Tiprelestat for treatment of hospitalized COVID-19: results of the double-blind randomized placebo-controlled COMCOVID trial
et al., Advances in Therapy, doi:10.1007/s12325-025-03362-w, Sep 2025
RCT 17 hospitalized COVID-19 patients showing no significant differences with tiprelestat (recombinant human elafin, a neutrophil elastase inhibitor). There was a trend toward benefit for oxygen support.
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risk of death, 188.9% higher, RR 2.89, p = 1.00, treatment 1 of 9 (11.1%), control 0 of 8 (0.0%), continuity correction due to zero event (with reciprocal of the contrasting arm).
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risk of progression, 11.1% lower, RR 0.89, p = 1.00, treatment 1 of 9 (11.1%), control 1 of 8 (12.5%), NNT 72, registry.
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ICU time, 22.2% lower, relative time 0.78, p = 0.85, treatment mean 1.4 (±3.9) n=9, control mean 1.8 (±4.6) n=8.
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oxygen time, 40.0% lower, relative time 0.60, p = 0.52, treatment mean 2.4 (±3.6) n=9, control mean 4.0 (±6.2) n=8.
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| Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates |
Bergs et al., 16 Sep 2025, Double Blind Randomized Controlled Trial, placebo-controlled, Germany, peer-reviewed, 12 authors, study period May 2023 - May 2024.
Contact: ibergs@ukaachen.de.
Tiprelestat is a recombinant human elafin protein administered intravenously that acts as an anti-inflammatory agent through reversible inhibition of neutrophil elastase and proteinase 3, aiming to attenuate neutrophil-driven lung injury in severe COVID-19.
Abstract: ## ORIGINAL RESEARCH
Tiprelestat for treatment of hospitalized COVID-19: results of the double-blind randomized placebo-controlled COMCOVID trial
Ingmar Bergs · Stephan Budweiser · Hans-Heinrich Henneicke-von Zepelin ·
Hagen Kelm · Tom Bollmann · Johannes-Josef Tebbe · Stephan Sorichter · Stefan Lüth ·
Stephan Walterspacher · Henning Wege · Oliver Wiedow · Michael Dreher
Received: July 30, 2025 / Accepted: August 29, 2025 / Published online: September 16, 2025 © The Author(s) 2025, corrected publication (2025)
ABSTRACT
Introduction : Tiprelestat (recombinant human elafin) reversibly inhibits human neutrophil elastase. This can reduce overactivity of this
Ingmar Bergs and Stephan Budweiser contributed equally.
Supplementary Information The online version contains supplementary material available at https:// doi. org/ 10. 1007/ s12325- 025- 03362-w.
I. Bergs ( *
) · M. Dreher
Department of Pneumology and Intensive Care Medicine, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany e-mail: ibergs@ukaachen.de
S. Budweiser
Department of Internal Medicine III, RoMed Klinikum Rosenheim, Rosenheim, Germany
H.-H. Henneicke-von Zepelin · O. Wiedow tiakis Biotech AG, Kiel, Germany
H. Kelm
Department of Pneumology, Ruppin Hospital, Neuruppin, Germany
T. Bollmann
Department of Pneumology, Helios Hospital, Stralsund, Germany
J.-J. Tebbe
Department of Gastroenterology and Infectiology, Hospital Lippe, Medical School and University Medical Center OWL, Bielefeld University, Bielefeld, Germany enzyme in COVID-19-patients and might prohibit further organ damage and progression to severe disease. This protein had yet not been tested in COVID-19 patients.
Methods : This prospective, multicenter, randomized, double-blind, placebo-controlled trial investigated Tiprelestat in adult patients hospitalized for COVID-19 in 7 hospitals in Germany between May 2023 and May 2024. Patients received 100 mg Tiprelestat or placebo twice a day for 7 days, or shorter if no longer hospitalized due to COVID-19. Data about efficacy,
S. Sorichter
Department of Pneumology and Respiratory Medicine, St. Josefskrankenhaus, Freiburg i.B., Germany
S. Lüth
Department of Internal Medicine II, University Hospital, Brandenburg an der Havel, Germany
S. Walterspacher
Department Department of Pneumology, Medical Clinic, Hospital of Konstanz, Constance, Germany, and Witten/Herdecke University, Witten, Germany
H. Wege
Department of General Internal Medicine, Oncology/Haematology, Gastroenterology and Infectiology, Hospital Esslingen, Esslingen, Germany
Vol.:(0123456789)
safety, and pharmacokinetic trough levels were collected over 29 days.
Results : A total of 296 patients were planned. Due to slow recruitment during the end of the pandemic, only 17 patients were finally included. Of these, 9 received Tiprelestat and 8 placebo. The mean treatment exposition was 9.1 ± 4.8 (SD, maximum 15) 30-min infusions with Tiprelestat and 7.8 ± 3.2 (maximum 14) with placebo. No relevant abnormalities in clinical or laboratory blood parameters were suspected to be caused by Tiprelestat. None of the Tiprelestat-treated patients developed severe COVID-19 (WHO Clinical Progression Scale ≥ 6). The number of days with any oxygen support tended to be lower in the Tiprelestat group (2.4 ± 3.6 days) compared to placebo (4.0 ± 6.2 days). Stable plasma trough levels of Tiprelestat were shown upon repeated administration for up to 7 days, even in patients with..
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