ABSTRACT
Background. One of the most important components of COVID-19 therapy is the suppression of the hyperergic immune response. There is an urgent need ofcreating the optimaltactics ofefficientandsafe anti-inflammatory therapy. Anew methodoftreatment ofCOVID-19withinhalation ofultra-low (non-cytotoxic)doses of the alkylating drug melphalan is proposed, based on previous experimental, preclinical, and clinical data on its use in severe bronchial asthma. The aim. To evaluate the efficacy and safety of inhalation of ultra-low doses of melphalan in hospitalized patients with COVID-19-associated lung damage. Materials andmethods. A prospective, open, controlled, blindfor the centralexpert study was conducted. Sixty adult patients were included, 30 patients were consecutively admitted to the hospital and received nebulized inhalations of 0.1 mg of melphalan for 7 days. Thirty patients ofthe control group were selectedby an independentexpertretrospectively using the computer algorithm for selecting“close” patients based on the “case-control” principle. The primary endpoints were the dynamics on the WHO Clinical Improvement Scale and the dynamics of dyspnea according to the modified Borg scale, secondary – assessment of adverse events, dynamics of indicators of clinical, biochemical blood tests, lungs computed tomography data from the beginning ofinhalations in the melphalan group andfrom the corresponding day in the control group. Results. Inhalations of melphalan led to a significant improvement in the clinical condition ofpatients according to the WHOscale, decrease in the intensity ofdyspnea on day 7 of treatment and by the time of discharge, a significant anti-inflammatory effect. Adverse events and dynamics of laboratory parameters did not differ from the control group. Conclusion. The method of treatment of COVID-19 by inhalation of ultra-low doses of the alkylating drug melphalan is safe and leads to a significant clinical improvement of hospitalized patients with COVID-19-associated lung damage. © 2022 by the Author(s).
ABSTRACT
The development of an effective and safe drug for the treatment of patients with COVID-19 is currently an urgent task for the global medical community. Given that lung damage remains the predominant syndrome in COVID-19, and the development of acute respiratory distress syndrome (ARDS) is the most common reason for transfer to intensive care unit and connection to artificial lung ventilation, it seems promising to study the effectiveness and safety of surfactant therapy, successfully proven in practice in the treatment of adult and preterm infants ARDS. Despite the fact that most studies are devoted to the use of this method in patients in the acute stage, we present a case from our own practice of Surfactant-BL inhalation in a patient with COVID-19-associated pneumonia at the 2nd stage of rehabilitation treatment. Clinical signs of respiratory failure (RR 22 per minute, Sa O2 86% on atmospheric air, 95% on insufflation of humidified oxygen 7 L/min), high percentage of lung tissue damage according to thoracic CT (55% - CT3) on admission to the Medical Rehabilitation Unit, as well as a score of 6 on the NEWS2 scale served as a basis for the patient to receive Surfactant-BL inhalation for the indication »prevention of the development of acute respiratory distress syndrome« in a dosage of 75 mg twice a day for 5 days. Positive dynamics of clinical data at the end of the course of inhalations (decrease of RR to 16 per minute, increase of Sa O2 to 90% on atmospheric air and to 95% on insufflation of humidified oxygen 5 l/min, improvement of auscultatory picture), as well as the control thoracic CT scan, which showed a decrease of lung parenchyma damage to 45.2% (CT-2), indicated the effectiveness and safety of this method in the complex rehabilitation of COVID-19 patient, being a basis for further investigation of this issue. © 2021, Remedium Group Ltd. All rights reserved.