Letter Postgrad Med J: first published as 10.1136/postgradmedj-2021-140143 on 1 April 2021. Downloaded from Clofazimine: another inhibit the proliferation and activation Both authors cowrote the initial draft manuscript and of T-lymphocytes­ through inhibition of equally contributed to the final draft’s validation. potential magic bullet for the sodium–potassium ATPase.3 4 This Funding The authors have not declared a specific the treatment of COVID-19? immunomodulatory effect of clofazi- grant for this research from any funding agency in the public, commercial or not-for­ -profit­ sectors. mine has proven beneficial in the treat- ment of autoimmune disorders such as Competing interests None declared. 4 As of March 2020, the novel COVID-19 and . Yuan Patient consent for publication Not required. caused by SARS-­CoV-2 was declared a et al reported significant decrease in Provenance and peer review Not commissioned; pandemic. The novelty of the virus is the the mRNA expression of interleukin 6 internally peer reviewed. driving force for numerous clinical trials (p=0.0001), Tumor necrosis factor-­alpha This article is made freely available for use in taking place in an attempt to discover (TNF-α) (p=0.0006) and C-­C chemokine accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until appropriate therapeutic agents.1 Many receptor type 4 (CCR4) (p=0.0029) in the 2 otherwise determined by BMJ. You may use, download pharmacological agents have shown prom- hamsters treated with clofazimine. and print the article for any lawful, non-­commercial ising results, including clofazimine.2 3 Interestingly, antiviral synergistic effects purpose (including text and data mining) provided that More recently, a prospective open-­label have been reported when clofazimine is all copyright notices and trade marks are retained. 2 randomised controlled of coadministered with remdesivir. The © Author(s) (or their employer(s)) 2021. No commercial dual therapy with interferon beta-1b­ and coapplication of clofazimine and remde- re-use­ . See rights and permissions. Published by BMJ. clofazimine for patients infected with sivir in an in vitro cellular assay with a COVID-19 is being conducted. 10% concentration of fetal bovine serum Clofazimine is licensed for use against resulted in a nearly 20-fold­ reduction in To cite Egiz A, Gala D. Postgrad Med J Epub ahead of mycobacterial infection and as an adjunct the concentrations of remdesivir required print: [please include Day Month Year]. doi:10.1136/ agent for the treatment of multibacillary to inhibit viral replication by 90%. This postgradmedj-2021-140143 . However, it has also proven to synergistic pharmacological effect did Accepted 20 March 2021 2 comprise immunosuppressive properties. not elicit detectable cytotoxic changes. Postgrad Med J 2021;0:1. Therefore, we would like to outline a However, to further narrow the in vivo doi:10.1136/postgradmedj-2021-140143 potential use for clofazimine in COVID-19 side effects profile, clofazimine can be administered via inhalation reducing its ORCID iD infections, where it could be a potential Abdullah Egiz http://orcid.​ ​org/0000-​ ​0003-0304-​ ​7982 prophylactic and therapeutic agent in the systemic side effects such as skin discolor- management of critically ill patients. ation and gastrointestinal discomfort.5 In summary, clofazimine with its anti-­ REFERENCES The most important cause of mortality 1 Wong CKH, Wan EYF, Luo S, et al. Clinical outcomes postinfection with COVID-19 is a cyto- inflammatory and immunomodulatory of different therapeutic options for COVID-19 in two kine storm leading to end organ damage effect with minimal side effects could Chinese case cohorts: a propensity-­score analysis. from inflammation.2 Thus, one of the increase survival in critically ill patients EClinicalMedicine 2021;32:100743. main therapeutic treatments being used infected with the COVID-19 virus. 2 Yuan S, Yin X, Meng X, et al. Clofazimine is a broad-­ spectrum coronavirus inhibitor that antagonizes SARS-­ to increase survival, reduce inflamma- CoV-2 replication in primary human cell culture and tory sequelae and decrease hospitalisation Abdullah Egiz ‍ ‍ , Dhir Gala hamsters. Res Sq 2020. doi:10.21203/rs.​ ​3.rs-​ ​86169/v1​ 3 Wan W, Zhu S, Li S, et al. High-­Throughput screening following COVID-19 pneumonia are anti-­ School of Medicine, University of Central Lancashire, http://pmj.bmj.com/ inflammatory drugs. Clofazimine is an Preston, UK of an FDA-­approved drug library identifies inhibitors against arenaviruses and SARS-­CoV-2. ACS Infectious antibiotic with anti-inflammatory­ proper- Correspondence to Abdullah Egiz, School of Diseases 2020;38. ties, which can potentially be used for the Medicine, University of Central Lancashire, Preston, UK; 4 Cholo MC, Steel HC, Fourie PB, et al. Clofazimine: treatment of COVID-19.2 3 AMAEgiz@​ ​uclan.ac.​ ​uk current status and future prospects. J Antimicrob Chemother 2012;67:290–8. In patients with severe infection Twitter Abdullah Egiz @EgizAbdullah leading to cytokine storm, the use of 5 Banaschewski B, Verma D, Pennings LJ, et al. Contributors AE contributed to the conceptualisation Clofazimine inhalation suspension for the aerosol immunosuppressive agents has proven of the underpinning hypothesis. Both authors (AE and treatment of pulmonary nontuberculous mycobacterial on September 27, 2021 by guest. Protected copyright. 2 3 beneficial. Indeed, clofazimine can DNG) contributed to data collection and data analysis. infections. J Cyst Fibros 2019;18:714–20.

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