Clinical, Biochemical and Molecular Evaluations of Ivermectin Mucoadhesive Nanosuspension Nasal Spray in Reducing Upper Respiratory Symptoms of Mild COVID-19
Zaki F Aref, Shamardan Ezz Eldin S Bazeed, Mohammed H Hassan, Abeer S Hassan, Alaa Rashad, Rehab G Hassan, Aida A Abdelmaksoud
International Journal of Nanomedicine, doi:10.2147/ijn.s313093
Background: Ivermectin is an FDA-approved broad-spectrum anti-parasitic agent that has been shown to inhibit SARS-CoV-2 replication in vitro. Objective: We aimed to assess the therapeutic efficacy of ivermectin mucoadhesive nanosuspension intranasal spray in treatment of patients with mild COVID-19. Methods: This clinical trial included 114 patients diagnosed as mild COVID-19. Patients were divided randomly into two age and sex-matched groups; group A comprising 57 patients received ivermectin nanosuspension nasal spray twice daily plus the Egyptian protocol of treatment for mild COVID-19 and group B comprising 57 patients received the Egyptian protocol for mild COVID-19 only. Evaluation of the patients was performed depending on improvement of presenting manifestations, negativity of two consecutive pharyngeal swabs for the COVID-19 nucleic acid via rRT-PCR and assessments of hematological and biochemical parameters in the form of complete blood counts, C-reactive protein, serum ferritin and d-dimer which were performed at presentation and 7 days later. Results: Of the included patients confirmed with mild COVID-19, 82 were males (71.9%) and 32 females (28.1%) with mean age 45.1 ± 18.9. In group A, 54 patients (94.7%) achieved 2 consecutive negative PCR nasopharyngeal swabs in comparison to 43 patients (75.4%) in group B with P = 0.004. The durations of fever, cough, dyspnea and anosmia were significantly shorter in group A than group B, without significant difference regarding the duration of gastrointestinal symptoms. Duration taken for nasopharyngeal swab to be negative was significantly shorter in group A than in group B (8.3± 2.8 days versus 12.9 ± 4.3 days; P = 0.0001).
Conclusion: Local use of ivermectin mucoadhesive nanosuspension nasal spray is safe and effective in treatment of patients with mild COVID-19 with rapid viral clearance and shortening the anosmia duration. Clinicaltrials.gov Identifier: NCT04716569; https://clinicaltrials.gov/ct2/show/ NCT04716569.
Disclosure No potential conflicts of interest between authors to be declare.
Dovepress
References
Abdelmaksoud, Ghweil, Hassan, Olfactory disturbances as presenting manifestation among egyptian patients with COVID-19: possible role of zinc, Biol Trace Elem Res,
doi:10.1007/s12011-020-02546-5
Alam, Murshed, Bhiuyan, Saber, Alam, A case series of 100 COVID-19 positive patients treated with combination of ivermectin and doxycycline, J Bangladesh Coll Phys Surg,
doi:10.3329/jbcps.v38i0.47512
Alshweiat, Csóka, Tömösi, Nasal delivery of nanosuspension-based mucoadhesive formulation with improved bioavailability of loratadine: preparation, characterization, and in vivo evaluation, Int J Pharm,
doi:10.1016/j.ijpharm.2020.119166
Aly, Rahman, Indicators of critical illness and predictors of mortality in COVID-19 patients, Infect Drug Resist,
doi:10.2147/IDR.S261159
Alzahrani, Saadeldin, Ahmad, The potential use of mesenchymal stem cells and their derived exosomes as immunomodulatory agents for COVID-19 patients, Stem Cells Int,
