As expected, a continuous decrease in the mean virus load was observed in all study groups during the 11 treatment days. On day 16, an on-site visit (V8) for female patients was conducted to perform a urine pregnancy test and to assess the safety of the therapy. De Vries, R. D. et al. By submitting a comment you agree to abide by our Terms and Community Guidelines. Of note, the mean viral load value showed small variability, thereby supporting the power of the current study. Nasal steroid sprays may reduce the severity of COVID-19, according to a new study. Lancet Infect. C.L. Cite this article. Trials underway to see if Boots cold remedy can tackle coronavirus Nasal vaccines for COVID-19 offer hope and face hurdles - Science News To obtain 6). 4). While PCR results in the placebo group turned negative only on day 11 of treatment, individual patients of the 0.1% azelastine group already showed negative PCR test results from day 2 on. What scientists say. Treatment kits were manufactured by URSAPHARM Arzneimittel GmbH, Saarbruecken, Germany, according to the randomization list (as sequentially numbered containers). The Sponsor designed a dual chamber nasal spray bottle for NORS administration. Pharmaceutics 14, 2502. https://doi.org/10.3390/pharmaceutics14112502 (2022). Comirnaty is also authorized . 384, 671673. Kalle Saksela, MD, PhD, virologist, University of Helsinki, Nature Communications: Intranasal trimeric sherpabody inhibits SARS-CoV-2 including recent immunoevasive Omicron subvariants.. Investigators assessed patients status throughout the trial including safety follow-ups (days 16 and 60). Interestingly, significantly greater decrease in viral load was shown on day 4 of treatment in patients with high viral burden (Ct<25) treated with 0.1% azelastine compared to placebo, indicating that azelastine treatment may be advantageous for this patient population, particularly at an early timepoint of infection. Kim, M.-C. et al. also provided experimental evidence for the inhibition of the enzyme in a kinetic activity assay7. The improvement of the symptom shortness of breath was significantly greater on days 3 (p=0.004) and 4 (p=0.011) in the 0.1% azelastine group compared to placebo (supplementary Figure S3). IGM-6268. 17(2), 19. COVID-19 vaccines teach the immune system to recognize a particular protein on SARS-CoV-2 that is known as the spike protein. Suitable for 90 patients were recruited between 09/03/2021 and 28/04/2021, constituting the safety analysis set. The hope is the vaccines will build immunity in one spot the coronavirus often invades . In an in vitro screening of 1,800 approved drugs by use of a SARS-CoV-2-S pseudovirus entry inhibitor model, 15 drugs were identified as active inhibitors, but only seven of these drugs were identified as active against SARS-CoV-2, three of which were anti-histamines: clemastine, trimeprazine and azelastine hydrochloride5. These devices release a low-velocity aerosol mist that can be slowly inhaled over a longer period of time than metered dose and dry powder inhalers. Article were involved in data management. Z. Gesundheitswissenschaften J. 62, 50937, Cologne, Germany, You can also search for this author in Nasal Sprays Could Protect You From Serious COVID-19 Illness 20, e192e197. 13, 861295. https://doi.org/10.3389/fphar.2022.861295 (2022). Short intervals of swab collection time points, particularly during early days of infection, and high number of PCR tests aimed to monitor SARS-CoV-2 viral loads as closely as possible, considering that only limited knowledge regarding details of viral clearance was publicly available at the time of the study development. Initial report of decreased SARS-CoV-2 viral load after inoculation with the BNT162b2 vaccine. The antiviral also could offer an alternative to people who cannot or do not respond to a vaccine. ICE-COVID, will investigate whether Dual Defence can either prevent Covid-19 infection or reduce . Symptoms were evaluated on a 5-point scale from 1=symptom absent or present very weakly to 5=symptom present very strongly: anosmia, ageusia, cough, sore throat, shortness of breath, coryza, general weakness, headache, aching limb, loss of appetite, pneumonia, nausea, abdominal pain, vomiting, diarrhea, conjunctivitis, rash, lymph node swelling, apathy, somnolence. