The Efficacy of the Mineralcorticoid Receptor Antagonist Canrenone in COVID-19 Patients
Marco Vicenzi, Massimiliano Ruscica, Simona Iodice, Irene Rota, Angelo Ratti, Roberta Di Cosola, Alberto Corsini, Valentina Bollati, Stefano Aliberti, Francesco Blasi
Journal of Clinical Medicine, doi:10.3390/jcm9092943
Background: In COVID-19 patients, aldosterone via angiotensin-converting enzyme-2 deregulation may be responsible for systemic and pulmonary vasoconstriction, inflammation, and oxidative organ damage. Aim: To verify retrospectively the impact of the mineralcorticoid receptor antagonist canrenone i.v. on the need of invasive ventilatory support and/or all-cause in-hospital mortality. Methods: Sixty-nine consecutive COVID-19 patients, hospitalized for moderate to severe respiratory failure at Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico of Milan, received two different therapeutic approaches in usual care according to the personal skills and pharmacological management experience of the referral medical team. Group A (n = 39) were given vasodilator agents or renin-angiotensin-aldosterone system (RAAS) inhibitors and group B (n = 30) were given canrenone i.v. Results: Among the 69 consecutive COVID-19 patients, those not receiving canrenone i.v. (group A) had an event-free rate of 51% and a survival rate of 64%. Group B (given a mean dose of 200 mg/q.d. of canrenone for at least two days of continuous administration) showed an event-free rate of 80% with a survival rate of 87%. Kaplan-Meier analysis for composite outcomes and mortality showed log rank statistics of 0.0004 and 0.0052, respectively. Conclusions: The novelty of our observation relies on the independent positive impact of canrenone on the all-cause mortality and clinical improvement of COVID-19 patients ranging from moderate to severe diseases.
Author Contributions: Conceptualization, M.V., M.R., S.A., and F.B.; formal analysis, S.I.; investigation, I.R., R.D.C., and A.R.; resourcesa dn writing-original draft preparation, M.V., M.R., A.C., and V.B.; writing-review and editing, M.V., M.R., A.C., V.B., S.A., and F.B. All authors have read and agreed to the published version of the manuscript.
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'abstract': '<jats:p>Background: In COVID-19 patients, aldosterone via angiotensin-converting enzyme-2 '
'deregulation may be responsible for systemic and pulmonary vasoconstriction, inflammation, '
'and oxidative organ damage. Aim: To verify retrospectively the impact of the mineralcorticoid '
'receptor antagonist canrenone i.v. on the need of invasive ventilatory support and/or '
'all-cause in-hospital mortality. Methods: Sixty-nine consecutive COVID-19 patients, '
'hospitalized for moderate to severe respiratory failure at Fondazione Istituti di Ricovero e '
'Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico of Milan, '
'received two different therapeutic approaches in usual care according to the personal skills '
'and pharmacological management experience of the referral medical team. Group A (n = 39) were '
'given vasodilator agents or renin–angiotensin–aldosterone system (RAAS) inhibitors and group '
'B (n = 30) were given canrenone i.v. Results: Among the 69 consecutive COVID-19 patients, '
'those not receiving canrenone i.v. (group A) had an event-free rate of 51% and a survival '
'rate of 64%. Group B (given a mean dose of 200 mg/q.d. of canrenone for at least two days of '
'continuous administration) showed an event-free rate of 80% with a survival rate of 87%. '
'Kaplan–Meier analysis for composite outcomes and mortality showed log rank statistics of '
'0.0004 and 0.0052, respectively. Conclusions: The novelty of our observation relies on the '
'independent positive impact of canrenone on the all-cause mortality and clinical improvement '
'of COVID-19 patients ranging from moderate to severe diseases.</jats:p>',
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