doi:10.1155/2020/8835986
Aref, TCPDF
Azeem, Ashraf, Rasheed, Anjum, Hameed, Evaluation of cytotoxicity and antiviral activity of ivermectin against newcastle disease virus, Pak J Pharm Sci
Errecalde, Lifschitz, Vecchioli, Safety and pharmacokinetic assessments of a novel ivermectin nasal spray formulation in a pig model, J Pharm Sci,
doi:10.1016/j.xphs.2021.01.017
Gallego, Nishiura, Sah, Rodriguez-Morales, The COVID-19 outbreak and implications for the Tokyo 2020 Summer Olympic Games, Travel Med Infect Dis,
doi:10.1016/j.tmaid.2020.101604
Ghweil, Hassan, Khodeary, Characteristics, outcomes and indicators of severity for COVID-19 among sample of ESNA Quarantine Hospital's Patients, Egypt: a retrospective study, Infect Drug Resist,
doi:10.2147/IDR.S263489
Götz, Magar, Dornfeld, Influenza A viruses escape from MxA restriction at the expense of efficient nuclear vRNP import, Sci Rep,
doi:10.1038/srep23138
Jabeen, Khader, Jabeen, A review on the antiparasitic drug ivermectin for various viral infections and possibilities of using it for novel severe acute respiratory syndrome coronavirus 2: new hope to treat coronavirus disease
Ketkar, Yang, Wormser, Wang, Lack of efficacy of ivermectin for prevention of a lethal Zika virus infection in a murine system, Diagn Microbiol Infect Dis,
doi:10.1016/j.diagmicrobio.2019.03.012
Kumar, Singh, Kumari, Current understanding of the influence of environmental factors on SARS-CoV-2 transmission, persistence, and infectivity, Environ Sci Pollut Res Int,
doi:10.1007/s11356-020-12165-1
Lehrer, Rheinstein, Ivermectin docks to the SARS-CoV-2 spike receptor-binding domain attached to ACE2, Vivo,
doi:10.21873/invivo.12134
Liu, Chen, Lin, Han, Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients, J Infect,
doi:10.1016/j.jinf.2020.03.005
Lundberg, Pinkham, Baer, Nuclear import and export inhibitors alter capsid protein distribution in mammalian cells and reduce venezuelan equine encephalitis virus replication, Antiviral Res,
doi:10.1016/j.antiviral.2013.10.004
Mahase, Covid-19: death rate is 0.66% and increases with age, study estimates, BMJ,
doi:10.1136/bmj.m1327
Marhl, Grubelnik, Magdič, Markovič, Diabetes and metabolic syndrome as risk factors for COVID-19, Diabetes Metab Syndr,
doi:10.1016/j.dsx.2020.05.013
Mastrangelo, Pezzullo, Burghgraeve, Ivermectin is a potent inhibitor of flavivirus replication specifically targeting NS3 helicase activity: new prospects for an old drug, J Antimicrob Chemother,
doi:10.1093/jac/dks147
Rajter, Sherman, Fatteh, Vogel, Sacks et al., Use of ivermectin is associated with lower mortality in hospitalized patients with coronavirus disease 2019: the ivermectin in COVID nineteen study, Chest,
doi:10.1016/j.chest.2020.10.009
Rodriguez-Morales, Gallego, Escalera-Antezana, COVID-19 in Latin America: the implications of the first confirmed case in Brazil, Travel Med Infect Dis,
doi:10.1016/j.tmaid.2020.101613
Rodriguez-Morales, Sánchez-Duque, Hernández-Botero, Preparación y control dela enfermedad por coronavirus 2019 (COVID-19) en América Latina, Acta Medica Peruana,
doi:10.35663/amp.2020.371.909
Saindane, Pagar, Vavia, Nanosuspension based in situ gelling nasal spray of carvedilol: development, in vitro and in vivo characterization, Aaps Pharmscitech,
