Are there any studies of fenofibrate used to treat COVID-19?

Comment by InpharmD Researcher

There are no studies of fenofibrate used to clinically treat COVID-19. However, an in vitro study showed fenofibrate may be a promising agent against SARS-CoV-2 infection. Human data is needed, and two ongoing randomized controlled trials assessing fenofibrate 145 mg/day as an intervention for COVID-19 aim to be completed in late 2021.

  

LitCovid: fenofibrate = 16 results

Background

An in vitro study conducted in Vero cell cultures found fenofibrate and fenofibric acid reduced viral infection by up to 70%. Full-length ACE2 was amplified and created for the cell cultures. Live SARS-CoV-2 (hCOV-19/England/2/2020 strain) were introduced with dilutions. The cells were then cultured for 24 or 48 hours before being frozen and harvested for analysis. An enzyme-linked immunosorbent assay (ELISA) consisting of immobilized, recombinant ACE2 was conducted to determine the inhibitory effect of fibrates on SARS-CoV-2 binding to ACE2. While there was no inhibition of receptor-binding domain (RBD) observed with any of the fibrates when the assays were conducted on ice (to minimize endocytosis), modest to significant RBD inhibition was seen at 37°C. After 48 h, 59% of control infected Vero cells were still positive for spike protein. When fenofibrate was introduced, there was a reduction in virus infection by 18-65% compared to the control. While the results of this study cannot be extrapolated for human or animal use, this study identifies fenofibrate as a potential therapeutic agent for treating SARS-CoV-2 infection. [1], [2]

There are two human clinical trials registered to study fenofibrate for COVID-19. The FEnofibRate as a Metabolic INtervention for COVID-19 (FERMIN) trial aims to assess fenofibrate 145 mg/day versus placebo for 10 days in patients diagnosed with COVID-19. This study is currently enrolling by invitation and is estimated to be completed by October 31, 2021. The Fenofibrate for Patients With COVID-19 Requiring Hospitalization (FENOC) study aims to assess fenofibrate 145 mg versus usual care versus placebo. While this study is still recruiting, it is estimated to be completed in December 2021. [3], [4]

References:

[1] Davies SP, Mycroft-West CJ, Pagani I, et al. The hyperlipidaemic drug fenofibrate significantly reduces infection by sars-cov-2 in cell culture models. Front Pharmacol. 2021;12:660490. doi:10.3389/fphar.2021.660490
[2] Buschard K. Fenofibrate increases the amount of sulfatide which seems beneficial against Covid-19. Medical Hypotheses. 2020;143:110127. doi:10.1016/j.mehy.2020.110127
[3] ClinicalTrials.gov. FEnofibRate as a Metabolic INtervention for COVID-19 (FERMIN). https://clinicaltrials.gov/ct2/show/NCT04517396. Updated March 8, 2021. Accessed August 9, 2021.
[4] ClinicalTrials.gov. Fenofibrate for Patients With COVID-19 Requiring Hospitalization (FENOC). https://clinicaltrials.gov/ct2/show/NCT04661930. Updated December 10, 2020. Accessed August 9, 2021.