Evaluating the effect of Edaravone on clinical outcome of patients with severe COVID-19 admitted to ICU: a randomized clinical trial

Abstract

Cytokine storm is the most prominent hallmark in patients with coronavirus disease 2019 (COVID-19) that stimulates the free radical storm, both of which induce an overactive immune response during viral infection. We hypothesized that owning to its radical-scavenging and anti-inflammatory properties, Edaravone could reduce multi-organ injury, clinical complications, and mortality in severe COVID-19 cases. This single-center randomized clinical trial was accompanied in the intensive care units (ICUs) of the teaching hospital of Tabriz University of Medical Sciences to evaluate the effect of Edaravone on the outcome of patients with severe COVID-19. Thirty-eight patients admitted to ICU were included and randomized into two control and intervention arms. Patients in the intervention group received 30 mg Edaravone by slow intravenous infusion for three days in addition to receiving national therapy. The primary outcome was the need for intubation, the intubation length, and mortality rate. Secondary endpoints were clinical improvement. Edaravone administration improved the primary outcomes; it decreased the need for endotracheal intubation and mechanical ventilation [10.52% ( n = 2) versus 42.1% ( n = 8); p = 0.03] and intubation length [3 (1–7) versus 28 (4–28), p = 0.04] compared to control group. Baseline characteristics and laboratory tests were similar between the studied groups. No marked differences were observed in secondary endpoints ( p > 0.05). Administration of Edaravone could decrease the need for mechanical ventilation and length of intubation in severe COVID-19 patients admitted to ICU.

Effectiveness of edaravone in preventing contrast‐induced nephropathy in high‐risk patients undergoing coronary angiography: A randomized, double‐blind trial

“…Moreover, edaravone exhibits the ability to safeguard organs against inflammation, radiation, and ischemia–reperfusion injury. 27 , 28 , 29 , 30 In animal models, pre‐treatment with edaravone has been shown to attenuate renal injury and histologic changes after contrast administration via increasing renal antioxidant capacity. 31 Correspondingly, in the present study, the administration of edaravone 1 h before contrast usage resulted in a decrease in the incidence of CIN, with only one patient experiencing CIN development compared to four patients in the control group.…”

The effect of Fingolimod on patients with moderate to severe COVID‐19

“…Numerous studies have been done to examine the benefit of different medications that were allocated based on their mechanism of action to improve the outcomes of patients with COVID‐19. 18 Li and colleagues reported that lopinavir/ritonavir (LPV/r) or arbidol monotherapy exerted little benefit in enhancing the clinical outcomes of mild/moderate COVID‐19 patients. 19 In another randomized clinical trial in COVID‐19 patients with mild‐to‐moderate pneumonia, it has been shown that anakinra (a recombinant human IL‐1 receptor antagonist) could not enhance patients' outcomes and was not effective in reducing the need for non‐invasive or mechanical ventilation or death.…”

“…Numerous studies have been done to examine the benefit of different medications that were allocated based on their mechanism of action to improve the outcomes of patients with COVID‐19 18 . Li and colleagues reported that lopinavir/ritonavir (LPV/r) or arbidol monotherapy exerted little benefit in enhancing the clinical outcomes of mild/moderate COVID‐19 patients 19 .…”