c19early.org COVID-19 treatment researchCOVID-19 treatments

Recombinant Human C1 Esterase Inhibitor (Ruconest®) in the Prevention of Severe SARS-CoV-2 Infection in Hospitalized Patients With COVID-19: a Randomized, Parallel-group, Open-label, Multi-center Pilot Trial in the US

Bernstein et al., NCT04530136, NCT04530136, Dec 2021
Late treatmentRCT · NCT04530136 · 38 patients · USA
Conestat alfa for COVID-19
Bernstein et al. NCT04530136 · December 2021
Lower mortality and ventilation
Not statistically significant · p = 0.29 (mortality) and p = 0.078 (ventilation)
RCT 38 hospitalized COVID-19 patients showing non-significant improvements with conestat alfa. Results of this manufacturer RCT are notably better than the non-manufacturer RCT1.
Standard of Care (SOC) for COVID-19 in the study country, the USA, is very poor with very low average efficacy for approved treatments2. Only expensive, high-profit treatments were approved for early treatment. Low-cost treatments were excluded, reducing the probability of early treatment due to access and cost barriers, and eliminating complementary and synergistic benefits seen with many low-cost treatments.
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OutcomeImprovementEffect · pTreatmentControl
risk of death 77.6% lower · RR 0.22 · p = 0.29 77.6% lowerRR 0.22p = 0.29 0 of 27 (0.0%) 1 of 11 (9.1%) treatment 0 of 27 (0.0%), control 1 of 11 (9.1%)NNT 11continuity correction due to zero events
risk of mechanical ventilation 87.4% lower · RR 0.13 · p = 0.08 87.4% lowerRR 0.13p = 0.08 0 of 27 (0.0%) 2 of 11 (18.2%) treatment 0 of 27 (0.0%), control 2 of 11 (18.2%)NNT 5.5continuity correction due to zero events
risk of progression 45.7% lower · RR 0.54 · p = 0.07 45.7% lowerRR 0.54p = 0.07 12 of 27 (44.4%) 9 of 11 (81.8%) treatment 12 of 27 (44.4%), control 9 of 11 (81.8%)non-invasive ventilationNNT 2.7
hospitalization time 52.3% lower · relative time 0.48 · p = 0.06 52.3% lowerrelative time 0.48p = 0.06 mean 5.38 (±1.76) n=27 mean 11.27 (±16.01) n=11 mean 5.38 (±1.76) n=27, mean 11.27 (±16.01) n=11

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates.

Bernstein et al., 1 Dec 2021, Single Blind Randomized Controlled Trial, USA, preprint, 1 author, trial NCT04530136 (history). Contact: a.relan@pharming.com.
$0 $500 $1,000+ Efficacy vs. cost for COVID-19 treatment protocols c19early.org November 2026 USA Angola Colombia Kenya Mozambique Myanmar South Africa Peru Philippines Vietnam Japan Argentina Nepal Iran Bangladesh Ethiopia Ghana Germany Mexico South Korea United Kingdom Saudi Arabia Algeria Morocco Yemen Poland Uzbekistan India China Venezuela DR Congo Madagascar Thailand Uganda Egypt Nigeria Taiwan Fiji Zambia Bosnia-Herzegovina Jordan Georgia Switzerland Dominican Republic Bolivia Côte d'Ivoire Eritrea Togo Bulgaria Greece Slovakia Iceland New Zealand Trinidad and Tobago Mongolia Czechia Belarus Israel Haiti North Macedonia Hong Kong Qatar Panama Serbia USA favored high-profit treatments.The average efficacy of treatments was very low.High-cost protocols reduce early treatment, andforgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
$0 $500 $1,000+ Efficacy vs. cost for COVID-19treatment protocols worldwide c19early.org November 2026 USA Angola Colombia Kenya Mozambique Myanmar South Africa Peru Philippines Vietnam Japan Argentina Nepal Iran Bangladesh Ethiopia Ghana Germany Mexico South Korea United Kingdom Saudi Arabia Algeria Morocco Yemen Poland Uzbekistan India China Venezuela DR Congo Madagascar Thailand Uganda Egypt Taiwan Fiji Zambia Jordan Georgia Switzerland Dominican Rep. Bolivia Côte d'Ivoire Eritrea Togo Sri Lanka Bulgaria Greece Slovakia New Zealand Trinidad and Tobago Mongolia Czechia Belarus Israel North Macedonia Hong Kong Qatar Panama Serbia USA favored high-profit treatments.The average efficacy was very low.High-cost protocols reduce early treatment,and forgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
Late treatment
is less effective