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Efficacy of oral amantadine among patients hospitalised with COVID-19: A randomised, double-blind, placebo-controlled, multicentre study - 27/04/23

Doi : 10.1016/j.rmed.2023.107198 
Adam Barczyk a, , Małgorzata Czajkowska-Malinowska b, Małgorzata Farnik a, Marek Barczyk c, Łukasz Boda d, Szczepan Cofta e, Jan Duława f, Maciej Dyrbuś g, h, Rafał Harat i, Maciej Huk j, Sylwia Kotecka k, Artur Nahorecki l, Jacek Nasiłowski m, n, o, Wojciech Naumnik p, Grzegorz Przybylski q, r, Monika Słaboń-Willand s, Szymon Skoczyński a, Krystian Wita t, Grzegorz Zioło u, Piotr Kuna v
a Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland 
b Department of Lung Diseases and Respiratory Failure, Centre of Sleep Medicine and Respiratory Care, Kuyavian-Pomeranian Pulmonology Centre, Bydgoszcz, Poland 
c Department of Computer Networks and Systems, Silesian University of Technology, Gliwice, Poland 
d Faculty of Chemistry, Jagiellonian University, Krakow, Poland 
e Department of Respiratory Diseases, Alergology and Pulmonary Oncology, Medical University, Poznań, Poland 
f Department of Internal Medicine and Metabolic Diseases, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland 
g Temporary Hospital Pyrzowice, Poland 
h 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland 
i Department of Lung Diseases, District Hospital in Chrzanów, Chrzanów, Poland 
j Department of Applied Informatics, Faculty of Information and Communication Technology Wroclaw University of Science and Technology, Wrocław, Poland 
k Pharmacy "Wielkopolska", Pharmacy Group Czerniewicz, Poznań, Poland 
l Department of Internal Medicine and Infectious Diseases, St.Lucas Hospital in Bolesławiec, Bolesławiec, Poland 
m National Temporary Hospital, Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland 
n Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland 
o Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland 
p 1st Department of Lung Diseases and Chemotherapy of Respiratory Neoplasms, Medical University of Białystok, Białystok, Poland 
q Department of Lung Diseases, Neoplasms and Tuberculosis, Faculty of Medicine, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland 
r The Kuyavian and Pomerania Pulmonology Center in Bydgoszcz, Bydgoszcz, Poland 
s Emergency Department, Leszek Giec Upper-Silesian Medical Centre of the Silesian Medical University in Katowice, Katowice, Poland 
t 1st Department of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland 
u Lubuskie Center for Pulmonology, Torzym, Poland 
v Division of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Poland 

Corresponding author. Ziołowa 45-47 Str., 40-635, Katowice, Poland.Ziołowa 45-47 Str.Katowice40-635Poland

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Abstract

Background

Amantadine has been proposed as a treatment for COVID-19 because it shows anti-SARS-CoV-2 activity in vitro. However, to date, no controlled study has assessed the safety and efficacy of amantadine in COVID-19.

Research question

Whether amantadine is effective and safe among patients with different COVID-19 severity classifications.

Study design

and Methods: This was multi-centre, randomised, placebo-controlled study.Patients with oxygen saturation ≤94% and no need for high-flow oxygen or ventilatory support were randomly allocated to receive oral amantadine or placebo (1:1) for 10 days in addition to standard care. The primary endpoint was time to recovery assessed over 28 days since randomisation, defined as discharge from hospital or no need for supplemental oxygen.

Results

The study was terminated early due to a lack of efficacy after an interim analysis. Final data from 95 patients who received amantadine (mean age, 60.2 years; 65% male; 66% with comorbidities) and 91 patients who received placebo (mean age, 55.8 years; 60% male; 68% with comorbidities) were obtained. The median (95% CI) time to recovery was 10 days both in the amantadine (9–11) and placebo arms (8–11; subhazard ratio = 0.94 [95%CI 0.7–1.3]). The percentage of deaths and percentage of patients who required intensive care at 14 and 28 days did not significantly differ between the amantadine and placebo groups.

Interpretation

Adding amantadine to standard care in patients hospitalised with COVID-19 did not increase the likelihood of recovery.

Clinical trial registration

ClinicalTrials.gov; No.: NCT04952519; www.clinicaltrials.gov.

Le texte complet de cet article est disponible en PDF.

Highlights

The first controlled study of the effectiveness of amantadine in COVID-19.
Study population: patients with moderate to severe COVID-19.
Amantadine was not clinically effective compared to placebo.
Treatment of COVID-19 patients with amantadine was safe.

Le texte complet de cet article est disponible en PDF.

Keywords : Amantadine, COVID- 19, Hospitalisation, Randomised controlled trial, SARS

Abbreviations : COVID-19, OR, PCR, SARS-CoV-2, SD, sHRs


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