doi:10.1208/s12249-012-9896-y
Shouman, Hegazy, Nafae, Use of ivermectin as a potential chemoprophylaxis for COVID-19 in Egypt: a randomised clinical trial, J Clin Diagn Res,
doi:10.7860/JCDR/2020/46795.0000
Siddiqui, Danciu, Ashraf, Plants-derived biomolecules as potent antiviral phytomedicines: new insights on ethnobotanical evidences against coronaviruses, Plants,
doi:10.3390/plants9091244
Siddiqui, Jahan, Ashraf, Current status and strategic possibilities on potential use of combinational drug therapy against COVID-19 caused by SARS-CoV-2, J Biomol Struct Dyn,
doi:10.1080/07391102.2020.1802345
Singh, Gupta, Ghosh, Misra, Diabetes in COVID-19: prevalence, pathophysiology, prognosis and practical considerations, Diabetes Metab Syndr,
doi:10.1016/j.dsx.2020.04.004
Surti, Patel, Adnan, Ilimaquinone (marine sponge metabolite) as a novel inhibitor of SARS-CoV-2 key target proteins in comparison with suggested COVID-19 drugs: designing, docking and molecular dynamics simulation study, RSC Adv,
doi:10.1039/D0RA06379G
Wagstaff, Rawlinson, Hearps, Jans, An AlphaScreen ® -based assay for high-throughput screening for specific inhibitors of nuclear import, J Biomol Screen,
doi:10.1177/1087057110390360
Wagstaff, Sivakumaran, Heaton, Harrich, Jans, Ivermectin is a specific inhibitor of importin α/β-mediated nuclear import able to inhibit replication of HIV-1 and dengue virus, Biochem J,
doi:10.1042/BJ20120150
Wang, Jin, Ren, Updating the diagnostic criteria of COVID-19 "suspected case" and "confirmed case" is necessary, Mil Med Res,
doi:10.1186/s40779-020-00245-9
Xia, Quan, Piao, Preparation of stable nitrendipine nanosuspensions using the precipitation-ultrasonication method for enhancement of dissolution and oral bioavailability, Eur J Pharm Sci,
doi:10.1016/j.ejps.2010.04.006
Yang, Zheng, Gou, Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis, Int J Infect Dis,
doi:10.1016/j.ijid.2020.03.017
Zhang, Wang, Jia, Risk factors for disease severity, unimprovement, and mortality in COVID-19 patients in Wuhan, China, Clin Microbiol Infect,
doi:10.1016/j.cmi.2020.04.012
{ 'indexed': {'date-parts': [[2024, 4, 8]], 'date-time': '2024-04-08T17:19:13Z', 'timestamp': 1712596753713},
'reference-count': 41,
'publisher': 'Informa UK Limited',
'license': [ { 'start': { 'date-parts': [[2021, 6, 1]],
'date-time': '2021-06-01T00:00:00Z',
'timestamp': 1622505600000},
'content-version': 'unspecified',
'delay-in-days': 0,
'URL': 'http://creativecommons.org/licenses/by-nc/3.0/'}],
'content-domain': {'domain': [], 'crossmark-restriction': False},
'DOI': '10.2147/ijn.s313093',
'type': 'journal-article',
'created': {'date-parts': [[2021, 6, 14]], 'date-time': '2021-06-14T20:46:25Z', 'timestamp': 1623703585000},
'page': '4063-4072',
'source': 'Crossref',
'is-referenced-by-count': 36,
'title': 'Clinical, Biochemical and Molecular Evaluations of Ivermectin Mucoadhesive Nanosuspension Nasal '
'Spray in Reducing Upper Respiratory Symptoms of Mild COVID-19',
'prefix': '10.2147',
'volume': 'Volume 16',
'author': [ { 'ORCID': 'http://orcid.org/0000-0002-1803-735X',
'authenticated-orcid': True,
'given': 'Zaki F',
'family': 'Aref',
'sequence': 'first',
'affiliation': []},
{ 'ORCID': 'http://orcid.org/0000-0001-7653-0006',
'authenticated-orcid': True,
'given': 'Shamardan Ezz Eldin S',