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. To infect a cell, the virus tricks several of that cells proteins, including one called TMPRSS2, to gain entry. Researchers supported in part by the National Institute of Allergy and Infectious Diseases (NIAID) have developed a nasal spray that has the potential to not only treat COVID-19 but also prevent SARS-CoV-2 infection in a way that the virus cant mutate to avoid. Striking antibody evasion manifested by the Omicron variant of SARS-CoV-2. A final safety follow-up and assessment of the patient status (WHO scale) by phone call was done on day 60 (V9) for all patients. Receive 51 print issues and online access, Get just this article for as long as you need it, Prices may be subject to local taxes which are calculated during checkout, doi: https://doi.org/10.1038/d41586-022-03341-z. For calibration purposes of quantitative assessments, reference samples were included with each PCR run. The efficacy of the treatment was judged as good or very good by 75.0% (0.1% azelastine treatment), 74.1% (0.02% azelastine treatment) and 50.0% (placebo treatment) of patients. https://doi.org/10.2147/idr.S391630 (2022). The liquid contains NO at 0.11 ppm*hour, which acts as a viricidal agent. https://doi.org/10.1038/s41598-023-32546-z, DOI: https://doi.org/10.1038/s41598-023-32546-z. Science 371, 13791382 (2021). PubMed Boots Dual Defence Nasal Spray is used to dampen the symptoms of cold and flu. 27, 790792. Boots Dual Defence Nasal Spray 20ml - Boots The dual-target RT-PCR independently targets the ORF1a/b and the sarbecovirus E genes, and assays were considered positive if at least one target returned a positive result (Ct values reflecting an inverse relationship with viral load). Michel, J. et al. Those compounds were tested in human lung and colon cells that were then exposed to SARS-CoV-2. HG, MS, and FK declare no conflict of interest. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiological . Rep. 12, 899. https://doi.org/10.1038/s41598-021-04573-1 (2022). It should be noted that the SARS-CoV-2 alpha variant (B.1.1.7) was the dominant variant in Germany during the enrolment phase of the current study16. Even in cases where the antiviral does not prevent coronavirus infection, the treatment could slow infection. CAS Nitric Oxide Nasal Spray (NONS) as Prevention for Treatment of Sci. CAS FH is the CEO of URSAPHARM Arzneimittel GmbH. Virological assessment of hospitalized patients with COVID-2019. Ghahremanpour, M. M. et al. Chem. Inhibition of SARS-CoV-2 by bentonite-based nasal spray - News-Medical.net Sign up for the Nature Briefing newsletter what matters in science, free to your inbox daily. Future studies will help understanding the impact of azelastine hydrochloride in treating SARS-CoV-2 infected patients. Since the start of the Coronavirus Disease 2019 (COVID-19) pandemic, several independent research groups revealed azelastines potential as a promising candidate for drug repurposing to reduce SARS-CoV-2 viral load and infection rates5,6,7,8,9,10. In animal models, by directly inactivating the virus,TriSb92 offers immediate and robust protection against coronavirus infection and severe COVID, said Anna R. Mkel, PhD, lead author of the study and a senior scientist in the Department of Virology at the University of Helsinki in Finland., Thestudy was published online March 24 in Nature Communications.. Antiviral efficacy was observed at an EC50 of~6M, which is an approximately 400-fold lower concentration compared to commercially available azelastine nasal sprays. https://doi.org/10.1007/s11739-021-02786-w (2021). Researchers have looked for ways to prevent SARS-CoV-2 infection that the virus cant learn to dodge or evade by mutating. Hamasaki, Y. et al. The mean bmi of participants was 24.915.27. The researchers compared mice treated with TriSb92 before and after exposure to SARS-CoV-2. The physical and mental health summary scores of the SF-36 questionnaire improved during the course of the treatment without statistical differences between groups (data not shown). Allergy Asthma Immunol. Information on individual variants was obtained through the original laboratory reports, when available. [1] Nasal delivery of an IgM offers broad protection from SARS-CoV-2 variants. A pilot study of 0.4% povidone-iodine nasal spray to eradicate SARS-CoV-2 in the nasopharynx. SARS-CoV-2 RNA levels in nasopharyngeal swabs were determined by quantitative RT-PCR using the cobas SARS-CoV-2 Test on the cobas 6800 system (Roche Diagnostic, Mannheim, Germany). was the principal investigator responsible for the conduct of the study, M.G. Povidone iodine mouthwash, gargle, and nasal spray to reduce nasopharyngeal viral load in patients with COVID-19: A randomized clinical trial. Slider with three articles shown per slide. Furthermore, three independent groups predicted interaction of azelastine hydrochloride with the main protease of SARS-CoV-2: main protease (Mpro) or 3C-like cysteine protease (3CLpro)7,8,9. First report on a double-blind placebo-controlled phase II clinical trial. In this context, it is interesting to note that publications indicate that individuals vaccinated against SARS-CoV-2 have lower viral loads and are less contagious24,25. Liu, L. et al. Pharmacol. 