RAndomized Clinical Trial Of NAfamostat Mesylate, A Potent Transmembrane Protease Serine 2 (TMPRSS2) Inhibitor, in Patients with COVID-19 Pneumonia

DOI record: { "DOI": "10.3390/jcm12206618", "ISSN": [ "2077-0383" ], "URL": "http://dx.doi.org/10.3390/jcm12206618", "abstract": "<jats:p>Even though SARS-CoV-2 was declared by WHO as constituting no longer a public health emergency, the development of effective treatments against SARS-CoV-2 infection remains a critical issue to prevent complications, particularly in fragile patients. The protease inhibitor nafamostat, currently used in Japan and Korea for pancreatitis, owing to its anticoagulant properties for disseminated intravascular coagulation (DIC), is appealing for the treatment of COVID-19 infection, because it potently inhibits the transmembrane protease serine 2 (TMPRSS2) that, after virus binding to ACE-2, allows virus entry into the cells and replication. Moreover, it could prevent the DIC and pulmonary embolism frequently associated with COVID-19 infection. The goal of the RAndomized Clinical Trial Of NAfamostat (RACONA) study, designed as a prospective randomized, double-blind placebo-controlled clinical trial, was to investigate the efficacy and safety of nafamostat mesylate (0.10 mg/kg/h iv for 7 days), on top of the optimal treatment, in COVID-19 hospitalized patients. We could screen 131 patients, but due to the predefined strict inclusion and exclusion criteria, only 15 could be randomized to group 1 (n = 7) or group 2 (n = 8). The results of an ad interim safety analysis showed similar overall trends for variables evaluating renal function, coagulation, and inflammation. No adverse events, including hyperkalemia, were found to be associated with nafamostat. Thus, the RACONA study showed a good safety profile of nafamostat, suggesting that it could be usefully used in COVID-19 hospitalized patients.</jats:p>", "alternative-id": [ "jcm12206618" ], "author": [ { "ORCID": "https://orcid.org/0000-0002-3639-4086", "affiliation": [ { "name": "Internal Emergency Medicine Unit, Specialized Center for Blood Pressure Disorders-Regione Veneto, Department of Medicine—DIMED, University of Padua, 35128 Padua, Italy" } ], "authenticated-orcid": false, "family": "Seccia", "given": "Teresa Maria", "sequence": "first" }, { "ORCID": "https://orcid.org/0000-0001-9877-1054", "affiliation": [ { "name": "Internal Emergency Medicine Unit, Specialized Center for Blood Pressure Disorders-Regione Veneto, Department of Medicine—DIMED, University of Padua, 35128 Padua, Italy" } ], "authenticated-orcid": false, "family": "Shagjaa", "given": "Tungalagtamir", "sequence": "additional" }, { "ORCID": "https://orcid.org/0000-0002-8767-1995", "affiliation": [ { "name": "Department of Pharmaceutical & Pharmacological Sciences, University of Padua, 35131 Padua, Italy" } ], "authenticated-orcid": false, "family": "Morpurgo", "given": "Margherita", "sequence": "additional" }, { "ORCID": "https://orcid.org/0000-0002-3775-0011", "affiliation": [ { "name": "Internal Emergency Medicine Unit, Specialized Center for Blood Pressure Disorders-Regione Veneto, Department of Medicine—DIMED, University of Padua, 35128 Padua, Italy" } ], "authenticated-orcid": false, "family": "Caroccia", "given": "Brasilina", "sequence": "additional" }, { "ORCID": "https://orcid.org/0000-0003-4735-1636", "affiliation": [ { "name": "Internal Emergency Medicine Unit, Specialized Center for Blood Pressure Disorders-Regione Veneto, Department of Medicine—DIMED, University of Padua, 35128 Padua, Italy" } ], "authenticated-orcid": false, "family": "Sanga", "given": "Viola", "sequence": "additional" }, { "affiliation": [ { "name": "Pharmacy, University Hospital of Padua, 35126 Padua, Italy" } ], "family": "Faoro", "given": "Sonia", "sequence": "additional" }, { "ORCID": "https://orcid.org/0000-0003-0396-4377", "affiliation": [ { "name": "Pharmacy, University Hospital of Padua, 35126 Padua, Italy" } ], "authenticated-orcid": false, "family": "Venturini", "given": "Francesca", "sequence": "additional" }, { "affiliation": [ { "name": "Pharmacy, University Hospital of Padua, 35126 Padua, Italy" } ], "family": "Iadicicco", "given": "Girolama", "sequence": "additional" }, { "affiliation": [ { "name": "Pneumology, University Hospital of Padua, 35126 Padua, Italy" } ], "family": "Lococo", "given": "Sara", "sequence": "additional" }, { "ORCID": "https://orcid.org/0000-0003-0263-0703", "affiliation": [ { "name": "Infectious Diseases, University Hospital of Padua, 35126 Padua, Italy" } ], "authenticated-orcid": false, "family": "Mazzitelli", "given": "Maria", "sequence": "additional" }, { "affiliation": [ { "name": "Internal Medicine 3, University Hospital of Padua, 35128 Padua, Italy" } ], "family": "Farnia", "given": "Filippo", "sequence": "additional" }, { "ORCID": "https://orcid.org/0000-0003-3445-0387", "affiliation": [ { "name": "Internal Medicine 3, University Hospital of Padua, 35128 Padua, Italy" } ], "authenticated-orcid": false, "family": "Fioretto", "given": "Paola", "sequence": "additional" }, { "ORCID": "https://orcid.org/0000-0001-7996-3720", "affiliation": [ { "name": "Yokohama City University, Yokohama 236-0027, Japan" } ], "authenticated-orcid": false, "family": "Kobayashi", "given": "Yusuke", "sequence": "additional" }, { "ORCID": "https://orcid.org/0000-0001-7906-0580", "affiliation": [ { "name": "Biostatistics, Epidemiology and Public Health Unit, University of Padua, 35131 Padua, Italy" } ], "authenticated-orcid": false, "family": "Gregori", "given": "Dario", "sequence": "additional" }, { "ORCID": "https://orcid.org/0000-0002-7963-0931", "affiliation": [ { "name": "Internal Emergency Medicine Unit, Specialized Center for Blood Pressure Disorders-Regione Veneto, Department of Medicine—DIMED, University of Padua, 35128 Padua, Italy" } ], "authenticated-orcid": false, "family": "Rossi", "given": "Gian Paolo", "sequence": "additional" } ], "container-title": "Journal of Clinical Medicine", "container-title-short": "JCM", "content-domain": { "crossmark-restriction": false, "domain": [] }, "created": { "date-parts": [ [ 2023, 10, 19 ] ], "date-time": "2023-10-19T09:43:28Z", "timestamp": 1697708608000 }, "deposited": { "date-parts": [ [ 2023, 10, 19 ] ], "date-time": "2023-10-19T11:36:04Z", "timestamp": 1697715364000 }, "funder": [ { "award": [ "B/2020/0138" ], "name": "Fondazione Compagnia San Paolo" } ], "indexed": { "date-parts": [ [ 2025, 2, 21 ] ], "date-time": "2025-02-21T19:30:54Z", "timestamp": 1740166254218, "version": "3.37.3" }, "is-referenced-by-count": 4, "issue": "20", "issued": { "date-parts": [ [ 2023, 10, 19 ] ] }, "journal-issue": { "issue": "20", "published-online": { "date-parts": [ [ 2023, 10 ] 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