Use of Pulmozyme in ARDS
in patients with Covid-19.
The Saturday July 25, 2020 edition of the Palm Beach Post1 in its front page mentioned the fact that a colleague of ours who had been on a ventilator for 87 days, left the hospital, a success story of Covid-19. Buried in the article was an interesting tidbit. The institution where he was hospitalized, Palm Beach Gardens Hospital, had used dornase alfa as a modality of treatment. At the time, it sounded like one more option that might or might not turn out to be as efficacious as promised. Now that we have used Remdesevir and have noticed that it has not lived up to its billing and the WHO has even gone so far as recommending that it be removed as a therapeutic intervention2, other agents are being given a second look or are being sought. The hoopla of hydroxychloroquine has come and gone. Melatonin3, Decadron4 have recently been reported as offering some help with the condition. Even colchicine5 seems to also help according to a recent but not yet published study from Canada6.
Curious about this novel method, I contacted Dr. Darwich, an intensivist at the above hospital, who told me his center has the largest group of patients treated with Pulmozyme in the country. He has data submitted and accepted for publication in the near future. He states that treatment works best early on and it causes a breakup of mucous being formed in the alveoli; at the same time, it’s delivered in aerosolized form using an antiviral filter to prevent dissemination of the virus during the administration. The interest in the off-label use of the product began when a case report was published as a letter to the editor last year7.
Dornase is approved for Cystic fibrosis. It is not a stretch to think that the pathogenesis of Covid-19 inflammation in the alveolus is similar and therefore it should in theory work in both situations.
© 2020 The Author(s). Published by Elsevier Ltd,NMNI,35, 100689
A search on the site www.clinincaltrials.gov reveals that 1 trial on the use of dornase in Covid-19 was completed at the Feinstein Institute of Medical Research in Manhasset, one is actively recruiting patients at Brigham and Women and another one at University of South Alabama. Dornase’s effectiveness in improving pulmonary complications in Covid-19 is still awaiting publication of investigational data. However, it seems promising.
Reynald altéma, md
3. Zhang R, Wang X, Ni L, Di X, Ma B, Niu S, Liu C, Reiter RJ. COVID-19: Melatonin as a potential adjuvant treatment. Life Sci. 2020 Jun 1;250:117583.
4. Tomazini BM, Maia IS, et al. Effect of Dexamethasone on Days Alive and Ventilator-Free in Patients with Moderate or Severe Acute Respiratory Distress Syndrome and COVID-19: The CoDEX Randomized Clinical Trial. JAMA. 2020;324(13):1307–1316.
5. Nasiripour S, Zamani F, Farasatinasab M. Can Colchicine as an Old Anti-Inflammatory Agent Be Effective in COVID-19? J Clin Pharmacol. 2020 Jul;60(7):828-829.
7. A. P., Earhart, New Microbes and New Infections, Volume 35 Number C, May 2020.
Reynald Altéma, MD