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Cárdenas G, Chávez-Canales M, Espinosa AM, Jordán-Ríos A, Malagon DA, Murillo MFM, Araujo LVT, Campos RLB, Wong-Chew RM, González LER, Cresencio KI, Velázquez EG, de la Cerda MR, Leyva Y, Hernández-Ruiz J, Hernández-Medel ML, León-Hernández M, Quero KM, Monciváis AS, Sarmiento EB, Reynoso RIA, Reyes DM, Del Río Ambriz LR, Hernández JSG, Cruz J, Ferrer SIV, Huerta L, Fierro NA, Hernández M, Pérez-Tapia M, Meneses G, Rosas G, Hernández-Aceves JA, Cervantes-Torres J, Valdez RA, Rodríguez AF, Espíndola-Arriaga E, Ortiz M, Salazar EA, Barba CC, Besedovsky H, Romano MC, Jung H, Bobes RJ, Soldevila G, López-Alvarenga JC, Fragoso G, Laclette JP, Sciutto E. Intranasal Versus Intravenous Dexamethasone to Treat Hospitalized COVID-19 Patients: A Randomized Multicenter Clinical Trial. Arch Med Res 2024; 55:102960. [PMID: 38290199 DOI: 10.1016/j.arcmed.2024.102960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 12/04/2023] [Accepted: 01/16/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND SARS-CoV2 induces flu-like symptoms that can rapidly progress to severe acute lung injury and even death. The virus also invades the central nervous system (CNS), causing neuroinflammation and death from central failure. Intravenous (IV) or oral dexamethasone (DXM) reduced 28 d mortality in patients who required supplemental oxygen compared to those who received conventional care alone. Through these routes, DMX fails to reach therapeutic levels in the CNS. In contrast, the intranasal (IN) route produces therapeutic levels of DXM in the CNS, even at low doses, with similar systemic bioavailability. AIMS To compare IN vs. IV DXM treatment in hospitalized patients with COVID-19. METHODS A controlled, multicenter, open-label trial. Patients with COVID-19 (69) were randomly assigned to receive IN-DXM (0.12 mg/kg for three days, followed by 0.6 mg/kg for up to seven days) or IV-DXM (6 mg/d for 10 d). The primary outcome was clinical improvement, as defined by the National Early Warning Score (NEWS) ordinal scale. The secondary outcome was death at 28 d between IV and IN patients. Effects of both treatments on biochemical and immunoinflammatory profiles were also recorded. RESULTS Initially, no significant differences in clinical severity, biometrics, and immunoinflammatory parameters were found between both groups. The NEWS-2 score was reduced, in 23 IN-DXM treated patients, with no significant variations in the 46 IV-DXM treated ones. Ten IV-DXM-treated patients and only one IN-DXM patient died. CONCLUSIONS IN-DMX reduced NEWS-2 and mortality more efficiently than IV-DXM, suggesting that IN is a more efficient route of DXM administration.
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Affiliation(s)
- Graciela Cárdenas
- Neurology Department, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - María Chávez-Canales
- Research Unit Universidad Autónoma de Mexico, Instituto Nacional de Cardiología Ignacio Chávez and Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ana María Espinosa
- Clinical Pharmacology Unit, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
| | | | - Daniel Anica Malagon
- Clinical Pharmacology Unit, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
| | | | | | | | - Rosa María Wong-Chew
- Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | | | | | | | - Yoana Leyva
- Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Joselin Hernández-Ruiz
- Clinical Pharmacology Unit, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
| | | | - Mireya León-Hernández
- Clinical Pharmacology Unit, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Karen Medina Quero
- Hospital Militar, Secretaría de la Defensa Nacional, Mexico City, Mexico
| | | | | | | | | | | | | | - Jocelyn Cruz
- Neurology Department, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Sergio Iván Valdés Ferrer
- Neurology and Psychiatry Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Leonor Huerta
- Inmunology Department, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Nora Alma Fierro
- Inmunology Department, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Marisela Hernández
- Inmunology Department, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Mayra Pérez-Tapia
- Bioprocess Development and Research Unit, Escuela Nacional de Ciencias Biológicas del Instituto Politécnico Nacional, Mexico City, Mexico
| | - Gabriela Meneses
- Instituto de Diagnóstico y Referencia Epidemiológicos Dr. Manuel Martínez Báez, Mexico City, Mexico
| | - Gabriela Rosas
- Faculty of Medicine, Universidad Autónoma del Estado de Morelos, Cuernavaca, Morelos, Mexico
| | - Juan Alberto Hernández-Aceves
- Inmunology Department, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Jaquelynne Cervantes-Torres
- Inmunology Department, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ricardo A Valdez
- Physiology, Biophysics and Neurosciences Department, Centro de Investigación y Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico
| | - Anai Fuentes Rodríguez
- National Flow Cytometry Laboratory, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, México
| | - Erick Espíndola-Arriaga
- National Flow Cytometry Laboratory, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, México
| | - Mauricio Ortiz
- National Flow Cytometry Laboratory, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, México
| | - Evelyn Alvarez Salazar
- National Flow Cytometry Laboratory, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, México
| | - Carlos Castellanos Barba
- National Flow Cytometry Laboratory, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, México
| | - Hugo Besedovsky
- Institute of Physiology and Pathophysiology, Marburg, Germany
| | - Marta C Romano
- Physiology, Biophysics and Neurosciences Department, Centro de Investigación y Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico
| | - Helgi Jung
- Faculty of Chemistry, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Raúl J Bobes
- Inmunology Department, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Gloria Soldevila
- Inmunology Department, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico; National Flow Cytometry Laboratory, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, México
| | | | - Gladis Fragoso
- Inmunology Department, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Juan Pedro Laclette
- Inmunology Department, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Edda Sciutto
- Inmunology Department, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico.