'family': 'Bazeed',
'sequence': 'additional',
'affiliation': []},
{ 'ORCID': 'http://orcid.org/0000-0003-2698-9438',
'authenticated-orcid': True,
'given': 'Mohammed H',
'family': 'Hassan',
'sequence': 'additional',
'affiliation': []},
{ 'ORCID': 'http://orcid.org/0000-0001-8984-2957',
'authenticated-orcid': True,
'given': 'Abeer S',
'family': 'Hassan',
'sequence': 'additional',
'affiliation': []},
{'given': 'Alaa', 'family': 'Rashad', 'sequence': 'additional', 'affiliation': []},
{'given': 'Rehab G', 'family': 'Hassan', 'sequence': 'additional', 'affiliation': []},
{'given': 'Aida A', 'family': 'Abdelmaksoud', 'sequence': 'additional', 'affiliation': []}],
'member': '301',
'published-online': {'date-parts': [[2021, 6]]},
'reference': [ { 'key': 'ref1',
'doi-asserted-by': 'crossref',
'unstructured': 'El-Sayed, A., Kamel, M. Coronaviruses in humans and animals: the role of '
'bats in viral evolution. Environ Sci Pollut Res. 2021;28:19589–19600. '
'doi:10.1007/s11356-021-12553-1',
'DOI': '10.1007/s11356-021-12553-1'},
{ 'key': 'ref2',
'doi-asserted-by': 'publisher',
'first-page': '42',
'DOI': '10.1208/s12248-007-9000-9',
'volume': '10',
'author': 'González Canga',
'year': '2008',
'journal-title': 'AAPS J'},
{ 'key': 'ref3',
'doi-asserted-by': 'publisher',
'first-page': '23138',
'DOI': '10.1038/srep23138',
'volume': '6',
'author': 'Götz',
'year': '2016',
'journal-title': 'Sci Rep'},
{ 'key': 'ref4',
'doi-asserted-by': 'publisher',
'first-page': '851',
'DOI': '10.1042/BJ20120150',
'volume': '443',
'author': 'Wagstaff',
'year': '2012',
'journal-title': 'Biochem J'},
{ 'key': 'ref5',
'doi-asserted-by': 'publisher',
'first-page': '1',
'DOI': '10.1080/07391102.2020.1802345',
'author': 'Siddiqui',
'year': '2020',
'journal-title': 'J Biomol Struct Dyn'},
{ 'key': 'ref6',
'doi-asserted-by': 'publisher',
'first-page': '1244',
'DOI': '10.3390/plants9091244',
'volume': '9',
'author': 'Siddiqui',
'year': '2020',
'journal-title': 'Plants'},
{ 'key': 'ref7',
'doi-asserted-by': 'publisher',
'first-page': '37707',
'DOI': '10.1039/D0RA06379G',
'volume': '10',
'author': 'Surti',
'year': '2020',
'journal-title': 'RSC Adv'},
{ 'key': 'ref8',
'doi-asserted-by': 'publisher',
'first-page': '8835986',
'DOI': '10.1155/2020/8835986',
'volume': '2020',
'author': 'Alzahrani',
'year': '2020',
'journal-title': 'Stem Cells Int'},
{ 'key': 'ref9',
'doi-asserted-by': 'publisher',
'first-page': '192',
'DOI': '10.1177/1087057110390360',
'volume': '16',
'author': 'Wagstaff',
'year': '2011',
'journal-title': 'J Biomol Screen'},
{ 'key': 'ref10',
'doi-asserted-by': 'publisher',
'first-page': '104787',
'DOI': '10.1016/j.antiviral.2020.104787',
'volume': '178',
'author': 'Caly',
'year': '2020',
'journal-title': 'Antiviral Res'},
{ 'key': 'ref11',
'doi-asserted-by': 'publisher',
'first-page': '38',
'DOI': '10.1016/j.diagmicrobio.2019.03.012',
'volume': '95',
'author': 'Ketkar',
'year': '2019',
'journal-title': 'Diagn Microbiol Infect Dis'},
{ 'key': 'ref12',
'doi-asserted-by': 'publisher',
'first-page': '119166',
'DOI': '10.1016/j.ijpharm.2020.119166',
'volume': '579',
'author': 'Alshweiat',
'year': '2020',
'journal-title': 'Int J Pharm'},
{ 'key': 'ref13',
'doi-asserted-by': 'publisher',
'first-page': '6459',
'DOI': '10.2174/0929867326666190827151741',
'volume': '26',
'author': 'Alshweiat',
'year': '2019',
