Abstract:
Corona virus infection is a respiratory infection, compromising the normal breathing in critical patients by damaging the lungs. Novel severe acute respiratory syndrome coronavirus 2 infection (SARS-Cov-2) is an acute respiratory and infectious disease. Virus enters through the mucous membranes of orofacial region and reach the TG where it resides and take control of its peptides including Substance P (SP). SP is the main neuropeptide, neuromodulator and neuro-hormone of TG, associated with nociception and inflammation under noxious stimulus. SP release is triggered and consequently, it affects the immune cells, blood vessels to release the mediators for inflammation. Cytokine storming is initiated and cause respiratory distress, bronchoconstriction and death in complicated cases. Neurokinin-1 Receptor (NK-1R) antagonist and glucocorticoids may be used to alleviate the symptoms and treat this infection. SP is the main culprit seem to be involved in the triggering of inflammatory pathways in SARS-Cov-2 infection. It has direct association with cardiorespiratory rhythm, sleep-wake cycle, nociception, ventilator responses and regulates many important physiological and pathological roles. Its over-secretion should be blocked by NK-1R antagonist to treat COVID-19 driven inflammatory responses and organ damage. The aim of this study was to evaluate the clinical outcomes of Substance P receptor Neurokinin 1 antagonist in Covid- 19 patients against the usual treatments as controls. Methods: It is a randomized clinical trial, open label, having two arms, conducted at Bahria International Hospital, Lahore, Pakistan. PCR positive, hospitalized patients with more than 18 years of age, both genders, moderate to critical phase were included. 119 patients were randomly allocated in both arms, having 52 patients in control group A and 67 patients in interventional group B. Lab investigations were performed in both the groups before and after the intervention. One arm received normal management and care while the other received Neurokinin-1 Receptor antagonist, Aprepitant, in addition. Dexamethasone, a corticosteroid was also administered orally to both the groups. Mean age of patients in group A was 56.05 years while 58.1 years in group B. There were 28 males in group A and 39 in group B while 24 females in group A and 28 in group B. There were 3 critical patients in group A and 6 in group B. Biochemical and hematological parameters in both groups showed difference in C-reactive protein reduction in the intervention group, improvement in platelet count in group B, ferritin and LDH levels were also normalized in group B indicative of a reduced inflammation. However it was not much significant due to smaller sample size. Conclusions: The findings of this current study give a strong clue for the therapeutic potential of Aprepitant. Patients who received a combination therapy of Aprepitant and Dexamethasone showed improved clinical outcomes, laboratory findings and reduced C-reactive protein which is an inflammatory marker. A second use of medicine Aprepitant (80mg) in combination with Dexamethasone for 5 days in severe to critically ill COVID-19 patients is recommended to improve ventillatory response, reduce inflammation and organ damage. A combined therapeutic approach including corticosteroid, dexamethasone along with Neurokinin-1 Receptor, Aprepitant is suggested for an effective therapeutic strategy for COVID-19 infection. Trial Registration: This trial is registered in clinicaltrials.gov (NCT04468646). To Determine the Efficacy f Neurokinin 1 Receptor Antagonist as a Therapeutic Tool Against Cytokine Storm and Respiratory Failure in Covid-19 Patients.
Page(s):
409-409
DOI:
DOI not available
Published:
Journal: Abstract Book on International Conference on Food and Applied Sciences (ICFAS-23) 3-5 August 23, Volume: 0, Issue: 0, Year: 2023
Keywords:
Dexamethasone
,
Aprepitant
,
COVID19 Infection
,
Neurokinin1 Receptor
,
Substance P
,
Trigeminal nerve