Camostat Mesylate May Reduce Severity of Coronavirus Disease 2019 Sepsis: A First Observation.

Abstract

Severe acute respiratory syndrome coronavirus 2 cell entry depends on angiotensin-converting enzyme 2 and transmembrane serine protease 2 and is blocked in cell culture by camostat mesylate, a clinically proven protease inhibitor. Whether camostat mesylate is able to lower disease burden in coronavirus disease 2019 sepsis is currently unknown.

DESIGN:

Retrospective observational case series.

SETTING:

Patient treated in ICU of University hospital Göttingen, Germany.

PATIENTS:

Eleven critical ill coronavirus disease 2019 patients with organ failure were treated in ICU.

INTERVENTIONS:

Compassionate use of camostat mesylate (six patients, camostat group) or hydroxychloroquine (five patients, hydroxychloroquine group).

MEASUREMENTS AND MAIN RESULTS:

Clinical courses were assessed by Sepsis-related Organ Failure Assessment score at days 1, 3, and 8. Further, viral load, oxygenation, and inflammatory markers were determined. Sepsis-related Organ Failure Assessment score was comparable between camostat and hydroxychloroquine groups upon ICU admission. During observation, the Sepsis-related Organ Failure Assessment score decreased in the camostat group but remained elevated in the hydroxychloroquine group. The decline in disease severity in camostat mesylate treated patients was paralleled by a decline in inflammatory markers and improvement of oxygenation.

CONCLUSIONS:

The severity of coronavirus disease 2019 decreased upon camostat mesylate treatment within a period of 8 days and a similar effect was not observed in patients receiving hydroxychloroquine. Camostat mesylate thus warrants further evaluation within randomized clinical trials.

• Authors: Heike Hofmann-Winkler, Onnen Moerer, Sabine Alt-Epping, Anselm Bräuer, Benedikt Büttner, Martin Müller, Torben Fricke, Julian Grundmann, Lars-Olav Harnisch, Daniel Heise, Andrea Kernchen, Meike Pressler, Caspar Stephani, Björn Tampe, Artur Kaul, Sabine Gärtner, Stefanie Kramer, Stefan Pöhlmann, Martin Sebastian Winkler
• Journal: Critical care explorations (Crit Care Explor) Vol. 2 Issue 11 Pg. e0284 (Nov 2020) ISSN: 2639-8028 [Electronic] United States
• PMID: 33225308 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.