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Camostat mesylate therapy in critically ill patients with COVID-19 pneumonia

Sakr et al., Intensive Care Medicine, doi:10.1007/s00134-021-06395-1
Apr 2021  
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Mortality 67% Improvement Relative Risk Ventilation 10% Hospitalization time -17% Camostat for COVID-19  Sakr et al.  LATE TREATMENT Is late treatment with camostat beneficial for COVID-19? PSM retrospective 122 patients in Germany (March - July 2020) Lower mortality with camostat (p=0.011) Sakr et al., Intensive Care Medicine, Apr 2021 Favorscamostat Favorscontrol 0 0.5 1 1.5 2+
Retrospective 371 critically ill COVID-19 patients showing lower mortality with camostat mesylate treatment.
risk of death, 66.7% lower, RR 0.33, p = 0.01, treatment 6 of 61 (9.8%), control 18 of 61 (29.5%), NNT 5.1, propensity score matching.
risk of mechanical ventilation, 10.0% lower, RR 0.90, p = 1.00, treatment 9 of 61 (14.8%), control 10 of 61 (16.4%), NNT 61, propensity score matching.
hospitalization time, 16.7% higher, relative time 1.17, p = 0.35, treatment 61, control 61, propensity score matching.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Sakr et al., 12 Apr 2021, retrospective, Germany, peer-reviewed, 11 authors, study period 16 March, 2020 - 19 July, 2020. Contact: (corresponding author).
This PaperMiscellaneousAll
Abstract: Intensive Care Med (2021) 47:707–709 LETTER Camostat mesylate therapy in critically ill patients with COVID‑19 pneumonia Yasser Sakr1* , Hatim Bensasi2, Ahmed Taha3, Michael Bauer1 and Khaled Ismail2 on behalf of the UAE-Jena Research Group © 2021 The Author(s) Dear Editor, Camostat mesylate inhibits several serine proteases implicated in SARSCoV and SARS-CoV-2 virus-to-host cell membrane fusion, such as transmembrane serine protease (TMPRSS) 2, − 13, and − 11D/E/F [1–3]. In particular, inhibition of the SARS-CoV-2-activating host cell TMPRSS2 have been shown to block SARS-CoV-2 entry into the lung cells and represents, therefore, a possible therapeutic option in patients with coronavirus disease 2019 (COVID-19) [4]. A preliminary observation suggested that camostat mesylate may be also effective to treat the most advanced cases of COVID-19 with organ dysfunction [5]; however, randomized clinical trials are ongoing. In a retrospective analysis of 371 adult patients (> 18 years) admitted to the intensive care unit (ICU) of Al Ain Hospital, Abu Dhabi, United Arabs Emirates between March 16 and July 19, 2020 with COVID-19 pneumonia, we assessed whether treatment with camostat mesylate is associated with an improved outcome (Figure S1–2, Supplementary material). Details of data collection, patients’ management, and statistical methods are presented in appendix S1 of the supplementary material. Off-label camostat mesylate ­(Foipan®, Osaka, Japan) was given to 141 (38%) patients on admission to the ICU (200 mg po TID) for 7 days (Table 1 and table S1–2 of the Supplementary material). The overall ICU and hospital *Correspondence: 1 Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07743 Jena, Germany Full author information is available at the end of the article The members of UAE-Jena Research Group are listed in the acknowledgements. lengths of stay were 9 (25–75% interquartile range 5–17) and 18 (25–75% interquartile range 13–29) days, respectively, and ICU and hospital mortality rates were both 20.2% (n = 75). ICU/hospital mortality rate were lower (9.9 vs. 26.5, p < 0.001); whereas, the hospital length of stay was longer in patients who received camostat mesylate than who did not (Table 1). In a propensity score-adjusted multivariable Cox proportional hazard analysis in the whole cohort, camostat mesylate therapy was independently associated with a lower risk of in-hospital death, right censored at 60 days (relative hazard 0.31, 95% confidence interval 0.15–0.60, p = 0.001; table S3 and figure S3 of the supplementary material). Moreover, after inversed propensity treatment weight (IPTW)-adjustment and robust estimation using generalized estimating equations, camostat mesylate therapy was found to be independently associated with a lower risk of in-hospital death (odds ratio 0.254; 95% confidence interval 0.108–0.595, p < 0.001). In 122 propensity score-matched patients (61 pairs), ICU/hospital mortality rates (9.8 vs. 29.5, p = 0.006), the need for vasopressor therapy (45.9 vs. 67.2%, p = 0.018) or invasive mechanical ventilation (47.5 vs. 67.2%, p = 0.045) during the ICU stay were lower; whereas, 60-day survival was higher (log rank ­Chi2 = 18.6, p < 0.001) in patients treated with camostat mesylate than those who were not (Table 1, tables S1–3 and figure S4 of the supplementary material). Nonetheless, despite of..
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Late treatment
is less effective
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