Inhaled Dornase Alfa Fails to Improve Hypoxia in Severe COVID-19: RCT Results
Overview
A randomized controlled trial evaluated inhaled dornase alfa in hospitalized COVID-19 patients with hypoxia. The study found no significant difference in time to oxygen cessation or hospital discharge between dornase alfa and placebo groups. Secondary outcomes including mortality and length of stay were also similar.
Background
Severe COVID-19 often leads to respiratory failure characterized by hypoxia and sometimes progresses to ARDS. Neutrophil extracellular traps (NETs) contribute to lung injury and increased sputum viscosity. Dornase alfa, a recombinant DNase I, degrades NETs and is used in cystic fibrosis to improve sputum clearance. Early case series suggested potential benefits of dornase alfa in COVID-19, prompting this randomized trial to assess its efficacy in reducing hypoxia.
Data Highlights
Outcome
Dornase Alfa Group (n=?)
Placebo Group (n=?)
Result
Primary outcome: Time to oxygen cessation or discharge
No significant difference
No significant difference
NS
Mortality
Similar
Similar
NS
New episode of hypoxia
Similar
Similar
NS
Length of hospital stay
Similar
Similar
NS
Adverse events
Similar
Similar
NS
Key Findings
Aerosolized dornase alfa administered twice daily for 5 days did not improve hypoxia compared to placebo in hospitalized COVID-19 patients.
No difference was observed in mortality rates between treatment and placebo groups.
Secondary outcomes such as new hypoxia episodes, length of hospital stay, and adverse events were comparable across groups.
Subgroup analysis by age (<65 vs ≥65 years) showed no differential treatment effect.
The study was stopped early due to emergence of the Omicron variant, limiting further enrollment.
Heterogeneity in viral variants and vaccination status may have influenced results.
Clinical Implications
Inhaled dornase alfa should not be considered an effective treatment to improve oxygenation or reduce hospital stay in patients hospitalized with acute COVID-19 hypoxia. Clinicians should continue to rely on established supportive care measures. Further research is needed to explore the role of DNase I in other respiratory infections or different patient populations.
Conclusion
This randomized controlled trial demonstrated that inhaled dornase alfa does not improve clinical outcomes in hospitalized COVID-19 patients with hypoxia. The findings do not support its routine use for managing severe respiratory failure in COVID-19.
References
Original Article 2024 -- Inhaled Dornase Alfa (DNase I) for Managing Severe Respiratory Failure in COVID-19: Results from a Randomized Controlled Study
by Per Åkesson, Lisa Mellhammar, Magnus Rasmussen, Malin Inghammar, Sara Jesperson, Fredrik Månsson, Elin Economou Lundeberg, John Walles, Martin Wallberg, Attila Frigyesi, Adam Linder
