Int J Infect Dis. 2020 Dec 14:S1201-9712(20)32546-7. doi: 10.1016/j.ijid.2020.12.023. Online ahead of print.
OBJECTIVES: The aim was to evaluate the safety and effectiveness of thalidomide, an immunomodulatory agent, in combination with glucocorticoid for the treatment of COVID-19 patients with life-threatening symptoms.
METHODS: A nonrandomized comparative case series study was performed. Six patients received thalidomide 100 mg per day (with therapy lasting for ≥7 days) plus low-dose short-term dexamethasone, and 6 control patients matched with patients in the thalidomide group, received low-dose short-term treatment with dexamethasone alone. The main outcomes were: the duration of SARS-CoV-2 negative conversion from admission; length of hospital stay; and changes in inflammatory cytokine concentrations and lymphocyte subsets.
RESULTS: The median thalidomide treatment time was 12.0 days. The median durations of SARS-CoV-2 negative conversion from admission (11.0 vs 23.0 days, P = 0.043) and hospital stay lengths were both briefer in the thalidomide group compared to the controls (18.5 vs 30.0 days, P = 0.043). The mean reduction rates at 7-10 days after treatment for serum interleukin-6 and interferon-γ concentrations were greater in the thalidomide group compared to the controls. Alterations in lymphocyte numbers in the subsets between the 2 groups were similar.
CONCLUSIONS: Thalidomide plus short-term glucocorticoid therapy is an effective and safe regimen for the treatment of severely ill COVID-19 patients. The mechanism of action is most likely inhibition of inflammatory cytokine production.