4). Thus, eligibility criteria were designed carefully to investigate a clearly defined, homogeneous study population of low-risk patients with a narrow age range. . Similarly, no clinically relevant differences regarding blood oxygen saturation values were detected between groups (data not shown). 16, 275282. At the end of the treatment, 48.2% of the patients of the 0.1% azelastine group showed no detection of the ORF 1a/b gene, whereas only 23.1% of patients of the placebo group showed negative PCR results (supplementary Table S4). Researchers found that for people who regularly used a prescription corticosteroid like Beconase or Nasonex before getting sick with COVID-19, the risk of severe outcomes like hospitalization and death dropped by as much as 25%. https://doi.org/10.1038/s41586-020-2196-x (2020). "CofixRX is an antiviral nasal spray that offers up to 8 hours of protection from many cold and flu viruses." [from your CofixRx Nasal Spray product label] "Lasts for up to 8 hours per. Antiviral activity was subsequently verified in cell culture. Because N-0385 was suitable for use as a nasal spray, researchers used a mouse model that develops severe COVID-19 and gave the mice either N-0385 or control doses of saline in their noses. Duration of culturable SARS-CoV-2 in hospitalized patients with covid-19. D.G., C.S. Ralph Msges. Viruses 13, 895. https://doi.org/10.3390/v13050895 (2021). Betadine as COVID-19 Prevention Risks - Health The data that support the findings of this study are available from URSAPHARM Arzneimittel GmbH but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Pharmaceutics 14, 2059. https://doi.org/10.3390/pharmaceutics14102059 (2022). This is similar to the natural SARS-CoV-2 clearance time of approximately 2weeks. March 31, 2023 An antiviral therapy in early development has the potential to prevent COVID-19 infections when given as a nasal spray as little as 4 hours before exposure. JPK and CL have received grants from the sponsor URSAPHARM Arzneimittel GmbH for performing this trial. Xlear have developed and patented a xylitol containing nasal spray for the treatment of upper-respiratory tract infections. The researchers picked four compounds that worked at very low concentrations and did not negatively affect the host cells. Comparable numbers of adverse events occurred in all treatment groups with no safety concerns. Recently, Shmuel et al. Continuous data were described by statistical estimates (mean, standard deviation, median, minimum, and maximum values). Article The investigators judged the efficacy as good or very good in 74.1% (0.1% azelastine treatment), 82.1% (0.02% azelastine treatment) and 73.1% (placebo treatment) of treated patients. *p=0.005 comparing the decrease of viral load on day 4 in the 0.1% azelastine group (log10 1.901.03) compared to placebo (log10 1.050.70; p=0.005). Additionally, safety follow-ups were performed at 2 time-points. Scientific Reports (Sci Rep) Patient disposition. Will there be a COVID winter wave? Nat. The reduction of the symptom score from baseline to day 11 was 8.389.42 in the 0.02% azelastine group and 11.129.45 in the placebo group. Dis. . 24 COVID-19 status classified as negative, asymptomatic, mild, or severe. Identification of 14 known drugs as inhibitors of the main protease of SARS-CoV-2. Viruses 12, 1384. https://doi.org/10.3390/v12121384 (2020). Nasal sprays may be a promising first line of defense against SARS-CoV-2 infection. P eople who receive a Covid booster dose in the UK next month will be among the first in the world to receive Moderna's dual-variant vaccine, which protects against two strains of the virus.But . PM, MF, DG, CS and BS are employed at URSAPHARM Arzneimittel GmbH. Researchers are developing coronavirus vaccines that will be sprayed up the nose. The viral load reduction of the ORF 1a/b gene from baseline to day 11 was log10 5.042.05 in the 0.1% azelastine group, log10 4.391.74 in the 0.02% azelastine and log10 4.151.34 in the placebo group. Pediatr. Provided by the Springer Nature SharedIt content-sharing initiative. Treatment of COVID-19 with a hypertonic solution containing seawater, xylitol, panthenol and lactic acid was shown to reduce