The primary objective of the study is to evaluate the days until reaching clinical stability after starting randomization in hospitalized patients with elevated inflammatory parameters and severe COVID-19 lung injury.
Unfortunately, the treatment of COVID-19 disease is still based on life support therapies. Nowadays, there is no scientific evidence from clinical trials regarding the efficacy or safety of different drugs to treat COVID-19 patients, despite some of them evolving to fatal severe lung injury due to important inflammatory process secondary to pro-inflammatory cytokines. Interestingly, Tacrolimus has been shown to inhibit both pro-inflammatory cytokines and, also, human coronavirus SARS-Cov replication, but it has not specifically been tested in COVID-19 patients. Our working hypothesis is that severe SARS-CoV-2 (COVID-19) pneumonia is secondary to a deleterious inflammatory process; so, the use of Methylprednisolone pulses and Tacrolimus in hospitalized severe COVID-19 lung injury patients might have a positive clinical effect. Given the COVID-19 current health emergency, this study could provide useful evidence to treat some COVID-19 patients with Methylprednisolona and Tacrolimus, which might represent a new therapeutic option for them. Tacrolimus is a drug with more than 20 years of experience, and therefore, its side effects are well known and usually reversible. In addition, since tacrolimus is a low-cost and easy to produce at large-scale drug, it could be used to treat a large number of patients. The administration of this drugs could not only decrease mortality secondary to lung involvement by COVID-19, but also decrease the excessive burden of care that intensive care units are bearing.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
84
the necessary dose to obtain blood levels of 8-10 ng / ml
120mg of methylprednisolone daily for 3 consecutive days
Hospital Universitari de Bellvitge
L'Hospitalet de Llobregat, Barcelona, Spain
RECRUITINGTime to reach clinical stability
Assess the days until clinical stability is achieved after initiating randomization in hospitalized patients with elevated inflammatory parameters and severe COVID-19 lung injury. Clinical stability is defined if all the following criteria are met for 48 consecutive hours: Body temperature ≤ 37.0ºC; PaO2 / FiO2\> 400 and / or SatO2 / FiO2\> 300; Respiratory rate ≤ 24 rpm
Time frame: 28 days
Time to reach an afebrile state for 48 hours.
days
Time frame: 56 days
Time to reach PaO2 / FiO2> 400 and / or SatO2 / FiO2> 300
days
Time frame: 56 days
Time to reach FR ≤ 24 rpm for 48 hours
days
Time frame: 56 days
Time to normalization of D-dimer (<250 ug / L)
days
Time frame: 56 days
Time until PCR normalization (<5mg / L).
days
Time frame: 56 days
Time until normalization of ferritin (<400ug / L)
days
Time frame: 56 days
Study the impact of immunosuppressive treatment on viral load using quantitative PCR
viral load
Time frame: 56 days
Time until hospital discharge
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days
Time frame: 56 days
Need for ventilatory support devices
days
Time frame: 56 days
Duration that it is necessary to maintain ventilatory support.
days
Time frame: 56 days
COVID-19 mortality
days
Time frame: 56 days
all-cause mortality
days
Time frame: 56 days
Analyze the expanded cytokine profile before the start of treatment and their evolution every 7 days after admission
cytokines quantification technique by Luminex
Time frame: 56 days
Describe the side effects and their severity attributed to tacrolimus and / or methylprednisolone.
IDIBELL Clinical Research and Clinical Trials Unit will oversee the monitoring and pharmacovigilance
Time frame: 56 days