The bradykinin-2 receptor antagonist, icatibant, improves lung function in patients with SARS-CoV2 associated ARDS - First results of a prospective off-label use patient-related observational study.

SARS-CoV2-associated adult respiratory distress syndrome (COVID19-ARDS)
frequently leads to fatal respiratory failure in COVID19. Currently, there
is no curative treatment option for severe COVID19-ARDS other than
mechanical ventilation therapy and extracorporal membrane oxygenation
(ECMO). We investigated whether modification of the kallikrein-kinin
system in vivo attenuates the progression of SARS-CoV2-induced ARDS. The
aim of the study was to investigate the effect of blockade of the B2R on
the course of COVID19-ARDS. In an observational study including
53 COVID19-ARDS patients, patients received the bradykinin-2-receptor
antagonist (B2RAg) icatibant. After icatibant substitution,
respiratory rate in COVID19-ARDS reduced by a maximum of 32% (24.9/min to
16.8/min) with a concomitant reduction in oxygen substitution by 59% (6.1
LO2/min to 2.5 LO2/min). The data show that the use of icatibant in the
early phase of COVID19-ARDS is suitable to stabilize pulmonary gas
exchange. Furthermore, early icatibant substitution seems to be able to
reduce the rate of necessary invasive ventilation in COVID19-ARDS.
Observational data suggest that inhibition of bradykinin signalling leads
to stabilization of lung function in SARS-CoV2-associated ARDS. Further
prospective placebo-controlled studies are needed to investigate the
impact of the kallikrein-kinin system on the development of COVID19-ARDS
in vivo.