Mineralocorticoid Use in COVID-19 Patients
Study Details
Study Description
Brief Summary
There is a considerable variability in aldosterone levels between individuals, and this may explain the wide variability in disease severity among those infected so we designed a pilot study to test for the safety and efficacy of fludrocortisone addition to standard of care in hospitalised COVID-19 patients.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
|
Phase 3 |
Detailed Description
Many studies have shown involvement of renin-angiotensin-aldosterone system (RAAS) in pathophysiology of COVID-19. There is a considerable variability between people infected with SARS-COV-2 virus in terms of severity. At pathophysiological level there are variable degrees of increased capillary permeability with resultant fluid leak. We hypothesize that the physiological response to overcome this fluid leak mainly involves stimulation of mineralocorticoid (aldosterone) pathway. Hence; those with defective mineralocorticoid response are at high risk for disease complications.
Aldosterone secretion capacity is affected by many factors whether physiological (age, sex, ethnicity and pregnancy) or pathological (e.g. smoking); this is reflected in wide differences (regarding aldosterone levels) between groups of people depending on these factors.
These variations in mineralocorticoid capacity between groups of people may explain why some certain groups are at high risk for severe disease while others are at a lower risk.
So we designed this pilot study to assess safety and efficacy of mineralocorticoid, in the form of fludrocortisone, as a potential treatment for COVID-19 by its addition to dexamethasone in hospitalized COVID-19 patients.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Experimental: Fludrocortisone arm 10 hospitalised COVID-19 patients meeting inclusion criteria will receive fludrocortisone 0.1 mg tablets in addition to dexamethasone 6 mg / 24 hours and standard care |
Drug: Fludrocortisone Acetate 0.1 MG
Fludrocortisone acetate 0.1 mg tablet / 12 hours; dose to be titrated according to response.
|
Outcome Measures
Primary Outcome Measures
- Time to recovery [28 days]
The first day, during the 28 days after enrollment, on which a patient met the criteria for category 1 or 2 on the eight-category ordinal scale
Secondary Outcome Measures
- Mortality Rate [28 days]
All-cause mortality rate over 28 days post enrollment.
- Length of hospital stay [28 days]
Number of days since enrollment till hospital discharge.
- Rate of ICU admission [28 days]
Number of patients who experienced worsening of clinical status necessitating ICU admission.
- Mechanical ventilation need [28 days]
Number of patients who needed invasive mechanical ventilation during hospitalisation.
- Improvement of lymphopenia [7 days]
Reversal of lymphopenia - measured at days 3 and 7 after initiation of treatment.
- Duration of Increased Supplemental Oxygen [28 days]
Number of days counted from enrollment over which the participant requires supplemental oxygen in excess over his/her baseline.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Male and non-pregnant female patients 18 years of age or older
-
Diagnosed with COVID-19 pneumonia as per local guidelines
-
Oxygen saturation (SaO2) of 93 % or less while they were breathing ambient air.
Exclusion Criteria:
-
A physician decision that involvement in the trial will not be in the patient's best interest, presence of any condition that would not allow the protocol to be followed safely.
-
known allergy or hypersensitivity to fludrocortisone.
-
known severe liver or kidney disease, uncontrolled hypertension, diabetes mellitus and peptic ulcer disease.
-
Hypokalemia (serum potassium of less than 3.5 mEq/L)
-
Use of medications that are contraindicated with fludrocortisone and that could not be replaced or stopped during the trial period.
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Ain Shams University | Cairo | Abbasia | Egypt | 11591 |
Sponsors and Collaborators
- Ain Shams University
Investigators
- Principal Investigator: Muhammad S Zeafan, Alazhar allergy and immunology center
Study Documents (Full-Text)
None provided.More Information
Publications
- Bauer JH. Age-related changes in the renin-aldosterone system. Physiological effects and clinical implications. Drugs Aging. 1993 May-Jun;3(3):238-45. Review.
- Coto E, Avanzas P, Gómez J. The Renin-Angiotensin-Aldosterone System and Coronavirus Disease 2019. Eur Cardiol. 2021 Mar 9;16:e07. doi: 10.15420/ecr.2020.30. eCollection 2021 Feb. Review.
- Gossain VV, Sherma NK, Srivastava L, Michelakis AM, Rovner DR. Hormonal effects of smoking--I: Effects on plasma renin activity. Am J Med Sci. 1986 May;291(5):321-4.
- Szymański P, Klisiewicz A, Lubiszewska B, Lipczyńska M, Kowalski M, Janas J, Hoffman P. Gender differences in angiotensin II and aldosterone secretion in patients with pressure overloaded systemic right ventricles are similar to those observed in systemic arterial hypertension. Int J Cardiol. 2011 Mar 17;147(3):366-70. doi: 10.1016/j.ijcard.2009.09.535. Epub 2009 Nov 7.
- Wang W, Tang J, Wei F. Updated understanding of the outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan, China. J Med Virol. 2020 Apr;92(4):441-447. doi: 10.1002/jmv.25689. Epub 2020 Feb 12.
- FMASU R111c/2021