Inhaled prostacyclin analogues in COVID-19 associated acute respiratory distress syndrome: scientific rationale

Background: COVID-19 associated acute respiratory distress syndrome (CARDS) is a severe form of SARS CoV-2 infection and affects about 15-30% of hospitalized patients with a high mortality rate. Growing research and data suggest several available drugs with appropriate pharmacological effects to treat COVID-19. Main body: Prostacyclin analogues are regiments for pulmonary artery hypertension. Prostacyclin analogues are expected to be beneficial in treating CARDS based on at least four rationales: (1) inhaled prostacyclin analogues improve oxygenation, V/Q mismatch, and act as an ARDS therapy alternative; (2) it alleviates direct SARS-CoV-2-related coagulopathy; (3) increases nitric oxide production; and (4) possible anti-inflammatory effect. Prostacyclin analogues are available in oral, intravenous, and inhaled forms. The inhaled form has the advantage over other forms, such as parenteral administration risks. Previously, a meta-analysis demonstrated the beneficial effects of inhaled prostaglandins for ARDS treatment, such as improved PaO2/FiO(2) and PaO2 along with reduced pulmonary artery pressure. Currently, two ongoing randomized controlled trials are evaluating inhaled epoprostenol (VPCOVID [NCT04452669]) and iloprost (ILOCOVID [NCT04445246]) for severe COVID-19 patients. Conclusions: Inhaled prostacyclin could be considered in patients with refractory, life-threatening hypoxia despite standard management.

Automated summary

Prostacyclin analogues are considered beneficial for treating CARDS due to their ability to improve oxygenation and pulmonary artery pressure, increase nitric oxide production, and potentially have anti-inflammatory effects. The inhaled form may be the ideal route of administration, with two ongoing clinical trials evaluating its efficacy in severe COVID-19 patients.