Title:The Potential Use of Cyclosporine Ultrafine Solution Pressurised Metered-
Dose Inhaler in the Treatment of COVID-19 Patients
Volume: 16
Issue: 1
Author(s): Touraj Ehtezazi *
Affiliation:
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Byrom Street, Liverpool, L3 3AF,
UK
Keywords:
COVID-19, cyclosporine A, inhalation, pressurised metered-dose inhaler, regulatory tests, approved drugs.
Abstract:
Introduction: Serious COVID-19 respiratory problems start when the virus reaches the
alveolar level, where type II cells get infected and die. Therefore, virus inhibition at the alveolar
level would help preventing these respiratory complications.
Method: A literature search was conducted to collect physicochemical properties of small
molecule compounds that could be used for the COVID-19 treatment. Compounds with low melting
points were selected along with those soluble in ethanol, hydrogen-bond donors, and acceptors.
Results: There are severe acute respiratory syndrome coronavirus inhibitors with physicochemical
properties suitable for the formulation as an ultrafine pressurised metered-dose inhaler (pMDI). Mycophenolic
acid, Debio 025, and cyclosporine A are prime candidates among these compounds. Cyclosporine
A (hereafter cyclosporine) is a potent SARS-CoV-2 inhibitor, and it has been used for
the treatment of COVID-19 patients, demonstrating an improved survival rate. Also, inhalation
therapy of nebulised cyclosporine was tolerated, which was used for patients with lung transplants.
Finally, cyclosporine has been formulated as a solution ultrafine pMDI. Although vaccine therapy
has started in most countries, inhalation therapies with non-immunological activities could minimise
the spread of the disease and be used in vaccine-hesitant individuals.
Conclusion: Ultrafine pMDI formulation of cyclosporine or Debio 025 should be investigated for
the inhalation therapy of COVID-19.