doi.org/10.1016/j.ebiom.2022.103856Test EBioMedicine, Vol 76, Iss, Pp 103856-(2022) |
| بيانات النشر: | Elsevier BV, 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | Male, Medicine (General), History, Polymers and Plastics, Kaplan-Meier Estimate, Guanidines, Industrial and Manufacturing Engineering, law.invention, Randomized controlled trial, Informed consent, law, SARS-CoV-2/COVID-19, Nafamostat mesylate, Medicine, Aged, 80 and over, education.field_of_study, Anti-Inflammatory Agents, Non-Steroidal, General Medicine, Middle Aged, Viral Load, Nafamostat, Thromboelastometry, Total manuscript word count, Treatment Outcome, Anesthesia, Infectious diseases, Administration, Intravenous, Female, Half-Life, Adult, medicine.medical_specialty, Population, Drug Administration Schedule, General Biochemistry, Genetics and Molecular Biology, Immunophenotyping, Respiratory medicine, R5-920, Pharmacokinetics, Internal medicine, Humans, Business and International Management, education, Aged, Pneumonitis, SARS-CoV-2, business.industry, COVID-19, medicine.disease, Benzamidines, COVID-19 Drug Treatment, Clinical trial, Pharmacodynamics, business, Biomarkers |
| الوصف: | Despite the success of vaccines and selected repurposed treatments, COVID-19 is likely to remain a global health problem and further chemotherapeutics are required. Many repurposed drugs have progressed rapidly to Phase 2 and 3 trials without characterisation of Pharmacokinetics (PK)/Pharmacodynamics (PD) including safety in COVID-19. One such drug is Nafamostat Mesylate (Nafamostat), a synthetic serine protease inhibitor with anticoagulant and anti-inflammatory properties. Preclinical data has demonstrated that it is has potent antiviral activity against SARS-CoV-2 by directly inhibiting the transmembrane protease serine 2 (TMPRSS2) dependent stage of host cell entry.MethodsWe present the findings of a phase Ib/II open label, platform randomised controlled trial (RCT), exploring the safety of intravenous Nafamostat in hospitalised patients with confirmed COVID-19 pneumonitis. Patients were assigned randomly to standard of care (SoC), Nafamostat or an alternative therapy. Secondary endpoints included clinical endpoints such as number of oxygen free days and clinical improvement/ deterioration, PK/PD, thromboelastometry, D Dimers, cytokines, immune cell flow cytometry and viral load.ResultsData is reported from 42 patients, 21 of which were randomly assigned to receive intravenous Nafamostat. The Nafamostat group developed significantly higher plasma creatinine levels, more adverse events and a lower number of oxygen free days. There were no other statistically significant differences in the primary or secondary endpoints between Nafamostat and SoC. PK data demonstrated that intravenous Nafamostat was rapidly broken down to inactive metabolites. We observed an antifibrinolytic profile, and no significant anticoagulant effects in thromboelastometry. Participants in the Nafamostat group had higher D Dimers compared to SoC. There were no differences in cytokine profile and immune cell phenotype and viral loads between the groups.ConclusionIn hospitalised patients with COVID-19, we did not observe evidence of anti-inflammatory, anticoagulant or antiviral activity with intravenous Nafamostat. Given the number of negative trials with repurposed drugs, our experimental medicine trial highlights the value of PK/PD studies prior to selecting drugs for efficacy trials. Given the mechanism of action, further evaluation of Nafamostat delivered via a different route may be warranted. This trial demonstrates the importance of experimental trials in new disease entities such as COVID-19 prior to selecting drugs for larger trials. |
| وصف الملف: | application/vnd.openxmlformats-officedocument.wordprocessingml.document; application/pdf |
| تدمد: | 1556-5068 2352-3964 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d08984770a1c6b75fcf7ed0f83784327Test https://doi.org/10.2139/ssrn.3958859Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....d08984770a1c6b75fcf7ed0f83784327 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15565068 23523964 |
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