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
Adedeji, Lazarus, Biochemical characterization of middle east respiratory syndrome coronavirus helicase e00235-16, mSphere
Arabi, Alothman, Balkhy, Al-Dawood, Aljohani et al., Treatment of middle east respiratory syndrome with a combination of lopinavirritonavir and interferon-β1b (MIRACLE trial): study protocol for a randomized controlled trial, Trials
Cavalcanti, Zampieri, Rosa, Azevedo, Veiga et al., Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19, N Engl J Med,
doi:10.1056/NEJMoa2019014
Chan, Lai, Chu, Tsui, Tam et al., Treatment of severe acute respiratory syndrome with lopinavir/ritonavir: a multicentre retrospective matched cohort study, Hong Kong Med J
Fu, Han, Zhu, Bai, Yi et al., Risk factors for viral RNA shedding in COVID-19 patients, Eur Respir J
Horby, Mafham, Linsell, Effect of hydroxychloroquine in hospitalized patients with COVID-19, N Engl J Med
Hung, Lung, Tso, Liu, Chung et al., Triple combination of interferon beta-1b, lopinavir-ritonavir, and ribavirin in the treatment of patients admitted to hospital with COVID-19: an open-label, randomised, phase 2 trial, Lancet
Ivanov, Thiel, Dobbe, Van Der Meer, Snijder et al., Multiple enzymatic activities associated with severe acute respiratory syndrome coronavirus helicase, J Virol
Jang, Lee, Yeo, Jeong, Kim, Isolation of inhibitory RNA aptamers against severe acute respiratory syndrome (SARS) coronavirus NTPase/Helicase, Biochem Biophys Res Commun
Martinez, Espinosa, Adamek, Thomas, Chau et al., Breathing new life into West Nile virus therapeutics; discovery and study of zafirlukast as an NS2B-NS3 protease inhibitor, Eur J Med Chem,
doi:10.1016/j.ejmech.2018.08.077
Mehyar, Mashhour, Islam, Alhadrami, Tolah et al., Discovery of Zafirlukast as a novel SARS-CoV-2 helicase inhibitor using in silico modelling and a FRET-based assay, SAR and QSAR in Environmental Research
Self, Semler, Leither, Casey, Angus et al., Effect of hydroxychloroquine on clinical status at 14 days in hospitalized patients with COVID-19: a randomized clinical trial, JAMA,
doi:10.1001/jama.2020.22240
Shum, Tanner, Differential inhibitory activities and stabilisation of DNA aptamers against the SARS coronavirus helicase, Chembiochem
Siddiqi, Mehra, COVID-19 illness in native and immunosuppressed states: a clinical-therapeutic staging proposal, J Heart Lung Transpl
Tanner, Watt, Chai, Lu, Peiris, The severe acute respiratory syndrome (SARS) coronavirus NTPase/helicase belongs to a distinct class of 5′ to 3′ viral helicases, J Biol Chem
Yamamoto, Yang, Yoshinaka, Amari, Nakano et al., HIV protease inhibitor nelfinavir inhibits replication of SARS-associated coronavirus, Biochem Biophys Res Commun
Zou, Ruan, Huang, Liang, Huang et al., SARS-CoV-2 viral load in upper respiratory specimens of infected patients, N Engl J Med,
doi:10.1056/NEJMc2001737
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