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Chirinos JA, Lopez-Jaramillo P, Giamarellos-Bourboulis EJ, Dávila-Del-Carpio GH, Bizri AR, Andrade-Villanueva JF, Salman O, Cure-Cure C, Rosado-Santander NR, Cornejo Giraldo MP, González-Hernández LA, Moghnieh R, Angeliki R, Cruz Saldarriaga ME, Pariona M, Medina C, Dimitroulis I, Vlachopoulos C, Gutierrez C, Rodriguez-Mori JE, Gomez-Laiton E, Cotrina Pereyra R, Ravelo Hernández JL, Arbañil H, Accini-Mendoza J, Pérez-Mayorga M, Milionis C, Poulakou G, Sánchez G, Valdivia-Vega R, Villavicencio-Carranza M, Ayala-García RJ, Castro-Callirgos CA, Alfaro Carrasco RM, Garrido Lecca Danos W, Sharkoski T, Greene K, Pourmussa B, Greczylo C, Ortega-Legaspi J, Jacoby D, Chittams J, Katsaounou P, Alexiou Z, Sympardi S, Sweitzer NK, Putt M, Cohen JB. A randomized clinical trial of lipid metabolism modulation with fenofibrate for acute coronavirus disease 2019. Nat Metab 2022; 4:1847-1857. [PMID: 36344766 PMCID: PMC9640855 DOI: 10.1038/s42255-022-00698-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cytotoxicity may involve inhibition of peroxisome proliferator-activated receptor alpha. Fenofibrate activates peroxisome proliferator-activated receptor alpha and inhibits SARS-CoV-2 replication in vitro. Whether fenofibrate can be used to treat coronavirus disease 2019 (COVID-19) infection in humans remains unknown. Here, we randomly assigned inpatients and outpatients with COVID-19 within 14 d of symptom onset to 145 mg of oral fenofibrate nanocrystal formulation versus placebo for 10 d, in a double-blinded fashion. The primary endpoint was a severity score whereby participants were ranked across hierarchical tiers incorporating time to death, mechanical ventilation duration, oxygenation, hospitalization and symptom severity and duration. In total, 701 participants were randomized to fenofibrate (n = 351) or placebo (n = 350). The mean age of participants was 49 ± 16 years, 330 (47%) were female, mean body mass index was 28 ± 6 kg/m2 and 102 (15%) had diabetes. Death occurred in 41 participants. Compared with placebo, fenofibrate had no effect on the primary endpoint. The median (interquartile range) rank in the placebo arm was 347 (172, 453) versus 345 (175, 453) in the fenofibrate arm (P = 0.819). There was no difference in secondary and exploratory endpoints, including all-cause death, across arms. There were 61 (17%) adverse events in the placebo arm compared with 46 (13%) in the fenofibrate arm, with slightly higher incidence of gastrointestinal side effects in the fenofibrate group. Overall, among patients with COVID-19, fenofibrate has no significant effect on various clinically relevant outcomes ( NCT04517396 ).
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Affiliation(s)
- Julio A Chirinos
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Patricio Lopez-Jaramillo
- Instituto de Investigación MASIRA, Facultad de Ciencias de la Salud, Universidad de Santander, Bucaramanga, Colombia
| | - Evangelos J Giamarellos-Bourboulis
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School and Hellenic Institute for the Study of Sepsis, Athens, Greece
| | | | | | | | - Oday Salman
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School and Hellenic Institute for the Study of Sepsis, Athens, Greece
- Department of Medicine, American University of Beirut, Beirut, Lebanon
| | | | | | | | - Luz A González-Hernández
- Unidad de VIH, Hospital Civil de Guadalajara and Universidad de Guadalajara, Guadalajara, Mexico
| | - Rima Moghnieh
- Department of Medicine, Makassed General Hospital, Beirut, Lebanon
| | - Rapti Angeliki
- 6th Department of Pulmonary Medicine, SOTIRIA Athens General Hospital of Chest Disease, Athens, Greece
| | - María E Cruz Saldarriaga
- Centro de Investigación de Enfermedades Infecciosas y Tropicales, Hospital Nacional Adolfo Guevara Velasco, Cuzco, Peru
| | - Marcos Pariona
- Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Peru
| | - Carola Medina
- Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Peru
| | - Ioannis Dimitroulis
- 6th Department of Pulmonary Medicine, SOTIRIA Athens General Hospital of Chest Disease, Athens, Greece
| | - Charalambos Vlachopoulos
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School,, Athens, Greece
| | | | - Juan E Rodriguez-Mori
- Department of Nephrology, Hospital Nacional Alberto Sabogal Sologuren, EsSalud, Lima, Peru
| | | | | | | | | | | | | | - Charalampos Milionis
- Department of Internal Medicine, Ioannina University General Hospital, Ioannina, Greece
| | - Garyfallia Poulakou
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | | | | | | | | | | | | | - Tiffany Sharkoski
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School and Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Katherine Greene
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School and Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Bianca Pourmussa
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School and Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Candy Greczylo
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School and Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Juan Ortega-Legaspi
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School and Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Douglas Jacoby
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School and Hellenic Institute for the Study of Sepsis, Athens, Greece
| | - Jesse Chittams
- Biostatistics Analysis Core, Office of Nursing Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Paraskevi Katsaounou
- Section of Pneumonology and Respiratory Failure, 1st Department of Critical Care Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Zoi Alexiou
- 2nd Department of Internal Medicine, THRIASIO Eleusis General Hospital, Eleusis, Greece
| | - Styliani Sympardi
- 1st Department of Internal Medicine, THRIASIO Eleusis General Hospital, Eleusis, Greece
| | - Nancy K Sweitzer
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- Division of Cardiology, University of Arizona, Tucson, AZ, USA
| | - Mary Putt
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jordana B Cohen
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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