{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T12:19:36Z","timestamp":1784204376775,"version":"3.55.0"},"reference-count":30,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T00:00:00Z","timestamp":1725580800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Starpharma Pty Ltd."}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceutics"],"abstract":"<jats:p>Background\/Objectives: Dendrimer-based astodrimer sodium nasal spray was assessed for its ability to reduce SARS-CoV-2 load in outpatients with COVID-19, which remains a severe illness for vulnerable groups. Methods: This was a randomised, double-blind, placebo-controlled clinical investigation evaluating the efficacy of astodrimer nasal spray in reducing SARS-CoV-2 viral burden in the nasopharynx of outpatients with COVID-19. Non-hospitalised adults with SARS-CoV-2 infection were randomised 1:1 to astodrimer or placebo four times daily from Day 1 to Day 7. Nasopharyngeal swabs for SARS-CoV-2 load determination were self-obtained daily from Day 1 to Day 8. The primary endpoint was an area under the curve of SARS-CoV-2 RNA copies\/mL through Day 8 (vAUCd1\u20138). The primary analysis population was the modified intent-to-treat population (mITT: all randomised participants exposed to the study treatment who had at least one post-baseline viral load determination). Safety analyses included all randomised participants exposed to the study treatment. Study registration: ISRCTN70449927; Results: 231 participants were recruited between 9 January and 20 September 2023. The safety population comprised 109 and 113 participants randomised to astodrimer and placebo, respectively, with 96 and 101 participants in the mITT. Astodrimer sodium nasal spray reduced the SARS-CoV-2 burden (vAUCd1\u20138) vs. placebo in non-hospitalised COVID-19 patients aged 16 years and over (\u22121.2 log10 copies\/mL \u00d7 Day). The reduction in SARS-CoV-2 load was statistically significant in those aged 45 years and older (\u22123.7, p = 0.017) and the effect increased in older age groups, including in those aged 65 years and older (\u22127.3, p = 0.005). Astodrimer sodium nasal spray increased the rate of viral clearance and helped alleviate some COVID-19 symptoms, especially loss of sense of smell. Overall, 31 participants (14%) had \u22651 adverse event (AE). Four AEs were deemed possibly related to treatment. Most AEs were of mild severity and occurred at similar rates in both treatment arms. Conclusions: Astodrimer nasal spray reduces viral burden and accelerates viral clearance, especially in older populations, and is well tolerated.<\/jats:p>","DOI":"10.3390\/pharmaceutics16091173","type":"journal-article","created":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T05:02:28Z","timestamp":1725598948000},"page":"1173","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Astodrimer Sodium Nasal Spray versus Placebo in Non-Hospitalised Patients with COVID-19: A Randomised, Double-Blinded, Placebo-Controlled Trial"],"prefix":"10.3390","volume":"16","author":[{"given":"Stephen","family":"Winchester","sequence":"first","affiliation":[{"name":"Frimley Health National Health Service Foundation Trust, Camberley GU16 7UJ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Castellarnau","sequence":"additional","affiliation":[{"name":"Starpharma Pty Ltd., Abbotsford, VIC 3067, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kashif","family":"Jabbar","sequence":"additional","affiliation":[{"name":"Ashford and St. Peter\u2019s Hospitals National Health Service Foundation Trust, Chertsey KT16 0PZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meera","family":"Nadir","sequence":"additional","affiliation":[{"name":"Ashford and St. Peter\u2019s Hospitals National Health Service Foundation Trust, Chertsey KT16 0PZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kapila","family":"Ranasinghe","sequence":"additional","affiliation":[{"name":"Ashford and St. Peter\u2019s Hospitals National Health Service Foundation Trust, Chertsey KT16 0PZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier","family":"Masramon","sequence":"additional","affiliation":[{"name":"Servicio de Asesor\u00eda a la Investigaci\u00f3n y Log\u00edstica (SAIL), 08027 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George R.","family":"Kinghorn","sequence":"additional","affiliation":[{"name":"Royal Hallamshire Hospital, University of Sheffield, Western Bank, Sheffield S10 2TN, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2856-6180","authenticated-orcid":false,"given":"Isaac","family":"John","sequence":"additional","affiliation":[{"name":"Ashford and St. Peter\u2019s Hospitals National Health Service Foundation Trust, Chertsey KT16 0PZ, UK"},{"name":"Royal Holloway, University of London, Egham TW20 0EX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9981-421X","authenticated-orcid":false,"given":"Jeremy R. A.","family":"Paull","sequence":"additional","affiliation":[{"name":"Starpharma Pty Ltd., Abbotsford, VIC 3067, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"m1728","DOI":"10.1136\/bmj.m1728","article-title":"Reducing Risks from Coronavirus Transmission in the Home-the Role of Viral Load","volume":"369","author":"Little","year":"2020","journal-title":"BMJ"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"16587","DOI":"10.1073\/pnas.2009799117","article-title":"Syrian Hamsters as a Small Animal Model for SARS-CoV-2 Infection and Countermeasure Development","volume":"117","author":"Imai","year":"2020","journal-title":"Proc. Natl. Acad. Sci. 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