Association between Nafamostat Mesylate and In-Hospital Mortality in Patients with Coronavirus Disease 2019: A Multicenter Observational Study

Abstract

Nafamostat mesylate may be effective against coronavirus disease 2019 (COVID-19). However, it is not known whether its use is associated with reduced in-hospital mortality in clinical practice. We conducted a retrospective observational study to evaluate the effect of nafamostat mesylate in patients with COVID-19 using the Medical Data Vision Co. Ltd. hospital-based database in Japan. We compared patients with COVID-19 who were (n = 121) and were not (n = 15,738) administered nafamostat mesylate within 2 days of admission between January and December 2020. We conducted a 1:4 propensity score matching with multiple imputations for smoking status and body mass index and combined the 20 imputed propensity score-matched datasets to obtain the adjusted odds ratio for in-hospital mortality. Crude in-hospital mortality was 13.2% (16/121) and 5.0% (790/15,738), respectively. In the propensity score-matched analysis with multiple imputations, the adjusted odds ratio (use vs. no use of nafamostat mesylate) for in-hospital mortality was 1.27 (95% confidence interval: 0.61–2.64; p = 0.52). Sensitivity analyses showed similar results. The results of this retrospective observational study did not support an association between nafamostat mesylate and improved in-hospital outcomes in patients with COVID-19, although further studies with larger sample sizes are warranted to assess the generalizability of our findings.

Inhibidores de la TMPRSS2 en el tratamiento de pacientes con COVID-19: revisión exploratoria

“…Con respecto a los ensayos clínicos, los tamaños de muestra regularmente eran pequeños (media 91±64) y la comparación consistía en terapia estándar frente a la terapia estándar más el inhibidor de la TMPRSS2, con un tiempo de duración de la intervención que oscilaba entre 5 y 14 días. En el Cuadro 1 se sintetizan los estudios teniendo en cuenta autor, año, país de realización, diseño, número de pacientes incluidos, fármaco administrado y resultados principales (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). Con relación a la apreciación critica de la evidencia, usando la escala PEDro se encontró que en 5/6 ensayos no hubo enmascaramiento, por lo que la calificación varió entre 7 y 11.…”

“…En relación con los estudios observacionales, todos coinciden en efectos positivos derivados del uso de los inhibidores de la TMPRSS2 en pacientes con COVID-19, sin embargo, la naturaleza de estos diseños no permite establecer recomendaciones fuertes. En las cohortes incluidas, las cuales sumaban un poco más de 15.00 pacientes, Nafamostat y Camostat se relacionaban con menor frecuencia de ingreso a UCI, menor requerimiento de ventilación mecánica e incluso reducción de la mortalidad (31,32).…”

Haematological and biochemical pathology markers for a predictive model for ITU admission and death from COVID‐19: A retrospective study

“…For example, in the Sotrovimab trial, it was shown that in the placebo group 13 of the 21 patients that died, died due to covid19‐related pneumonia, which might have been linked to changes in NLR, CRP and potassium as shown here [ 23 ]. Data from our study would also help to potential monitor other experimental or repurposed therapeutics such as nafamostat mesylate [ 24 , 25 ]. For example, In four consecutive SARS‐Cov‐2 positive critically ill patients, administration of nafamostat mesylate was associated with hyperkaliaemia.…”

Prevalence and characteristics of antibiotic prescription for acute COVID-19 patients in Japan

“…We analyzed DPC data for patient demographics (age and gender), diagnoses, comorbidity, prescriptions, and procedures. DPC data of the MDV have been used in recent studies on COVID-19 14 , 15 .…”