The Effects of Thalidomide as an Adjuvant Treatment Besides of Dexamethasone and Remdesivir on Patients with Moderate COVID-19

Introduction: The main pathogenesis of COVID-19, especially in patients with moderate to severe COVID-19 pneumonia, is through cytokine release syndrome. This cytokine release causes tissue edema, chemotaxis of immune cells, and also vascular endothelial disruption. Thalidomide is an old drug with several effects on inflammation and also on immune cells physiology.

Materials and Methods: 50 patients with moderate COVID-19 pneumonia, were included in this study in the Thalidomide group and control group. We administered Thalidomide 100 mg daily for 14 days + Dexamethasone + Remdesivir in the Thalidomide group and Dexamethasone + Remdesivir as the standard of care in our center in the control group. We evaluated oxygen saturation improvement to more than 94% and also the duration of hospital admission and mortality in our study.

Results: We did not find any difference between these two groups in terms of duration of hospital stay (8.9 days in the Thalidomide group versus 9.6 in the control group), improvement of oxygen saturation at the first week and second week (Pvalue: 0.70 and 0.826 respectively). There was no mortality in both groups. At the end of second week of treatment, the levels of inflammatory markers were not statistically different between these two groups (ESR, CRP, ferritin, LDH, fibrinogen with Pvalue: 0.509, 0.440, 0.121, 0.005, 0.114 respectively). Only LDH in the Thalidomide group was significantly lower at the end of the second week than the control group.

Conclusion: In our study, we did not find any relation between Thalidomide administration and effects on oxygen saturation improvement and also the duration of hospital admission and mortality.