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c19early.org COVID-19 treatment researchZafirlukastZafirlukast (more..)
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The efficacy of Zafirlukast as a SARS-CoV-2 helicase inhibitor in adult patients with moderate COVID-19 Pneumonia (pilot randomized clinical trial)

Ghobain et al., Journal of Infection and Public Health, doi:10.1016/j.jiph.2022.11.016, Dec 2022
https://c19early.org/ghobain.html
ICU admission -100% Improvement Relative Risk 7-point scale, day 28 -9% 7-point scale, day 14 -17% 7-point scale, day 7 12% Hospitalization time -15% Viral clearance -23% Zafirlukast  Ghobain et al.  LATE TREATMENT  DB RCT Is late treatment with zafirlukast beneficial for COVID-19? Double-blind RCT 40 patients in Saudi Arabia (Apr - Sep 2021) Longer hospitalization (p=0.47) and worse viral clearance (p=0.48), not sig. c19early.org Ghobain et al., J. Infection and Publi.., Dec 2022 Favorszafirlukast Favorscontrol 0 0.5 1 1.5 2+
RCT 40 hospitalized patients with moderate COVID-19 pneumonia showing no significant difference with zafirlukast treatment compared to placebo. Authors suggest that the lack of efficacy might be related to timing of drug administration relative to symptom onset or insufficient dosing.
Viral load measured by PCR may not accurately reflect infectious virus measured by viral culture. Porter et al. show that viral load early in infection was correlated with infectious virus, but viral load late in infection could be high even with low or undetectable infectious virus. Assessing viral load later in infection may underestimate reductions in infectious virus with treatment.
risk of ICU admission, 100% higher, RR 2.00, p = 1.00, treatment 2 of 20 (10.0%), control 1 of 20 (5.0%).
risk of 7-point scale, 9.1% higher, RR 1.09, p = 0.48, treatment 20, control 20, day 28.
risk of 7-point scale, 16.7% higher, RR 1.17, p = 0.60, treatment 20, control 20, day 14.
risk of 7-point scale, 12.5% lower, RR 0.88, p = 0.62, treatment 20, control 20, day 7.
hospitalization time, 15.3% higher, relative time 1.15, p = 0.47, treatment mean 8.3 (±5.9) n=20, control mean 7.2 (±3.4) n=20.
risk of no viral clearance, 23.1% higher, RR 1.23, p = 0.48, treatment 16 of 20 (80.0%), control 13 of 20 (65.0%).
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Ghobain et al., 31 Dec 2022, Double Blind Randomized Controlled Trial, placebo-controlled, Saudi Arabia, peer-reviewed, 11 authors, study period April 2021 - September 2021. Contact: alanezi@hotmail.com.
The efficacy of Zafirlukast as a SARS-CoV-2 helicase inhibitor in adult patients with moderate COVID-19 Pneumonia (pilot randomized clinical trial)
M Al Ghobain, F Rebh, A Saad, A H Khan, N Mehyar, A Mashhour, I Islam, Y Alobaida, A S Alaskar, M Boudjelal, M Al Jeraisy
Journal of Infection and Public Health, doi:10.1016/j.jiph.2022.11.016
Objective: To assess the efficacy of Zafirlukast as a SARS-CoV-2 Helicase Inhibitor in adult patients with moderate COVID-19 symptoms (hospitalized patients with COVID-19 pneumonia who were not admitted to an intensive care unit). Methods: We conducted a randomized, double blind, placebo-controlled, pilot trial with adult patients with moderate COVID-19 pneumonia. The sample was randomized to Zafirlukast 10 mg BD for 10 days plus standard care vs placebo plus standard care. The primary outcome was the complete resolution of all symptoms. The secondary outcomes were the duration of oxygen therapy, and length of hospital stay (LOS). Results: In total, 40 patients were randomized (20 to Zafirlukast and 20 to the control). The time to the resolution of clinical symptoms in both groups was not significantly different. Regarding the fever, 0.3 days [95 % CI, -1.19, 0.69], p = 0.76, for shortness of breath, the difference was 0.4 days [95 % CI, -2.67, 3.46], p = 0.68, for cough the difference was 0.2 days [95 % CI, -1.45, 1.95], p = 0.98, for sputum the difference was 0.5 days [95 % CI, -0.75, 1.85], p = 0.09, for vomiting the difference was 0.1 days [95 % CI, -0.50, 0.30], p = 0.93, for fatigue the difference was 0.3 days [95 % CI, -4.32, 3.62], p = 0.64. The LOS per day for the two groups was not significantly different, 1.1 days [95 % CI,-2.03, 4.28], p = 0.94, nor was the duration of oxygen therapy per days, 1.3 days [95 % CI, 4.49], p = 0.49. Regarding the 7 category ordinary scale, there was no significant difference between the two groups at day 7 (p-value = 0.62), day 14 (p-value = 0.60) and day 28 (p-value = 0.48). Conclusion: Among adult patients hospitalized with COVID-19 pneumonia, the treatment with Zafirlukast, compared to placebo, did not significantly improve symptoms resolution.
Ethical approval The trial was approved by Institutional Review Board of King Abdullah International Medical Research Center and the Saudi Food and Drug Authority. Competing interests None declared
References
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Late treatment
is less effective
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