'journal-title': 'Curr Med Chem'},
{ 'key': 'ref14',
'doi-asserted-by': 'publisher',
'first-page': '3023',
'DOI': '10.21873/invivo.12134',
'volume': '34',
'author': 'Lehrer',
'year': '2020',
'journal-title': 'In Vivo'},
{ 'key': 'ref15',
'doi-asserted-by': 'publisher',
'first-page': '101613',
'DOI': '10.1016/j.tmaid.2020.101613',
'volume': '35',
'author': 'Rodriguez-Morales',
'year': '2020',
'journal-title': 'Travel Med Infect Dis'},
{ 'key': 'ref16',
'doi-asserted-by': 'publisher',
'first-page': '3',
'DOI': '10.35663/amp.2020.371.909',
'volume': '37',
'author': 'Rodriguez-Morales',
'year': '2020',
'journal-title': 'Acta Medica Peruana'},
{ 'key': 'ref17',
'doi-asserted-by': 'publisher',
'first-page': '101604',
'DOI': '10.1016/j.tmaid.2020.101604',
'volume': '2020',
'author': 'Gallego',
'year': '2020',
'journal-title': 'Travel Med Infect Dis'},
{ 'key': 'ref18',
'doi-asserted-by': 'publisher',
'first-page': '1',
'DOI': '10.1007/s12011-020-02546-5',
'author': 'Abdelmaksoud',
'year': '2021',
'journal-title': 'Biol Trace Elem Res'},
{ 'key': 'ref19',
'doi-asserted-by': 'publisher',
'first-page': '1',
'DOI': '10.1186/s40779-020-00245-9',
'volume': '7',
'author': 'Wang',
'year': '2020',
'journal-title': 'Mil Med Res'},
{ 'key': 'ref20',
'doi-asserted-by': 'publisher',
'first-page': '45',
'DOI': '10.1186/s13613-020-00661-z',
'volume': '10',
'author': 'Li',
'year': '2020',
'journal-title': 'Ann Intensive Care'},
{ 'key': 'ref21',
'doi-asserted-by': 'publisher',
'first-page': '767',
'DOI': '10.1016/j.cmi.2020.04.012',
'volume': '26',
'author': 'Zhang',
'year': '2020',
'journal-title': 'Clin Microbiol Infect'},
{ 'key': 'ref22',
'unstructured': 'Ministry of Health and Population. Egyptian national guidelines for '
'COVID-19. 2020. Available online: '
'https://hiph.alexu.edu.eg/images/egyptian_national_guidelines_covid-19.pdf. '
'Accessed December 1, 2020.'},
{ 'key': 'ref23',
'doi-asserted-by': 'publisher',
'first-page': '325',
'DOI': '10.1016/j.ejps.2010.04.006',
'volume': '40',
'author': 'Xia',
'year': '2010',
'journal-title': 'Eur J Pharm Sci'},
{ 'key': 'ref24',
'doi-asserted-by': 'publisher',
'first-page': '93',
'DOI': '10.21608/AEJI.2020.93432',
'volume': '10',
'author': 'Hegazy',
'year': '2020',
'journal-title': 'Afro-Egypt J Infect Endem Dis'},
{ 'key': 'ref25',
'doi-asserted-by': 'publisher',
'first-page': '1884',
'DOI': '10.1093/jac/dks147',
'volume': '67',
'author': 'Mastrangelo',
'year': '2012',
'journal-title': 'J Antimicrob Chemother'},
{ 'key': 'ref26',
'doi-asserted-by': 'publisher',
'first-page': '662',
'DOI': '10.1016/j.antiviral.2013.10.004',
'volume': '100',
'author': 'Lundberg',
'year': '2013',
'journal-title': 'Antiviral Res'},
{ 'key': 'ref27',
'first-page': '597',
'volume': '28',
'author': 'Azeem',
'year': '2015',
'journal-title': 'Pak J Pharm Sci'},
{ 'key': 'ref28',
'doi-asserted-by': 'publisher',
'first-page': '21',
'DOI': '10.22159/ajpcr.2020.v13i8.38357',
'volume': '13',
'author': 'Jabeen',
'year': '2020',
'journal-title': 'Asian J Pharm Clin Res'},
{ 'key': 'ref29',
'doi-asserted-by': 'publisher',
'first-page': '2375',
'DOI': '10.2147/IDR.S263489',
'volume': '13',
'author': 'Ghweil',
'year': '2020',
'journal-title': 'Infect Drug Resist'},
{ 'key': 'ref30',
'doi-asserted-by': 'publisher',
'author': 'Liu',
'year': '2020',
'journal-title': 'J Infect',
