Covid-19 living Data

Pharmacologic treatments for covid-19 patients

Camostat Mesilate vs Placebo

Outpatients

Forest plots
(last update: 2022-10-20)

Summary of findings
(last update: 2022-10-23)

Patient or population: COVID-19 patients
Setting: Worldwide
Intervention: Camostat Mesilate
Comparison: Placebo

Outcome	Relative effect (95% CI)	Absolute effect (95% CI)¹		Certainty of the Evidence (GRADE)
Clinical improvement D28	RR: 0.77 (0.45 - 1.31)	100 fewer per 1000 (from 238 fewer to 134 more)		Very low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Serious single study from a single institution therefore results in this population might not be generalizable to other settings Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
1 trials Tobback E, 2022 96 participants		Camostat Mesilate 334 per 1,000 (195 - 568)	Placebo 433 per 1,000
Clinical improvement D60	Outcome not yet measured or reported
Hospitalisation or death *	RR: 0.88 (0.35 - 2.22)	6 fewer per 1000 (from 33 fewer to 63 more)		Low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Serious studies from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Serious due to wide confidence interval consistent with the possibility for no effect/trivial effect and the possibility for harm
2 trials Chupp G, 2022; NCT NCT04583592 2022 365 participants		Camostat Mesilate 45 per 1,000 (18 - 114)	Placebo 51 per 1,000
WHO progression score (level 7 or above) D28	Outcome not yet measured or reported
WHO progression score (level 7 or above) D60	Outcome not yet measured or reported
All-cause mortality D28	RR: 1.57 (0.06 - 38.18)	Absolute effects were not calculated due to zero events in the control group		Very low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Serious studies from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
3 trials Chupp G, 2022; NCT04524663 2022; NCT04583592 2022 414 participants		Camostat Mesilate 0 per 1,000 ( - )	Placebo 0 per 1,000
All-cause mortality D60	Outcome not yet measured or reported
Viral negative conversion D7	RR: 1.32 (0.73 - 2.40)	102 more per 1000 (from 86 fewer to 444 more)		Very low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Serious studies from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
2 trials Chupp G, 2022; NCTNCT04583592 2022 342 participants		Camostat Mesilate 419 per 1,000 (232 - 762)	Placebo 317 per 1,000
Adverse events	RR: 1.20 (0.97 - 1.47)	89 more per 1000 (from 13 fewer to 210 more)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to wide confidence interval consistent with the possibility for trivial effect/no effect and the possibility for harm
2 trials Tobback E, 2022; Chupp G, 2022 166 participants		Camostat Mesilate 535 per 1,000 (433 - 656)	Placebo 446 per 1,000
Serious adverse events	RR: 0.98 (0.39 - 2.51)	1 fewer per 1000 (from 31 fewer to 76 more)		Low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious We presume that the adverse event rates and the corresponding relative risks, are similar across diverse settings, therefore not downgraded for indirectness Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
3 trials Chupp G, 2022; NCT04524663 2022; NCT04583592 2022 414 participants		Camostat Mesilate 49 per 1,000 (20 - 126)	Placebo 50 per 1,000

¹The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

Hospitalized patients

Forest plots
(last update: 2022-10-20)

Summary of findings
(last update: 2022-10-23)

Patient or population: COVID-19 patients
Setting: Worldwide
Intervention: Camostat Mesilate
Comparison: Placebo

