Amantadine confers survival benefits on ICU patients with severe COVID-19

Treatment with amantadine appears to lower mortality among COVID-19 patients with severe respiratory failure in the intensive care unit (ICU), a retrospective study has found.

Researchers looked at the medical records of 241 COVID-19 patients (median age 65 years, 63.5 percent male, median body mass index 29.4 kg/m²) with respiratory insufficiency requiring mechanical ventilation in ICU. Of these, 141 patients (58.5 percent) received intravenous amantadine sulphate, whereas 100 (41.5 percent) were given standard of care only.

None of the patients included in the study had been vaccinated with the full dose of the SARS-CoV-2 vaccine. More than half (59 percent) of the patients had the wild-type variant SARS-CoV-2, while the remaining 41 percent were infected with the Alpha (B.1.1.7) variant. All patients received dexamethasone intravenously at a dose of ≥6 mg per day, 99 were given remdesivir, and 127 were administered tocilizumab.

Overall mortality was high at 72.6 percent, with significantly fewer patients dying in the amantadine arm than in the control arm (59.5 percent vs 91 percent; p=0.001).

Multivariate Cox analysis confirmed that treatment with amantadine was independently associated with lower mortality rate (hazard ratio [HR], 0.220, 95 percent confidence interval [CI], 0.146–0.333; p=0.001).

In the amantadine arm, survival was even higher among patients who received amantadine late (after 5 days; HR, 0.560, 95 percent CI, 0.313–0.999; p=0.050).

According to the researchers, the survival advantage with amantadine may be attributed to its potential anti-inflammatory and immunomodulatory effects.