During the COVID-19 pandemic, the elderly population has been disproportionately affected, especially those in nursing homes (NH). Inosine pranobex (IP) has been previously demonstrated to be effective in treating acute viral respiratory infections. In three NH experiencing the SARS-CoV-2 virus epidemic, we started treatment with IP as soon as clients tested PCR+. In Litovel, CZ, the difference in case-fatality rate (CFR) for the PCR+ group using vs. not using IP was statistically significant, and the odds ratio (OR) was 7.2. When comparing all those taking IP in the three NH vs. the non-drug PCR+ group in Litovel, the odds ratio was lower for all three NH, but still significant at 2.9. The CFR in all three tested NHs, age range 75-84, compared to the CFR in all NHs in the Czech Republic, was significantly reduced (7.5% vs. 18%) (OR: 2.8); there was also a significant difference across all age groups (OR: 1.7). In our study with 301 residents, the CFR was significantly reduced (OR: 2.8) to 11.9% (17/142) in comparison to a study in Ireland with 27.6% (211/764). We think the effect of IP was significant in this reduction; nevertheless, these are preliminary results that need larger-scale trials on COVID-19 patients.

Department for Tropical Travel Medicine and Immunization Institute of Postgraduate Health Education 100 05 Prague Czech Republic

Department of Pharmacology 3rd Faculty of Medicine Charles University 100 00 Prague Czech Republic

Department of Psychology Faculty of Philosophy and Arts Trnava University 918 43 Trnava Slovakia

Domov Důchodců Litovel 784 01 Litovel Czech Republic

Sanatorium Topas 534 01 Holice Czech Republic

Senior dům Beránek Úpice 542 32 Úpice Czech Republic

Pathogens. 2021 Sep 02;10(9):1121. doi: 10.3390/pathogens10091121. PubMed

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Pan Y., Zhang D., Yang P., Poon L.L.M., Wang Q. Viral load of SARS-CoV-2 in clinical samples. Lancet Infect. Dis. 2020;20:411–412. doi: 10.1016/S1473-3099(20)30113-4. PubMed DOI PMC

Woloshin S., Patel N., Kesselheim A.S. False Negative Tests for SARS-CoV-2 Infection-Challenges and Implications. N. Engl. J. Med. 2020;383:e38. doi: 10.1056/NEJMp2015897. PubMed DOI

Weinstein M.C., Freedberg K.A., Hyle E.P., Paltiel A.D. Waiting for Certainty on Covid-19 Antibody Tests—At What Cost? N. Engl. J. Med. 2020;383:e37. doi: 10.1056/NEJMp2017739. PubMed DOI

Waggoner S.N., Reighard S.D., Gyurova I.E., Cranert S.A., Mahl S.E., Karmele E.P., McNally J.P., Moran M.T., Brooks T.R., Yaqoob F., et al. Roles of natural killer cells in antiviral immunity. Curr. Opin. Virol. 2016;16:15–23. doi: 10.1016/j.coviro.2015.10.008. PubMed DOI PMC

Smyth M.J., Cretney E., Kelly J.M., Westwood J.A., Street S.E., Yagita H., Takeda K., Van Dommelen S.L., Degli-Esposti M.A., Hayakawa Y. Activation of NK cell cytotoxicity. Mol. Immunol. 2005;42:501–510. doi: 10.1016/j.molimm.2004.07.034. PubMed DOI

Moretta A., Marcenaro E., Parolini S., Ferlazzo G., Moretta L. NK cells at the interface between innate and adaptive immunity. Cell Death Differ. 2008;15:226–233. doi: 10.1038/sj.cdd.4402170. PubMed DOI

Ma Y., Li X., Kuang E. Viral Evasion of Natural Killer Cell Activation. Viruses. 2016;8:95. doi: 10.3390/v8040095. PubMed DOI PMC

Laing K., Hutchinson F. Immune Responses to Viruses. British Society for Immunology. [(accessed on 5 June 2020)]; Available online: https://www.immunology.org/public-information/bitesized-immunology/pathogens-and-disease/immune-responses-viruses.

Braciale T.J., Hahn Y.S. Immunity to viruses. Immunol. Rev. 2013;255:5–12. doi: 10.1111/imr.12109. PubMed DOI PMC

Kennelly S.P., Dyer A.H., Noonan C., Kennelly S.M., Martin A., O’Neill D., Fallon A. Asymptomatic carriage rates and case-fatality of SARS-CoV-2 infection in residents and staff in Irish nursing homes. Age Ageing. 2020 doi: 10.1093/ageing/afaa220. in press. PubMed DOI PMC

Shahid Z., Kalayanamitra R., McClafferty B., Kepko D., Ramgobin D., Patel R., Aggarwal C.S., Vunnam R., Sahu N., Bhatt D., et al. COVID-19 and Older Adults: What We Know. J. Am. Geriatr. Soc. 2020;68:926–929. doi: 10.1111/jgs.16472. PubMed DOI PMC

Vellas C., Delobel P., de Souto B.P., Izopet J. COVID-19, Virology and Geroscience: A Perspective. J. Nutr. Health Aging. 2020;24:685–691. doi: 10.1007/s12603-020-1416-2. PubMed DOI PMC

