Michelle Flores, Pharm D Candidate c/o 2027

According to clinical trial results from researchers at UCL, UCLH, and the Francis Crick Institute in the UK, dornase alfa, a drug commonly used to treat cystic fibrosis, improved outcomes for patients with severe COVID-19 pneumonia and may be used to treat other respiratory infections. A randomized unblinded trial sought to determine whether nebulized dornase alfa could mitigate the severe inflammation often seen in COVID-19 pneumonia and improve patient outcomes.¹

The study, published in the scientific journal, eLife, found that the drug, “Dornase alfa” reduced hyper-inflammation in COVID-19 pneumonia patients. Hyper-inflammation occurs when the body’s immune system reacts too strongly and may lead to tissue damage and death. Dornase alfa can potentially treat a range of respiratory infections, including those caused by influenza or bacterial pneumonia. It may also be beneficial for managing lung diseases such as pulmonary fibrosis. Dornase alfa, also known as DNase 1 or Pulmozyme, has received FDA approval for treating cystic fibrosis, aimed at breaking down dense mucus and reducing the risk of lung infections.² The next phase involves expanding clinical trials in order to validate these findings and explore Dornase alfa’s role in standard treatment protocols.¹

Severe COVID-19 pneumonia presents a formidable challenge to healthcare systems worldwide. Characterized by hyper-inflammation and respiratory distress, the condition often requires intensive care and prolonged hospitalization. Since the onset of the COVID-19 pandemic, the mortality rate associated with SARS-CoV-2 infections has significantly decreased. This decline can be attributed to enhanced immunity resulting from prior infection or vaccination, coupled with advancements in treatment strategies. One notable example is dexamethasone, a steroid effective in mitigating hyper-inflammation, which is a critical factor contributing to COVID-19 fatalities.³ However, it’s important to note that while dexamethasone has proven beneficial for many severely ill patients, it may not be suitable for all patients.

Researchers aimed to determine whether Pulmozyme could improve outcomes for 39 patients who were admitted to the hospital with severe COVID-19 pneumonia and who required oxygen. Approximately 30 patients were randomized to receive twice-daily nebulized Pulmozyme. In addition, they would receive the best available care (BAC), which included dexamethasone.  The remaining nine patients were randomized to receive BAC only. Measurements for C-reactive protein (a marker of systemic inflammation) levels in the blood were conducted over seven days or until patients were discharged from the hospital. Results showed that patients treated with Pulmozyme had a 33% reduction in systemic inflammation, in addition to the reduction provided by dexamethasone.⁴ Patients who received Dornase alfa required less oxygen and showed quicker discharge rates compared to those who received BAC alone. These added advantages could alleviate the strain on resources and hospital beds in the UK. Dr. Sarah Patel, a member of the research team, explains, “Our findings indicate that dornase alfa is a safe adjunctive treatment, providing a promising option for managing severe COVID-19 pneumonia without introducing significant additional risk.”¹

Dr. Venizelos Papayannopoulos, lead researcher at the Francis Crick Institute, emphasized, “While dexamethasone has demonstrated considerable success in treating severe COVID-19 pneumonia and is now standard practice in the UK, it may not be suitable for all patients, including those with diabetes…”² Dornase alfa’s potential extends beyond treating severe COVID-19, and the study’s findings suggest this as well. Shared mechanisms can benefit from its therapeutic effects. Given its mechanism of action in reducing hyper-inflammation, it holds potential for treating other respiratory infections, such as those caused by influenza or bacterial pneumonia, as well as chronic lung diseases like pulmonary fibrosis. This versatility underscores the drug’s potential to address a range of respiratory ailments.¹

In conclusion, the study’s findings show Dornase alfa’s dual potential as a critical treatment for severe COVID-19 pneumonia and a versatile tool in managing various respiratory infections and chronic lung diseases. With its ability to reduce hyper-inflammation and improve patient outcomes, alongside its FDA-approved status for cystic fibrosis, Dornase alfa emerges as a promising candidate for broader clinical use. As ongoing research expands its scope and efficacy, the hope is that Dornase alfa will not only alleviate the burden on healthcare systems during pandemics, but also offer new avenues for treating respiratory ailments, ultimately enhancing patient care and outcomes worldwide.

References:

1. Porter JC, Inshaw J, Solis VJ, et al. Anti-inflammatory therapy with nebulized dornase alfa for severe COVID-19 pneumonia: a randomized unblinded trial. Elife. 2024;12:RP87030. doi: 10.7554/eLife.87030.
2. Spencer D. Repurposed drug treats severe Covid-19 pneumonia. Drug Discovery World. https://www.ddw-online.com/repurposed-drug-improves-outcomes-in-severe-covid-19-pneumonia-30738-202407/. Published 07/17/2024.
3. Brogan J. Cystic fibrosis drug improves outcomes in severe COVID-19 pneumonia. Pharmacy Times. https://pharmatimes.com/news/cystic-fibrosis-drug-improves-outcomes-in-severe-covid-19-pneumonia/. Published 07/18/2024.
4. Midgley M. Repurposed drug improves outcomes for patients with severe COVID-19 pneumonia. University College London News. https://www.ucl.ac.uk/news/2024/jul/repurposed-drug-improves-outcomes-patients-severe-covid-19-pneumonia. Published 07/19/2024.