the viral shedding time in patients with asymptomatic or mild COVID-1920, whereas application of povidone iodine nasal spray showed only poor influence on SARS-CoV-2 viral titres21,22. Now, researchers at Swansea University will test it against Covid-19 Now, researchers at Swansea University. This is exemplified by the emergence of the highly immune evasive omicron variant that is resistant to many monoclonal antibodies authorized for clinical use34. Patient Rep. Outcomes 6, 26. https://doi.org/10.1186/s41687-022-00434-1 (2022). the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in For quantification of SARS-CoV-2-RNA in copies/mL, a standard curve derived from a dilution series of a SARS-CoV-2 cell culture isolate in VTM and adjusted to Ct values obtained from two samples with defined SARS-CoV-2-RNA copy numbers (106 and 105 copies/mL; INSTAND e.V., Duesseldorf, Germany) was used. The shown effects of azelastine nasal spray may thus be suggestive of azelastines potential as an antiviral treatment. contributed to the study conceptualisation. CAS The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Overall, data of the primary outcome did not show a normal distribution (ShapiroWilk test, p<0.05). This way, the virus moves on.. ISSN 0028-0836 (print). Inhibition of SARS-CoV-2 by bentonite-based nasal spray. Front. Drug Resist. were investigators involved in the conduct of the study. Symptoms were documented in patient diaries. Comirnaty is FDA-approved as a 2-dose series for the prevention of COVID-19 in individuals 12 years of age and older. If delivery took place within 24h after sampling, samples were to be stored at<25C, if storage period was greater than 24h (e.g., on Sundays), samples had to be stored and shipped at 28C. Rev. https://doi.org/10.1007/s10787-021-00847-2 (2021). But the spike protein may mutate to evade immune response. Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital, University of Cologne, Kerpener Str. Anti. . PubMed The primary endpoint of the CARVIN study was the assessment of virus load kinetics of SARS-CoV-2 by determining the presence and amount of viral carriage via PCR. Sci Rep 13, 6839 (2023). https://doi.org/10.1001/jamaoto.2020.5490 (2021). https://doi.org/10.6026/97320630016236 (2020). When treated with N-0385, 70% of the mice survived and had little to no lung damage. Intern. Konrat, R. et al. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Therefore, the primary analysis for the viral loads was conducted non-parametrically. An essential round-up of science news, opinion and analysis, delivered to your inbox every weekday. Researchers plan to continue testing the timing of when N-0385 should be administered and to expand testing into human clinical trials. Public Health 3, 21. https://doi.org/10.1007/BF02959944 (1995). It can be used to help return your sense of smell if it was lost during a viral infection or minor head trauma. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate. By application of a novel computational approach based on Shannon entropy homology, Konrat et al. Analyses were done on the entire data set (ITT) as well as on a subset population with high viral load defined by baseline Ct values below 25 (Ct<25). Topol is also editor-in-chief of Medscape, WebMD's sister site for medical professionals. The researchers first tried one dose a day for seven days, starting a day before SARS-CoV-2 infection. It also appears to work as a treatment if used within 4 hours after infection inside the nose, new research reveals., Known as TriSb92(brand name Covidin, from drugmaker Pandemblock Oy in Finland), the viral inhibitoralso appears effective against all coronavirus variants of concern, neutralizing even the Omicron variants BA.5, XBB, and BQ.1.1 in laboratory and mice studies., Unlike a COVID vaccine that boosts a persons immune system as protection, the antiviral nasal spray works more directly by blocking the virus, acting as a "biological mask in the nasal cavity," according to the biotechnology company set up to develop the treatment.. Preliminary results of the current study have been published as preprint15. But vaccines are fighting a changing opponent. 