The treatment with pioglitazone added to the standard treatment of patients with DM2 hospitalized for COVID-19 may produce a decrease in the number of patients who progress to a second phase of severe systemic inflammation.
According to the latest studies, the evolution of the SARS-CoV-2 (COVID-19) infection shows two clinically different phases: The first phase of viral and clinical infection of viriasis (fever, myalgia, etc.) affects all patients and it is resolved in asymptomatic patients or with clinically moderate-mild affectations. However, towards the end of the first week of illness, a not inconsiderable number of patients progress towards a second phase of rapid and abrupt deterioration of their respiratory and cardiac function. More and more data indicate an important role of overactivated macrophages, interleukin 6 (IL6) and an excessive inflammatory response in the genesis of this second phase of aggravation. Linking with this hypothesis, the adipose tissue densely infiltrated by macrophages is the source of one third of the body's IL6, its production being even greater in the fat of central disposition of male distribution. All of this could explain the worse prognosis observed in men, obese and with type 2 diabetes (DM2). Regarding the possible effect of pioglitazone on the expression of ACE2, there is little literature, and less evidence, about the response of this receptor to treatment with pioglitazone, and what is more important, its effect on COVID-19 infection. Two studies have analyzed the expression of this receptor after administration of pioglitazone in different murine models of liver and kidney disease. The conclusions of these studies were that the administration of pioglitazone in rats with hepatic steatosis increased the expression of ACE2. It is known that the increased expression of ACE2 facilitates the entry of SARS-CoV-2 into the cell, in animal models it has been seen that ACE2 protects against the development of respiratory distress syndrome and that severe cases of COVID-19 and SARS 2003 have been linked to the possible inhibition of ACE2 by the virus and the increase in angiotensin II. In conclusion, it is a safe and proven drug in patients with DM2, cheap, with years of clinical experience. The use of pioglitazone added to the conventional treatment of patients at high risk, such as patients with COVID-19 and DM2, could be accompanied by a better evolution of the patients, avoiding or mitigating the inflammatory process that already occurs before its onset. seems to trigger the second accelerated phase of the disease.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
8
Patients receive 30 mg/day of pioglitazone for the entire period they remain in hospital
Patients receive the standard of care, according to the hospital protocol for patients with type 2 diabetes mellitus hospitalized.
Hospital Ramón y Cajal
Madrid, Spain
Patients treated with pioglitazone, together with conventional treatment for COVID-19 infection, who during their admission evolve towards the need to receive support with mechanical ventilation, enter the ICU and / or die.
Number of patients receive pioglitazone treatment during their hospital stay who receive support with mechanical ventilation, enter the ICU and / or die.
Time frame: Through hospitalization period, an average of 10-20 days until hospital discharge
Incidence of pioglitazone treatment-Emergent Adverse Events in patients with DM2 and symptomatic SARS-CoV-2 infection.
Proportion of patients who develop heart failure or adverse reaction associated with treatment.
Time frame: Everyday through hospitalization period, an average of 10-20 days until hospital discharge
Biomarker analysis: systemic inflammation parameters during the administration of pioglitazone treatment.
Changes in this inflammation parameter: C-reactive protein (in mg/dl)
Time frame: Each 48 hours through hospitalization period, an average of 10-20 days until hospital discharge
Biomarker analysis: systemic inflammation parameters during the administration of pioglitazone treatment.
Changes in this inflammation parameter: D-dimer (in μg/mL)
Time frame: Each 48 hours through hospitalization period, an average of 10-20 days until hospital discharge
Biomarker analysis: systemic inflammation parameters during the administration of pioglitazone treatment.
Changes in this inflammation parameter: ferritin (in ng/mL)
Time frame: Each 48 hours through hospitalization period, an average of 10-20 days until hospital discharge
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Biomarker analysis: systemic inflammation parameters during the administration of pioglitazone treatment.
Changes in this inflammation parameter: creatine kinase (CK) (in mg/dL)
Time frame: Each 48 hours through hospitalization period, an average of 10-20 days until hospital discharge
Biomarker analysis: systemic inflammation parameters during the administration of pioglitazone treatment.
Changes in this inflammation parameter: number of lymphocytes (in μL)
Time frame: Each 48 hours through hospitalization period, an average of 10-20 days until hospital discharge