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Cárdenas G, Chávez-Canales M, Espinosa AM, Jordán-Ríos A, Malagon DA, Murillo MFM, Araujo LVT, Campos RLB, Wong-Chew RM, González LER, Cresencio KI, Velázquez EG, de la Cerda MR, Leyva Y, Hernández-Ruiz J, Hernández-Medel ML, León-Hernández M, Quero KM, Monciváis AS, Díaz SH, Martínez IRZ, Martínez-Cuazitl A, Salazar INM, Sarmiento EB, Peña AF, Hernández PS, Reynoso RIA, Reyes DM, del Río Ambriz LR, Bonilla RAA, Cruz J, Huerta L, Fierro NA, Hernández M, Pérez-Tapia M, Meneses G, Espíndola-Arriaga E, Rosas G, Chinney A, Mendoza SR, Hernández-Aceves JA, Cervantes-Torres J, Rodríguez AF, Alor RO, Francisco SO, Salazar EA, Besedovsky H, Romano MC, Bobes RJ, Jung H, Soldevila G, López-Alvarenga J, Fragoso G, Laclette JP, Sciutto E. Intranasal dexamethasone: a new clinical trial for the control of inflammation and neuroinflammation in COVID-19 patients. Trials 2022; 23:148. [PMID: 35164840 PMCID: PMC8845269 DOI: 10.1186/s13063-022-06075-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 02/01/2022] [Indexed: 12/15/2022] Open
Abstract
Background By end December of 2021, COVID-19 has infected around 276 million individuals and caused over 5 million deaths worldwide. Infection results in dysregulated systemic inflammation, multi-organ dysfunction, and critical illness. Cells of the central nervous system are also affected, triggering an uncontrolled neuroinflammatory response. Low doses of glucocorticoids, administered orally or intravenously, reduce mortality among moderate and severe COVID-19 patients. However, low doses administered by these routes do not reach therapeutic levels in the CNS. In contrast, intranasally administered dexamethasone can result in therapeutic doses in the CNS even at low doses. Methods This is an approved open-label, multicenter, randomized controlled trial to compare the effectiveness of intranasal versus intravenous dexamethasone administered in low doses to moderate and severe COVID-19 adult patients. The protocol is conducted in five health institutions in Mexico City. A total of 120 patients will be randomized into two groups (intravenous vs. intranasal) at a 1:1 ratio. Both groups will be treated with the corresponding dexamethasone scheme for 10 days. The primary outcome of the study will be clinical improvement, defined as a statistically significant reduction in the NEWS-2 score of patients with intranasal versus intravenous dexamethasone administration. The secondary outcome will be the reduction in mortality during hospitalization. Conclusions This protocol is currently in progress to improve the efficacy of the standard therapeutic dexamethasone regimen for moderate and severe COVID-19 patients. Trial registration ClinicalTrials.govNCT04513184. Registered November 12, 2020. Approved by La Comisión Federal para la Protección contra Riesgos Sanitarios (COFEPRIS) with identification number DI/20/407/04/36. People are currently being recruited. Graphical abstract ![]()
REVIVAL is a multicenter, open-label, randomized, controlled study to compare the standard low doses of intravenous dexamethasone with weight-adjusted low doses of intranasal dexamethasone. Intranasal dexamethasone can reach the respiratory tract more effectively than intravenous administration. Intranasal dexamethasone can reach the central nervous system in therapeutic concentrations, even at low doses. REVIVAL aims to reduce central failures and sequelae by controlling not only systemic inflammation but also neuroinflammation.
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Zem G, Khurrum M, Saab L, Nazari S, Tonyan O, Shahbazian A, Alvarez G, Leyva Y, Azatyan A, Majd A, Moshtael M, Shafagh S, Farivarmoheb N, Azalbar S, Harutyunyan K, Sabbaugh A, Kirungi C, Dzhambazian A, Khachatoorian C, Miranda S, Sherazi Z, Altunyan M, Iriana N, Aghdasi O, Dorian J, Ter-Papyan H, Zadori N, Hernandez F, Oppenheimer SB. Quantitative assay for evaluating anti‐clumping reagents. FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.655.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gregory Zem
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - M. Khurrum
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - L. Saab
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - S Nazari
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - O Tonyan
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - Az Shahbazian
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - G. Alvarez
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - Y Leyva
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - A Azatyan
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - A Majd
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - M. Moshtael
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - S Shafagh
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - N Farivarmoheb
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - S Azalbar
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - K. Harutyunyan
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - A Sabbaugh
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - C Kirungi
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - A Dzhambazian
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - C Khachatoorian
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - S Miranda
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - Z Sherazi
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - M. Altunyan
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - N Iriana
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - O Aghdasi
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - J. Dorian
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - H. Ter-Papyan
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - N Zadori
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - F. Hernandez
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
| | - SB Oppenheimer
- Center for Cancer and Developmental BiologyCalifornia State University NorthridgeNorthridgeCA
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