A randomized, double-blind, placebo-controlled study did not find evidence to support the hypothesis that imatinib shortens time needed on oxygen support for patients with severe COVID-19, according to the results of a study published in Lancet Respiratory Medicine.
Patients with COVID-19 requiring supplemental oxygen at 13 large teaching hospitals in the Netherlands between March 31, 2020, and January 4, 2021, were randomly assigned in a 1:1 ratio to receive an 800-mg loading dose of imatinib followed by 400 mg daily imatinib (n=197) or placebo (n=188) for 9 days. Clinical outcomes were assessed.
Patients in the intervention and placebo cohorts had a median age of 64 years; 74% and 63% were men, 39% and 40% were former or current smokers, and 29% and 47% had a body mass index (BMI) greater than 30 kg/m2, respectively.
Patients were enrolled in the study a median of 10 days after the onset of symptoms.
Supplemental oxygen or mechanical ventilation was discontinued for more than 48 hours by 81% of imatinib recipients and 76% of placebo recipients (hazard ratio [HR], 0.95; 95% CI, 0.76-1.20; P =.69).
At day 28, mortality rates were lower among the treatment group (8% vs 14%; HR, 0.51; 95% CI, 0.27-0.95; P =.034). After adjusting for all confounders, the mortality rate was no longer significantly lower among the intervention cohort (adjusted HR [aHR], 0.52; 95% CI, 0.26-1.05; P =.068).
Transfer to the intensive care unit (ICU) occurred among 20% of the imatinib and 18% of the placebo cohorts.
Mechanical ventilation was required by 77% and 79% of the treatment and placebo groups, respectively (HR, 1.07; 95% CI, 0.63-1.80; P =.814). Among imatinib recipients, the duration of mechanical ventilation was decreased (median, 7 vs 12 days; P =.0080) and the number of ventilator-free days in the ICU was increased (median, 22 vs 9 days; P =.018).
Adverse events of grade 3 or higher were reported by 46% and 44% of the treatment and placebo groups, respectively.
This study may have been limited by cohort imbalances of gender and BMI.
The study authors concluded that imatinib failed to decrease the time patients with COVID-19 required oxygen support. Some evidence suggests that imatinib may decrease mortality and duration of mechanical ventilation in the ICU setting, but additional studies would be needed to validate these preliminary findings.
Disclosure: Some study authors hold a patent related to protection against endothelial barrier dysfunction. Please see the original reference for a full list of authors’ disclosures.
Aman J, Duijvelaar E, Botros L, et al. Imatinib in patients with severe COVID-19: a randomised, double-blind, placebo-controlled, clinical trial. Lancet Respir Med. Published online June 17, 2021. doi:10.1016/S2213-2600(21)00237-X