62, 50937, Cologne, Germany, Medical Faculty, Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Kerpener Str. After having given informed consent, patients tested positively for SARS-CoV-2 were examined to assess eligibility according to inclusion/non-inclusion criteria and subsequently randomized to one of the three study groups. This observational study (HUN-VE: Hungarian Vaccine Effectiveness) estimated vaccine effectiveness against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19-related mortality in 3.7 million . Data was analysed primarily exploratively; there was no formal testing of a given hypothesis. https://doi.org/10.21203/rs.3.rs-864566/v1. Article Shapira, T. et al. Jean, F. (2022). A., Dion, S. P., Buchholz, D. W., Imbiakha, B., Olmstead, A. D., Jager, M., Dsilets, A., Gao, G., Martins, M., Vandal, T., Thompson, C. A. H., Chin, A., Rees, W. D., Steiner, T., Nabi, I. R., Marsault, E., Sahler, J., Diel, D. G., . Generally, treatment with azelastine appeared safe in SARS-CoV-2 positive patients: no serious adverse events were reported in the current study, and the number of adverse events was comparable between groups. At the end of the study (day 60), all except one single patient (placebo group) showed a score of 0. In a highly relevant and translational in vitro model using reconstituted human nasal tissue, a fivefold diluted commercially available azelastine nasal spray solution inhibited viral replication almost completely within 72h after SARS-CoV-2 infection10. Informed consent was obtained from all participants prior to involvement in the study. Objective of the study is to assess the efficacy of Carragelose nasal and throat spray in reducing the rate, severity, and duration of COVID-19 infections. A TMPRSS2 inhibitor acts as a pan-SARS-CoV-2 prophylactic and therapeutic. Molecular docking and dynamics simulation of FDA approved drugs with the main protease from 2019 novel coronavirus. Wiesmller (health authorities Cologne, Germany) for his support regarding regulatory issues, PD Dr. E. Raskopf for editorial assistance, and H. Papp for her assistance in PCR control experiments. Watts, A. M., Cripps, A. W., West, N. P. & Cox, A. J. Modulation of allergic inflammation in the nasal mucosa of allergic rhinitis sufferers with topical pharmaceutical agents. The study was termed CARVIN (referring to COVID-19: Azelastine nasal spray Reduces Virus-load In Nasal swabs). The Coronavirus Immunotherapy Consortium identified new candidate drugs based on monoclonal antibodies in work funded by NIAID. Of those, 27 patients belonged to the 0.1% azelastine group, 28 patients to the 0.02% azelastine group and 26 patients to the placebo group (Fig. 2 and supplementary Table S2). Ther. A complete list of inclusion and exclusion criteria is presented in Table 1. performed and supervised sample processing and viral load measurements. Simon, M. W. The efficacy of azelastine in the prophylaxis of acute upper respiratory tract infections. When treated with N-0385, 70% of the mice survived and had little to no lung damage. Only one of the 20 mice given saline survived. Similarly, when given 2 or 4 hours after SARS-CoV-2 had already infected the epithelium, TriSb92 was linked to a complete lack of the virus's RNA in the lungs. Since viral levels during early infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) tend to be highest in the nose and nasopharynx 1, a nasal spray with an active substance . Vincenzo Messina, Riccardo Nevola, Luigi Elio Adinolfi, Kara W. Chew, Carlee Moser, Davey M. Smith, Manaf AlQahtani, Nitya Kumar, Stephen L. Atkin, V. Spagnuolo, M. Guffanti, COVID-BioB study group, Manish C. Choudhary, Kara W. Chew, for the ACTIV-2/A5401 Study Team, Emma Pritchard, Philippa C. Matthews, Koen B. Pouwels, Vineet Agarwal, A. J. Venkatakrishnan, Venky Soundararajan, Pauline Maisonnasse, Jrmie Guedj, Roger Le Grand, Scientific Reports TriSb92 isone of multiple nasal spray approaches but unlikely to be as durable as effective nasal vaccines, saidEricTopol, MD, a professor of molecular medicine and executive vice president of Scripps Research in La Jolla, CA. Evaluation of AUC values (reflecting baseline adjusted decreases of viral load over 11days) showed that the 0.1% azelastine group exhibited a greater AUC value of 24.1413.12 (referring to greater decrease) compared to the placebo group with an AUC value of 18.894.70 (p=0.007, Fig. Pharmacol. When given in advance, none of the treated mice had SARS-CoV-2 RNA in their lungs, while untreated mice in the comparison group had abundant levels. KaplanMeier analysis results regarding the ORF 1a/b gene from baseline (day 1) until day 11 of treatment (ITT analysis set). Boots UK - Swansea University Research Study of NHS Frontline Workers 76, 469475. Many elderly people as well asindividuals who are immunodeficient for various reasons do not respond to vaccines, and are in the need of other protective measures, said Kalle Saksela, MD, PhD, senior author of the study and a virologist at the University