Inosine Pranobex Significantly Decreased the Case-Fatality Rate among PCR Positive Elderly with SARS-CoV-2 at Three Nursing Homes in the Czech Republic

Abstract

During the COVID-19 pandemic, the elderly population has been disproportionately affected, especially those in nursing homes (NH). Inosine pranobex (IP) has been previously demonstrated to be effective in treating acute viral respiratory infections. In three NH experiencing the SARS-CoV-2 virus epidemic, we started treatment with IP as soon as clients tested PCR+. In Litovel, CZ, the difference in case-fatality rate (CFR) for the PCR+ group using vs. not using IP was statistically significant, and the odds ratio (OR) was 7.2. When comparing all those taking IP in the three NH vs. the non-drug PCR+ group in Litovel, the odds ratio was lower for all three NH, but still significant at 2.9. The CFR in all three tested NHs, age range 75-84, compared to the CFR in all NHs in the Czech Republic, was significantly reduced (7.5% vs. 18%) (OR: 2.8); there was also a significant difference across all age groups (OR: 1.7). In our study with 301 residents, the CFR was significantly reduced (OR: 2.8) to 11.9% (17/142) in comparison to a study in Ireland with 27.6% (211/764). We think the effect of IP was significant in this reduction; nevertheless, these are preliminary results that need larger-scale trials on COVID-19 patients.

Keywords: COVID-19; acute respiratory viral infection; case-fatality rate; inosine pranobex; natural killer cells; nursing homes; treatment.

Figure 1

Three levels of antiviral immunity and the influence of specific COVID-19 treatment options. Legend: red dot—virus SARS-CoV-2; IP—inosine pranobex; NK cells—natural killer cells; CTL—cytotoxic T-lymphocyte (CD8+); APC—antigen presenting cell; Naïve Th—naïve helper T lymphocyte (CD4+ cell); Th1—type of helper cells that lead to an increased cell-mediated immunity; Th2—type of helper cells that lead to a humoral immune (antibody) response; T-Cell—a type of lymphocyte, which differentiate into helper, regulatory, or cytotoxic T cells or become memory T cells; B-Cell—B cells are involved in humoral immunity and differentiate into a plasma cell; plasma cell—short-lived antibody-producing cell derived from B-Cell; IgA, IgM, IgG—antibody classes of immunoglobulins; MF—macrophages, specialized cells involved in the detection, phagocytosis and destruction of SARS-CoV-2 virus; convalescent plasma—high titers of neutralizing antibodies against SARS-CoV-2 to experimentally treat several critical COVID-19 patients; tocilizumab—a humanized monoclonal antibody against the interleukin-6 receptor (IL6); favipiravir—an antiviral medication used to treat influenza and experimentally also COVID-19; hydroxycholochin (hydroxychloroquine)—suggested early in the pandemic as prevention or treatment method for COVID-19; remdesivir—a nucleotide analog prodrug indicated for treatment of COVID-19 disease in hospitalized patients.

Figure 2

Comparison of the case-fatality rate (CFR) for COVID-19 of residents at three nursing homes (Litovel, Holice, and Úpice) that used IP, with the CFR for COVID-19 of the residents of the Litovel nursing home, some of whom used IP and some of whom did not use IP.

Figure 3

Comparisons of the CFR for COVID-19 of the residents of three selected nursing homes (Litovel, Holice, and Úpice) in the CZ (142 clients PCR+/17 died) that used IP, to the CFR for COVID-19 patients from all nursing homes (NH) in the CZ (415/78) until 8/8/2020, and to the CFR of 21 NH in Ireland (211/764).