Icosapent Ethyl as supportive therapy in severe COVID-19 Pneumonia, a case series report
The new strain of coronavirus, labelled severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is at the heart of an ever-growing coronavirus disease 2019 (COVID-19) pandemic.
The use of icosapent ethyl as supportive therapy for the treatment of moderate to severe coronavirus disease 2019 (COVID-19) pneumonia was recently described in a case series published in the American Journal of Case Reports. The authors wrote, "In addition to the fact that more than 14 million confirmed cases have been reported, the actual burden of the virus is underestimated; of the numerous confirmed cases, there is a substantially greater amount of people that have actually been exposed or infected by the virus".
The respiratory sequelae morbidity commonly associated with SARS-CoV-2 infection are not solely caused by the viral infection itself, but also by an over-activated inflammatory host immune response, marked by an overall increase in inflammatory markers. Thus an anti-inflammatory therapy may be a driving point in combating SARS-CoV2-related disease. Several studies involving corticosteroids and other immunosuppressants have been proposed, and clinical trials are well underway. Icosapent ethyl, a form of eicosapentaenoic acid with anti-inflammatory activity, has been approved as an adjunctive treatment with statins in patients with hypertriglyceridemia. Icosapent ethyl is currently undergoing clinical trials to determine its anti-inflammatory effects in patients with coronavirus disease 2019 (COVID-19). Although there have been multiple studies performed concerning icosapent ethyl's anti-inflammatory activity in the treatment of hypertriglyceridemia, the mechanism of icosapent ethyl in dealing with COVID-19-induced inflammation remains speculative. Although icosapent ethyl is not currently approved as an anti-inflammatory treatment in patients with COVID-19, a recently reported case series did show some beneficial effects in reducing symptom severity.
CASE 1:
Researchers reported a case of 75-years-old man with a past medical history of hyperlipidemia, hypertension, type 2 diabetes mellitus, obesity, and benign prostatic hyperplasia. He was admitted in the hospital for a perirectal abscess and presented with fever, altered mental status, and hypoxia with chest tightness. Researchers tested him positive for COVID-19 using RTPCR and Chest X-ray demonstrated a focal right basal infiltrate suggestive of COVID-19 pneumonia. They performed chest drainage and started on icosapent ethyl 2 g twice a day by NG tube. The patient was then transferred to the ICU for hypoxia and continued systemic inflammatory response syndrome criteria. After 2 days of therapy, reductions in both creatinine (1.43 to 1.14) and C-reactive protein (CRP; 23.5 to 13.6) levels were observed. Following 2.5 days of treatment with icosapent ethyl and antibiotics, the patient was released from the ICU.
CASE 2:
Researchers then presented with a 23-year old man with a past medical history of type 2 diabetes mellitus and obesity. He was admitted in the hospital with acute kidney injury (AKI), hypoxia, hypercapnia and Acute Respiratory Distress Syndrome (ARDS) secondary to COVID-19 on July 2, 2020. On continuous treatment with antiviral therapy, immunosuppressive therapy, and convalescent plasma, his symptoms and inflammatory markers improved. However, he was continued with intubation before administration of icosapent ethyl. Following the addition of icosapent ethyl, the patient's chest X-ray resolved 3 days later and acute-phase reactants declined close to baseline levels. After 22 days of treatment, he was discharged by July 24.
CASE 3:
Researchers further reported a 24-year old man with a past medical history of autism contracted COVID-19 at his group home, and diagnosis of infection was confirmed by PCR. He was admitted to hospital with ARDS and respiratory failure secondary to COVID-19. He was administered with Icosapent ethyl from July 11 to July 14, mistakenly discontinued from July 15 to July 19, and subsequently restarted on July 20 after he developed severe pulmonary inflammation secondary to COVID-19. Following the addition of icosapent ethyl, the patient's chest X-ray resolved 3 days later and acute-phase reactants declined close to baseline levels. The researchers noted while he was not taking icosapent ethyl, his inflammatory markers increased in conjunction with his ventilatory requirement and he required significant supportive measures. After 3.5 days of treatment with icosapent ethyl and broad-spectrum antibiotics, his symptoms improved and he was discharged to rehabilitation.
The authors concluded, "This report of 3 cases describes the use of icosapent ethyl as a component of supportive treatments in ICU patients with moderate to severe COVID-19 pneumonia. However, as of yet there are no evidence-based treatments for SARS-CoV-2 infection from controlled clinical trials. The outcomes of ongoing clinical trials are awaited to determine whether icosapent ethyl has anti-inflammatory effects in patients with SARS-CoV-2 infection and which patients might benefit from the use of this adjunctive treatment".
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