Perrotta F., Corbi G., Mazzeo G., Boccia M., Aronne L., D’Agnano V., Komici K., Mazzarella G., Parrella R., Bianco A. COVID-19 and the elderly: Insights into pathogenesis and clinical decision-making. Aging Clin. Exp. Res. 2020;32:1599–1608. doi: 10.1007/s40520-020-01631-y. PubMed DOI PMC

Sliva J., Pantzartzi C.N., Votava M. Inosine Pranobex: A Key Player in the Game against a Wide Range of Viral Infections and Non-Infectious Diseases. Adv. Ther. 2019;36:1878–1905. doi: 10.1007/s12325-019-00995-6. PubMed DOI PMC

McCarthy M.T., Lin D., Soga T., Adam J., O’Callaghan C.A. Inosine pranobex enhances human NK cell cytotoxicity by inducing metabolic activation and NKG2D ligand expression. Eur. J. Immunol. 2020;50:130–137. doi: 10.1002/eji.201847948. PubMed DOI PMC

Rumel A.S., Newman A.S., O’Daly J., Duffy S., Grafton G., Brady C.A., Curnow S.J., Barnes N.M., Gordon J. Inosine Acedoben Dimepranol promotes an early and sustained increase in the natural killer cell component of circulating lymphocytes: A clinical trial supporting anti-viral indications. Int. Immunopharmacol. 2017;42:108–114. doi: 10.1016/j.intimp.2016.11.023. PubMed DOI

Hersey P., Edwards A. Effect of isoprinosine on natural killer cell activity of blood mononuclear cells in vitro and in vivo. Int. J. Immunopharmacol. 1984;6:315–320. doi: 10.1016/0192-0561(84)90048-1. PubMed DOI

Gayoso I., Sanchez-Correa B., Campos C., Alonso C., Pera A., Casado J.G., Morgado S., Tarazona R., Solana R. Immunosenescence of human natural killer cells. J. Innate Immun. 2011;3:337–343. doi: 10.1159/000328005. PubMed DOI

Hazeldine J., Lord J.M. The impact of aging on natural killer cell function and potential consequences for health in older adults. Ageing Res. Rev. 2013;12:1069–1078. doi: 10.1016/j.arr.2013.04.003. PubMed DOI PMC

Watzl C., Long E.O. Signal transduction during activation and inhibition of natural killer cells. Curr. Protoc. Immunol. 2010;90:11.9B.1–11.9B.17. PubMed PMC

World Health Organization Influenza: BRaVe Call to Action. [(accessed on 5 April 2020)]; Available online: http://www.who.int/influenza/patient_care/clinical/call_to_action/en.

Beran J., Salapova E., Spajdel M. Inosine pranobex is safe and effective for the treatment of subjects with confirmed acute respiratory viral infections: Analysis and subgroup analysis from a Phase 4, randomised, placebo-controlled, double-blind study. BMC Infect. Dis. 2016;16:648. doi: 10.1186/s12879-016-1965-5. PubMed DOI PMC

Thevarajan I., Nguyen T.H.O., Koutsakos M., Druce J., Caly L., van de Sandt C.E., Jia X., Nicholson S., Catton M., Cowie B., et al. Breadth of concomitant immune responses prior to patient recovery: A case report of non-severe COVID-19. Nat. Med. 2020;26:453–455. doi: 10.1038/s41591-020-0819-2. PubMed DOI PMC

Neill C., Sartaj M., Holcroft L., Hasan S.S., Conway B.R., Aldeyab M.A. Surveillance study of asymptomatic and presymptomatic coronavirus disease 2019 (COVID-19) in care homes in Northern Ireland. Infect. Control Hosp. Epidemiol. 2020:1–3. doi: 10.1017/ice.2020.1284. PubMed DOI PMC

Arons M.M., Hatfield K.M., Reddy S.C., Kimball A., James A., Jacobs J.R., Taylor J., Spicer K., Bardossy A.C., Oakley L.P., et al. Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility. N. Engl. J. Med. 2020;382:2081–2090. doi: 10.1056/NEJMoa2008457. PubMed DOI PMC

Graham N.S.N., Junghans C., Downes R., Sendall C., Lai H., McKirdy A., Elliott P., Howard R., Wingfield D., Priestman M., et al. SARS-CoV-2 infection, clinical features and outcome of COVID-19 in United Kingdom nursing homes. J. Infect. 2020;81:411–419. doi: 10.1016/j.jinf.2020.05.073. PubMed DOI PMC

Inosine Pranobex Deserves Attention as a Potential Immunomodulator to Achieve Early Alteration of the COVID-19 Disease Course

Predictive factors for a severe course of COVID-19 infection in myasthenia gravis patients with an overall impact on myasthenic outcome status and survival

Correction: Beran et al. Inosine Pranobex Significantly Decreased the Case-Fatality Rate among PCR Positive Elderly with SARS-CoV-2 at Three Nursing Homes in the Czech Republic. Pathogens 2020, 9, 1055

Immune Profile in Patients With COVID-19: Lymphocytes Exhaustion Markers in Relationship to Clinical Outcome