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
Mortality 78% improvement lower risk ← → higher risk Ventilation 87% Progression, non-inva.. 46% Hospitalization time 52% Conestat alfa  Bernstein et al.  LATE TREATMENT RCT Is late treatment with conestat alfa beneficial for COVID-19? RCT 38 patients in the USA Lower mortality (p=0.29) and ventilation (p=0.078), not sig. c19early.org Bernstein et al., NCT04530136, December 2021 0 0.5 1 1.5 2+ RR
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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risk of death, 77.6% lower, RR 0.22, p = 0.29, treatment 0 of 27 (0.0%), control 1 of 11 (9.1%), NNT 11, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm).
risk of mechanical ventilation, 87.4% lower, RR 0.13, p = 0.08, treatment 0 of 27 (0.0%), control 2 of 11 (18.2%), NNT 5.5, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm).
risk of progression, 45.7% lower, RR 0.54, p = 0.07, treatment 12 of 27 (44.4%), control 9 of 11 (81.8%), NNT 2.7, non-invasive ventilation.
hospitalization time, 52.3% lower, relative time 0.48, p = 0.06, treatment mean 5.38 (±1.76) n=27, control 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 December 2025 USA Russia Sudan Angola Colombia Kenya Mozambique Vietnam Peru Philippines Spain Brazil Italy France Japan Canada China Uzbekistan Nepal Ethiopia Iran Ghana Mexico South Korea Germany Bangladesh Saudi Arabia Algeria Morocco Yemen Poland India DR Congo Madagascar Thailand Uganda Venezuela Nigeria Egypt Bolivia Taiwan Zambia Fiji Bosnia-Herzegovina Ukraine Côte d'Ivoire Bulgaria Greece Slovakia Singapore Iceland New Zealand Czechia Mongolia Israel Trinidad and Tobago Hong Kong North Macedonia Belarus Qatar Panama Serbia CAR 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 December 2025 USA Russia Sudan Angola Colombia Kenya Mozambique Vietnam Peru Philippines Spain Brazil Italy France Japan Canada China Uzbekistan Nepal Ethiopia Iran Ghana Mexico South Korea Germany Bangladesh Saudi Arabia Algeria Morocco Yemen Poland India DR Congo Madagascar Thailand Uganda Venezuela Nigeria Egypt Bolivia Taiwan Zambia Fiji Ukraine Côte d'Ivoire Eritrea Bulgaria Greece Slovakia Singapore New Zealand Malawi Czechia Mongolia Israel Trinidad and Tobago North Macedonia Belarus Qatar Panama Serbia Syria 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
Please send us corrections, updates, or comments. c19early involves the extraction of 200,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. IMA and WCH provide treatment protocols.
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