of Helsinki. Prevention is the best medicine, and COVID-19 vaccines block most SARS-CoV-2 infections. During the throes of the COVID-19 pandemic, Anne Moscona didnt feel safe going to a restaurant or catching a flight. Mice treated with just a single dose of N-0385 on the day they were infected had a high survival rate as well. The spritz developed by Moscona's team is one of a raft of proposed nasal sprays to prevent SARS-CoV-2 infection. Odhar, H. A. et al. 8, e70. Both descriptive and exploratory statistics were performed. These nanobodies and TriSb92 target a specific part of the coronavirus spike protein called the receptor-binding domain (RBD). In addition, investigators measured body temperature during V1V7 and oxygen saturation of the blood (using a finger pulse oximeter) on V1, V3, and V5, V6 and V7. Both have the allure of being variant-proof, Topol added., Many laboratories are shifting from treatments using monoclonal antibodies to treatments using smaller antibody fragments called "nanobodies" because they are more cost-effective and are able to last longer in storage, Mkel and colleagues noted., Several of these nanobodies have shown promise against viruses in cell culture or animal models, including as an intranasal preventive treatment for SARS-CoV-2.. Biochem. Subgroups were analysed exploratorily (e.g., subgroups regarding gender, age, symptom severity, etc.). Zapor, M. Persistent detection and infectious potential of SARS-CoV-2 virus in clinical specimens from COVID-19 patients. ISSN 1476-4687 (online) COVID-19 nasal sprays may one day prevent and treat infection - ABC 62, 50937, Cologne, Germany, CEBINA GmbH, Karl-Farkas-Gasse 22, 1030, Vienna, Austria, Eszter Nagy,Valria Szijrt&Gbor Nagy, Department of Structural and Computational Biology, Max F. Perutz Laboratories, University of Vienna, Dr.-Bohr-Gasse 9, 1030, Vienna, Austria, Laboratory of Experimental Immunology, Institute of Virology, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Str. To obtain Chavda, V. P., Baviskar, K. P., Vaghela, D. A., Raut, S. S. & Bedse, A. P. (2023) Nasal sprays for treating COVID-19: A scientific note. Bearing in mind the low number of participants in the current proof-of-concept study, the results still build a promising foundation for a currently running phase III study, during which effects of azelastine nasal spray on symptom severity and progression to severe COVID-19 disease are investigated in a greater patient population. Thus, it should be kept in mind that treatment started at a time point where the peak of viral load had probably passed. PubMed H.G., M.S., and F.K. The first administration of the nasal spray was carried out in the presence of the investigator; products were subsequently self-administered for 11days (treatment phase). Detection of the alpha (B.1.1.7) variant was based on single nucleotide polymorphism analysis for SARS-CoV-2 spike gene mutation N501Y and deletion H69/V70. Patients aged 18 to 60years were eligible to participate if tested positive for SARS-CoV-2 in a Corona test centre by PCR test within 48h prior to inclusion and had to quarantine at home due to instructions of the local health authority. March 31, 2023 - An antiviral therapy in early development has the potential to prevent COVID-19 infections when given as a nasal spray as little as 4 hours before exposure. Early intervention with azelastine nasal spray may reduce viral load in SARS-CoV-2 infected patients, https://doi.org/10.1038/s41598-023-32546-z. Recent publications indicating that in vitro infectivity correlates with high virus concentrations (Ct25) in nasal swabs28,29,30 underline the importance of analysis of this subset population. Levine-Tiefenbrun, M. et al. All methods were carried out in accordance with relevant guidelines, and the principles of Good Clinical Practice and the Declaration of Helsinki were adhered to. Of note, the known bitter taste of azelastine was only negatively reported by a single patient, and compliance between treatment groups was comparable (meanSD: 97 0.129.7% compliance), thus indicating that the taste did not negatively influence treatment adherence. We are aware that this limited the capture of COVID-19 specific issues as questions were not specifically aimed for COVID-19 patients. Patients were visited and tested at home on regular basis by the investigators, physicians specialised in otorhinolaryngology, medical hygiene, or general medicine. Correspondence to By blocking that access, compounds that target TMPRSS2 have the potential to be effective against both current and future variants.