'DOI': '10.1016/j.jinf.2020.03.005'},
{ 'key': 'ref31',
'doi-asserted-by': 'publisher',
'first-page': 'm1327',
'DOI': '10.1136/bmj.m1327',
'volume': '369',
'author': 'Mahase',
'year': '2020',
'journal-title': 'BMJ'},
{ 'key': 'ref32',
'doi-asserted-by': 'publisher',
'first-page': '91',
'DOI': '10.1016/j.ijid.2020.03.017',
'volume': '94',
'author': 'Yang',
'year': '2020',
'journal-title': 'Int J Infect Dis'},
{ 'key': 'ref33',
'doi-asserted-by': 'publisher',
'first-page': '6267',
'DOI': '10.1007/s11356-020-12165-1',
'volume': '28',
'author': 'Kumar',
'year': '2021',
'journal-title': 'Environ Sci Pollut Res Int'},
{ 'key': 'ref34',
'doi-asserted-by': 'publisher',
'first-page': '1995',
'DOI': '10.2147/IDR.S261159',
'volume': '13',
'author': 'Aly',
'year': '2020',
'journal-title': 'Infect Drug Resist'},
{ 'key': 'ref35',
'doi-asserted-by': 'publisher',
'first-page': '671',
'DOI': '10.1016/j.dsx.2020.05.013',
'volume': '14',
'author': 'Marhl',
'year': '2020',
'journal-title': 'Diabetes Metab Syndr'},
{ 'key': 'ref36',
'doi-asserted-by': 'publisher',
'first-page': '303',
'DOI': '10.1016/j.dsx.2020.04.004',
'volume': '14',
'author': 'Singh',
'year': '2020',
'journal-title': 'Diabetes Metab Syndr'},
{ 'key': 'ref37',
'doi-asserted-by': 'publisher',
'author': 'Shouman',
'year': '2021',
'journal-title': 'J Clin Diagn Res',
'DOI': '10.7860/JCDR/2020/46795.0000'},
{ 'key': 'ref38',
'doi-asserted-by': 'publisher',
'first-page': '10',
'DOI': '10.3329/jbcps.v38i0.47512',
'volume': '38',
'author': 'Alam',
'year': '2020',
'journal-title': 'J Bangladesh Coll Phys Surg'},
{ 'key': 'ref39',
'doi-asserted-by': 'publisher',
'first-page': '85',
'DOI': '10.1016/j.chest.2020.10.009',
'volume': '159',
'author': 'Rajter',
'year': '2021',
'journal-title': 'Chest'},
{ 'key': 'ref40',
'doi-asserted-by': 'publisher',
'first-page': '189',
'DOI': '10.1208/s12249-012-9896-y',
'volume': '14',
'author': 'Saindane',
'year': '2013',
'journal-title': 'Aaps Pharmscitech'},
{ 'key': 'ref41',
'doi-asserted-by': 'publisher',
'first-page': '2501',
'DOI': '10.1016/j.xphs.2021.01.017',
'volume': '110',
'author': 'Errecalde',
'year': '2021',
'journal-title': 'J Pharm Sci'}],
'container-title': 'International Journal of Nanomedicine',
'original-title': [],
'language': 'en',
'link': [ { 'URL': 'https://www.dovepress.com/getfile.php?fileID=70515',
'content-type': 'application/pdf',
'content-version': 'vor',
'intended-application': 'text-mining'},
{ 'URL': 'https://www.dovepress.com/getfile.php?fileID=70515',
'content-type': 'application/pdf',
'content-version': 'vor',
'intended-application': 'similarity-checking'}],
'deposited': { 'date-parts': [[2021, 6, 14]],
'date-time': '2021-06-14T20:46:39Z',
'timestamp': 1623703599000},
'score': 1,
'resource': { 'primary': { 'URL': 'https://www.dovepress.com/clinical-biochemical-and-molecular-evaluations-of-ivermectin-mucoadhes-peer-reviewed-fulltext-article-IJN'}},
'subtitle': [],
'short-title': [],
'issued': {'date-parts': [[2021, 6]]},
'references-count': 41,
'URL': 'http://dx.doi.org/10.2147/IJN.S313093',
'relation': {},
'ISSN': ['1178-2013'],
'subject': [ 'Organic Chemistry', 'Drug Discovery', 'General Medicine', 'Biomaterials', 'Bioengineering',
'Biophysics', 'Pharmaceutical Science'],
'container-title-short': 'IJN',
'published': {'date-parts': [[2021, 6]]}}