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Nafamostat Mesylate Monotherapy in Patients with Moderate COVID-19: a Single-Center, Retrospective Study

Soma et al., Japanese Journal of Infectious Diseases, doi:10.7883/yoken.JJID.2021.699, Sep 2022
Mortality 80% Improvement Relative Risk Severe case -6% Nafamostat for COVID-19  Soma et al.  LATE TREATMENT Is late treatment with nafamostat beneficial for COVID-19? Retrospective 64 patients in Japan (March 2020 - January 2021) Lower mortality with nafamostat (not stat. sig., p=0.49) c19early.org Soma et al., Japanese J. Infectious Di.., Sep 2022 Favorsnafamostat Favorscontrol 0 0.5 1 1.5 2+
Retrospective 64 hospitalized patients with moderate COVID-19 showing no significant difference in clinical outcomes with nafamostat mesylate.
Standard of Care (SOC) for COVID-19 in the study country, Japan, is very poor with very low average efficacy for approved treatments1. Only expensive, high-profit treatments were approved. Low-cost treatments were excluded, reducing the probability of treatment—especially early—due to access and cost barriers, and eliminating complementary and synergistic benefits seen with many low-cost treatments.
Study covers TMPRSS2 inhibitors and nafamostat.
risk of death, 79.5% lower, RR 0.20, p = 0.49, treatment 0 of 31 (0.0%), control 2 of 33 (6.1%), NNT 16, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm).
risk of severe case, 6.5% higher, RR 1.06, p = 1.00, treatment 10 of 31 (32.3%), control 10 of 33 (30.3%).
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Soma et al., 30 Sep 2022, retrospective, Japan, peer-reviewed, 9 authors, study period 29 March, 2020 - 21 January, 2021. Contact: kfujii225@gmail.com.
Nafamostat Mesylate Monotherapy in Patients with Moderate COVID-19: a Single-Center, Retrospective Study
Tomomi Soma, Kentaro Fujii, Ayumi Yoshifuji, Taketomo Maruki, Kazuto Itoh, Daisuke Taniyama, Takahide Kikuchi, Naoki Hasegawa, Morio Nakamura
Japanese Journal of Infectious Diseases, doi:10.7883/yoken.jjid.2021.699
Coronavirus disease (COVID-19) has spread dramatically worldwide. Nafamostat mesylate inhibits intracellular entry of the novel severe acute respiratory syndrome coronavirus 2 and is believed to have therapeutic potential for treating patients with COVID-19. In this study, patients with moderate COVID-19 who were admitted to our hospital were retrospectively analyzed. Thirty-one patients received monotherapy with nafamostat mesylate, and 33 patients were treated conservatively. Nafamostat mesylate was administered with continuous intravenous infusion for an average of 4.5 days. Compared with the conservative treatment, nafamostat mesylate did not improve outcomes or laboratory data 5 days after admission. In addition, no significant differences in laboratory data 5 days after admission and outcomes in high-risk patients were observed. The incidence of hyperkalemia was significantly higher in the nafamostat mesylate group; however, none of the patients required additional treatment. In conclusion, monotherapy with nafamostat mesylate did not improve clinical outcomes in patients with moderate COVID-19. This study did not examine the therapeutic potential of combining nafamostat mesylate with other antiviral agents, and further investigation is required. Because of the high incidence of hyperkalemia, regular laboratory monitoring is required during the use of nafamostat mesylate.
Conflict of interest None to declare.
References
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Late treatment
is less effective
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