Mitigating the risks of post-acute sequelae of SARS-CoV-2 infection (PASC) with intranasal chlorpheniramine: perspectives from the ACCROS studies
Fernando Valerio-Pascua, Fernando Baires, Anupamjeet Kaur Sekhon, Mari L Tesch, Estela Jackeline Pineda, Syed A A Rizvi, Jarmanjeet Singh, David Abraham Cortes-Bandy, Amy C Madril, Jana Radwanski, Anita S Lewis, Miguel Sierra-Hoffman, Mark L Stevens, Franck F Rahaghi
BMC Infectious Diseases, doi:10.1186/s12879-024-10211-8
Background The World Health Organization (WHO) declared the end of the COVID-19 (SARS-CoV-2) global public health emergency on May 5, 2023, but its long-term consequences have still been haunting the global population. Post-acute sequelae of COVID-19 (PASC) and long-term COVID-19 are serious concerns and present with various symptoms. Intranasal chlorpheniramine (iCPM) has been shown to decrease the viral burden of SARS-COV-2. iCPM uses decreased COVID-19 disease progression and severity in Accelerating COVID-19 Clinical Recovery in an Outpatient Setting (ACROSS)-I & III randomized control trials (RCT). Methods This prospective survey study included 259 participants in ACROSS I and III RCTs. We compared the effect of iCPM versus placebo on the reduction of PASC symptoms. A PASC questionnaire containing 17 questions regarding the most common PASC symptoms was used in this study. T-test and Pearson chi-square statistics were performed according to continuous and categorical data using STATA 17.0 Basic Edition software.
Findings The iCPM cohort had a lower proportion of patients with fatigue or tiredness vs. placebo (0 Vs 17, 21, p < 0.001). iCPM cohort had a lower proportion of patients with difficulty concentrating or mental confusion (0 vs. 22, 27, p < 0.001). iCPM cohort had also a lower number of patients with difficulty in the ability to perform daily activities or work vs. placebo (1 Vs 38, 48, p < 0.001). A smaller number of patients in the iCPM cohort sought medical attention for PACS symptoms compared to placebo (0 vs. 48, 68, p < 0.001). Interpretation The use of intranasal chlorpheniramine shows promise in preventing COVID-19 progression to the often-debilitating post-COVID-19 syndrome PASC. The association between iCPM use and a lower prevalence of PASC symptoms is strong. Further studies are needed to establish the role of ICPM in preventing PASC.
Declarations Ethics approval and consent to participate This study was approved by the Institutional Review Board (IRB) of the Ethics Committee of Investigation of Infectious and Zoonotic Disease at the Universidad Nacional Autónoma de Honduras. Written informed consent was obtained from all participants prior to their involvement in the study. In cases where verbal consent was required (e.g., remote participation), this consent was documented and witnessed by study personnel. No waivers of consent were requested or provided by the ethics committee, and no minors were included in the study.
Consent for publication
Competing interests The authors declare no competing interests.
Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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