The use of icosapent ethyl as supportive therapy for the treatment of moderate to severe coronavirus disease 2019 (COVID-19) pneumonia was recently described in a case series published in the American Journal of Case Reports.
Icosapent ethyl, an ethyl ester of eicosapentaenoic acid, is believed to possess anti-inflammatory properties and is currently being evaluated in clinical trials for the treatment of COVID-19. In their report, the authors described the cases of 3 patients with moderate to severe COVID-19 pneumonia who were treated with 2g of icosapent ethyl administered twice daily via a nasogastric tube.
The first case involved a 75-year-old male with a past medical history significant for hyperlipidemia, obesity, and benign prostatic hyperplasia. While being hospitalized for a perirectal abscess, he tested positive for COVID-19 and his chest X-ray was suggestive of COVID-19 pneumonia. After undergoing a drainage procedure, the patient was transferred to the ICU due to hypoxia and continued systemic inflammatory response syndrome criteria. He was then initiated on icosapent ethyl, and after 2 days of therapy, reductions in both creatinine (1.43 to 1.14) and C-reactive protein (CRP; 23.5 to 13.6) levels were observed. Following 2.5 days of treatment with icosapent ethyl and antibiotics, the patient was released from the ICU.
The second case involved a 23-year-old male with a past medical history significant for obesity and diabetes who presented to the hospital with acute respiratory distress syndrome (ARDS) and respiratory failure secondary to COVID-19. Although the patient’s inflammatory makers improved after receiving antiviral therapy, immunosuppressive therapy, and convalescent plasma, he was still being considered for intubation prior to administration of icosapent ethyl. Following the addition of icosapent ethyl, the patient’s chest X-ray resolved 3 days later and acute-phase reactants declined close to baseline levels. The patient was released from the ICU and was later discharged from the hospital after 22 days.
In the third case, a 24-year-old male with a past medical history significant for autism was admitted to the ICU and intubated for ARDS secondary to COVID-19. The patient was initiated on antiviral therapy, immunosuppressive therapy, convalescent plasma, and icosapent ethyl. The authors reported that after only 3 days of administration, they observed a reduction in the patient’s inflammatory markers and acute-phase reactants to near baseline levels. Additionally, after icosapent ethyl was mistakenly discontinued for several days, the authors noted that the patient’s inflammatory makers and ventilatory requirements increased and that the he “required significant supportive measures.” The patient’s improvement from septic shock was attributed to therapy with broad-spectrum antibiotics as well as icosapent ethyl. The authors added that they observed a significant decrease in the patient’s acute-phase reactants as well as ventilatory requirements just 3.5 days after re-initiation of icosapent ethyl.
While the utility of icosapent ethyl as an adjunctive therapy for the treatment of moderate to severe COVID-19 pneumonia was demonstrated in these cases, the authors concluded that “the outcomes of ongoing clinical trials are awaited to determine whether icosapent ethyl has anti-inflammatory effects in patients with SARS-CoV-2 infection and which patients might benefit from the use of this adjunctive treatment.”
Suh W, Urits I, Viswanath O, et al. Three Cases of COVID-19 Pneumonia That Responded to Icosapent Ethyl Supportive Treatment. [published online November 11, 2020]. Am J Case Report. 2020; 21. doi: 10.12659/AJCR.928422.