Outcome	Relative effect (95% CI)	Absolute effect (95% CI)¹		Certainty of the Evidence (GRADE)
Clinical improvement D28	RR: 1.03 (0.94 - 1.13)	27 more per 1000 (from 54 fewer to 117 more)		Low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Multicentre study conducted across several countries, therefore not downgraded for indirectness Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
1 trials Gunst J, 2021 208 participants		Camostat Mesilate 926 per 1,000 (845 - 1000)	Placebo 899 per 1,000
Clinical improvement D60	Outcome not yet measured or reported
WHO progression score (level 7 or above) D28	RR: 0.99 (0.35 - 2.79)	0 fewer per 1000 (from 22 fewer to 61 more)		Low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
2 trials Kinoshita T, 2022; Gunst J, 2021 363 participants		Camostat Mesilate 34 per 1,000 (12 - 96)	Placebo 34 per 1,000
WHO progression score (level 7 or above) D60	Outcome not yet measured or reported
All-cause mortality D28	RR: 0.87 (0.29 - 2.60)	4 fewer per 1000 (from 24 fewer to 55 more)		Low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
2 trials Kinoshita T, 2022; Gunst J, 2021 363 participants		Camostat Mesilate 30 per 1,000 (10 - 89)	Placebo 34 per 1,000
All-cause mortality D60	Outcome not yet measured or reported
Viral negative conversion D7	RR: 0.96 (0.74 - 1.23)	25 fewer per 1000 (from 165 fewer to 146 more)		Very low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Serious despite a multicentre design this is a single study from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
1 trials Kinoshita T, 2022 148 participants		Camostat Mesilate 610 per 1,000 (470 - 781)	Placebo 635 per 1,000
Adverse events	RR: 0.83 (0.61 - 1.12)	62 fewer per 1000 (from 142 fewer to 44 more)		Low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding adequate randomization, deviation from intended intervention, and outcome measurement Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to wide confidence interval consistent with the possibility for benefit and the possibility for no effect/trivial effect
2 trials Kinoshita T, 2022; Gunst J, 2021 363 participants		Camostat Mesilate 301 per 1,000 (221 - 407)	Placebo 363 per 1,000
Serious adverse events	RR: 1.64 (0.84 - 3.23)	39 more per 1000 (from 10 fewer to 137 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding adequate randomization, deviation from intended intervention, and outcome measurement Inconsistency: Not serious Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
2 trials Kinoshita T, 2022; Gunst J, 2021 363 participants		Camostat Mesilate 101 per 1,000 (52 - 199)	Placebo 62 per 1,000

¹The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)

CI: Confidence interval; RR: Risk ratio

To access all information :

click here for Outpatients
click here for Hospitalized patients

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Permanent URL for this comparison: https://covid-nma.com/living_data/index.php?comparison=374

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Trial	Funding	Comparisons		Design	Participants	Sample size	Overall risk of bias Highest assessment	Full description
		Treatment 1	Treatment 2
NCT04524663 COPS-2003 NCT04524663, Unpublished, 2022 Full text	Not reported/unclear	Camostat Mesilate	Placebo	RCT	Outpatients with confirmed COVID-19 (mild) treated by one center in the USA.	N=49	Some concerns Details	Full description
NCT04583592 CAMELOT NCT04583592, Unpublished, 2022 Full text	Not reported/unclear	Camostat Mesilate	Placebo	RCT	Outpatients with confirmed COVID-19 (mild) treated by multiple centers in the USA.	N=295	Low Details	Full description
NCT04625114 Tobback E, Int J Infect Dis, 2022 Full text Commentary	Mixed	Camostat Mesilate	Placebo	RCT	Outpatients with confirmed COVID-19 (asymptomatic-mild) treated at a single center in Belgium.	N=96	Some concerns Details	Full description
NCT04657497; jRCT2031200198 CANDLE Kinoshita T, BMC Medicine, 2022 Full text Full text Commentary Commentary Commentary	Private	Camostat Mesilate	Placebo	RCT	Patients with confirmed COVID-19 (asymptomatic-mild) admitted to 21 centers in Japan.	N=155	Some concerns Details	Full description
NCT04353284 Chupp G, medRxiv, 2022 Full text Commentary Commentary	Mixed	Camostat Mesilate	Placebo	RCT	Outpatients with confirmed COVID-19 (mild) treated at a single center in USA.	N=70	Some concerns Details	Full description
NCT04321096 ; EudraCT Number: 2020001,20042 Gunst J, EClinicalMedicine, 2021 Full text Commentary	Private	Camostat Mesilate	Placebo	RCT	Patients with confirmed COVID-19 (mild-severe) admitted to 9 centers in Denmark and Sweden.	N=208	Some concerns Details	Full description