Micronized and Ultramicronized Palmitoylethanolamide in COVID-19 Patients

Overview

SARS-CoV-2 infection is a condition characterized by excessive leukocyte infiltration, massive release of chemokines, proteases and cytokines, the so-called "cytokine storm", which promote the inflammatory process and contribute to exacerbation of COVID-19 symptomatology. Because of the abnormal release of pro-inflammatory cytokines by non-neuronal cells of the immune system, such as the mast cells in periphery, and microglia at central level, the body activates a defensive neuroinflammatory process that, if not controlled, can become pathological. Therefore it's important to intervene early on neuroinflammation, in order to limit the progression of the disease. A possible intervention is represented by Palmitoylethanolamide (PEA), an endogenous molecule of the N-acylethanolamine family synthesized "on demand" in response to "stress factors" to restore tissue homeostasis, able to control mast cells and microglia uncontrolled activation. Experimental evidence in vitro and in vivo demonstrated the anti-inflammatory and neuroprotective effect of micronized and ultra-micronized PEA (mPEA and umPEA), confirmed in various clinical investigations conducted in patients with different pathological conditions. The aim of this study is to investigate the efficacy of a compound containing mPEA + umPEA on peripheral inflammatory markers, neuroinflammation, and others clinical parameters in intensive care patients with COVID-19 interstitial pneumonia.

Full Title of Study: “Efficacy of Palmitoylethanolamide, in add-on to Standard Therapy, on Inflammatory Markers of Patients With Interstitial Pneumonia Due to COVID-19. A Pilot Controlled, Randomized, Open Lable Clinical Study”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Supportive Care
    • Masking: None (Open Label)
  • Study Primary Completion Date: February 28, 2021

Interventions

  • Dietary Supplement: Micronized and ultra-micronized Palmitoylethanolamide (mPEA and umPEA, 300mg + 600mg) oral suspension
    • Micronized and ultra-micronized Palmitoylethanolamide is on the market in Italy as a Food for Special Medical Purposes
  • Combination Product: Standard Therapy
    • Standard therapy established for individual patients

Arms, Groups and Cohorts

  • Active Comparator: PEA Group
    • Normast® MPS (mPEA and umPEA 300mg + 600mg) oral suspension: 2700mg/die in 3 doses for 28 days, in add-on to standard therapy
  • Other: Control Group
    • Standard therapy only

Clinical Trial Outcome Measures

Primary Measures

  • Number of responder participants after 7 days of treatment
    • Time Frame: 7 days
    • Responder: decrease ≥ 30% from baseline of IL-6 blood levels

Secondary Measures

  • Change of pro-inflammatory markers (IL-6, IL-1 alpha, IL-1 beta, TNF-alpha, PCR, PCT, neopterin)
    • Time Frame: 0, 3, 7, 14, 28 days
  • Change of anti-inflammatory markers (IL-4, IL-10)
    • Time Frame: 0, 3, 7, 14, 28 days
  • Change of brain damage markers (S100b, ENS)
    • Time Frame: 0, 3, 7, 14, 28 days
  • Change of coagulation indices (INR, fibrinogen, D-dimer)
    • Time Frame: 0, 3, 7, 14, 28 days
  • Change of hematological parameters
    • Time Frame: 0, 3, 7, 14, 28 days
    • leukocyte formula (lymphocytes, CD4 / CD8 ratio)
  • Change of oxygenation indices (P/F ratio, lactates)
    • Time Frame: 0, 3, 7, 14, 28 days
  • Number of participants who developed delirium
    • Time Frame: 0, 3, 7, 14, 28 days
    • Confusion Assessment Method-Intensive Care Unit (CAM-ICU) (0-1: no delirium; >1 delirium)
  • Number of participants who developed anxiety and/or depression
    • Time Frame: 0, 3, 7, 14, 28 days
    • Hospital Anxiety and Depression Scale (HADS) (0: normal; 21: severe)

Participating in This Clinical Trial

Inclusion Criteria

  • Intensive Care Unit Hospitalization for interstitial pneumonia due to COVID-19 diagnosis (nasal swab/sputum/bronchoalveolar lavage positive for Sars-Cov-2 infection) Exclusion Criteria:

  • Pregnancy or breastfeeding; – Known allergy or hypersensitivity to the product or its excipients; – Inability to take the product per os or via nasogastric tube.

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Epitech Group SpA
  • Collaborator
    • Azienda Ospedaliera “Sant’Andrea”
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Prof.ssa Flaminia Coluzzi, MD, Principal Investigator, Azienda Ospedaliera Universitaria Sant’Andrea di Roma

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