A way has been found to relieve a key symptom of post-coital syndrome

A recent study led by Professor Sergei Avdeev, chief supernumerary pulmonologist of the Russian Ministry of Health, has shown that a drug based on the active ingredient bovgialuronidase azoximer (BA) is able to reduce one of the key symptoms of postovoid syndrome - exercise intolerance. About it on Tuesday writes the American medical portal STAT News.

It turned out that in patients taking the new therapy, blood oxygen saturation after exercise decreases 62% less often, and dyspnea after exercise occurs 27% less often than in patients in the control group. In patients with concomitant cardiovascular disease, lung function improved 26% under therapy.

According to the World Health Organization (WHO), post-coronavirus syndrome (long-QoV) is a multisystem disease that develops in 10-20% of percent of patients who have had a coronavirus infection. Its symptoms often include fatigue, dyspnea, and exercise intolerance. A number of patients develop pulmonary complications characterized by impaired respiratory function, respiratory symptoms, and residual changes in lung tissue resembling fibrosis. These symptoms may last for months or even years.

No WHO clinical guidelines for the management of pulmonary complications after COVID-19 have yet been released. However, the situation may be reversed by new work on the role of AD in long-COVID. The results of the study, which involved 392 patients, were presented at the November congress of the Asia Pacific Respiratory Society in Hong Kong.

The research team, led by Prof. Avdeev, decided to use azoximer bovgialuronidase injections as a new approach to the therapy of post-Covid lung complications. This choice is based on the fact that hyaluronic acid, which is cleaved by this active ingredient, plays an important role in chronic inflammation and fibrosis formation - key factors in the development of post-ovid pulmonary complications.

For example, animal studies have shown that bovgialuronidase azoximer, a component of a drug such as Longidaza, reduces fibrosis. At the same time, a pilot study on 160 patients treated after COVID-19 showed that the drug significantly improved pulmonary function, respiratory symptoms, and exercise tolerance.

Building on these findings, the research team embarked on a larger randomized, double-blind, placebo-controlled clinical trial in 392 patients with post-COVID pulmonary complications. Its participants had undergone COVID-19 within one year prior to inclusion in the study. They included both those who had the infection without hospitalization and those who required ventilatory support. Participants were infected with strains ranging from the severe Delta variant to the milder Omicron BA.5.

Their pulmonary complications manifested as a combination of restrictive lung disease, dyspnea, and pulmonary fibrosis evident on CT scan. For 71 days, half of the patients took BA and half took placebo. They were then monitored until day 180. The results showed that subjects who took the drug were 62% less likely to have decreased oxygen saturation and 27% less likely to experience dyspnea after exercise. These effects persisted for at least 3.5 months after the last dose of the drug, suggesting the drug's ability to lead to long-term improvement. All effects were statistically significant.

Significant beneficial effects on pulmonary function were observed in certain groups of patients: women, patients older than 60 years, those with cardiovascular disease, and those infected with earlier, more severe variants of the virus.

"Our study is one of the first to show a statistically significant effect of a new drug for the treatment of postviral pulmonary complications with a high level of evidence (...) Postviral syndrome remains a serious medical problem despite the end of the acute phase of the pandemic. Bovgialuronidase azoximer offers hope to patients suffering from dyspnea, fatigue, and decreased physical activity. The results suggest that research on hyaluronidase-based drugs should be continued - not only for the treatment of pulmonary complications of covitis, but also for other fibrotic diseases," says Sergei Avdeev.

The team of scientists is currently working on the development of an inhaled form of this active ingredient for the treatment of interstitial lung diseases. Doctors have already demonstrated the safety of the inhaled form in a Phase I study, Phase II studies on patients with idiopathic pulmonary fibrosis are planned for 2025.

Earlier about the study of a group of scientists led by Professor Avdeev wrote in the South China Morning Post. As the publication notes, to date, most doctors prescribe rehabilitation or antifibrotic drugs (such as nintedanib or pirfenidone), steroids, immunosuppressants, and n-acetylcysteine to patients with pulmonary postcopulmonary complications. However, steroids are generally ineffective in treating these symptoms.

"Antifibrotics can be effective, but side effects are numerous and frequent. Until now, there have been no large-scale randomized clinical trials of these treatments in patients with postcovitis syndrome," Avdeev noted in a conversation with SCMP.

That said, the new study, he said, reported only eight adverse events associated with the use of a BA-based drug.

"But the most important question is what are these side effects and how often do they cause our patients to stop taking the drug. Our data are very good. For example, in the BA group, only 5 patients discontinued therapy [due to adverse events] during the study," concluded Sergey Avdeev.