AMANTADINE FOR POST-EXPOSURE PROPHYLAXIS IN COVID-19 IN WESTERN HONDURAS

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Low –to-middle-income countries (LMIC) have been struggling throughout the coronavirus disease 2019 (COVID-19) pandemic with overwhelmed hospital system and lack of access for novel therapeutics. Remdesivir, the only antiviral approved by the FDA for the treatment of COVID-19, needs to be given intravenously thus requiring admission to the hospital. This might not be feasible for health systems overwhelmed by the viral disease. Amantadine is a drug that has been utilized mainly for patients with neurological diseases, such as Parkinson’s disease. Although it is more commonly used for neurological diseases, it has also been reappropriated for viral illness like H1N1. There have been observational studies noting that patients who take amantadine regularly have not developed the disease and it has even been utilized a therapeutic in patients with known COVID-19 disease with apparent success. The need for cheap, outpatient medications for COVID-19 is paramount and amantadine seems to be a viable option. We sought to describe the characteristics of patients who took amantadine as a post-exposure prophylactic (PEP) medication. METHODS: We conducted a prospective, observational pilot study of patients who visited a covid clinic in a rural area of Western Honduras, from September 1st, 2020 to October 31st 2020. Patients were included if they were older than18 years of age, with mild disease symptoms and had a positive COVID-19 RT-PCR test. Patients included in the study received the A77 protocol, which consist of amantadine 100 mg bid in the first 7 days of disease for a period of 7 days. Oxygen Saturation, C-Reactive Protein(CRP) and Blood Count samples were measured each day while they were on the protocol. RESULTS: A total of 26 patients were enrolled in the A77 PEP protocol, with a median age of 51 years, 19 were male and 7 were female. The median time for protocol initiation was three days after symptoms first appeared. Average oxygen saturation was 95% on room air, the mean CRP level was 28 mg/L. Most patients had no comorbidities with only 2 having diabetes mellitus and one with systemic lupus erythematosus. Home oxygen supplementation was used in 5 patients in the protocol and only 1 patient was hospitalized. CONCLUSIONS: We enrolled 26 patients with mild, confirmed COVID-19 to A77 PEP protocol, with a median age of 51 years. Most of the patients started A77 on their third day of illness, and most maintained a SpO2 of 95% during the course of the trial, with only 5 patients requiring supplemental oxygen and one requiring hospitalization.Amantadine seemed to be an effective therapeutic avenue in preventing patients with COVID-19 to advance to moderate or severe disease. It also seemed to be effective in preventing admission to the hospital. Our findings echo similar studies of amantadine being an effective PEP for patients with COVID-19.We are limited by a small sample size and lack of control group, but our findings can be utilized as hypothesis generating for larger studies regarding the role of amantadine in PEP for COVID-19. CLINICAL IMPLICATIONS: Amantadine seems to be an effective PEP medication for patients with COVID-19, which can be crucial for LMIC struggling with the pandemic and acquisition vaccines. More rigorous studies are required to confirm its effectiveness. DISCLOSURES: No relevant relationships by Balduino Carcamo, source=Web Response No relevant relationships by Orlando Garner, source=Web Response No relevant relationships by Eleazar Montalvan, source=Web Response No relevant relationships by Maria Pineda, source=Web Response