• Adeleh Sahebnasagh, Fatemeh Saghafi, Mohammadreza Safdari, Masoud Khataminia, Afsaneh Sadremomtaz, Zeinab Talaei, Hassan Rezai Ghaleno, Mahdi Bagheri, Solomon Habtemariam, and Razieh Avan.
• Department of Internal Medicine, Clinical Research Center, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran.
• J Clin Pharm Ther. 2020 Dec 1; 45 (6): 1515-1519.

What Is Known And ObjectiveThis article summarizes the effects of sivelestat on acute lung injury/acute respiratory distress syndrome (ALI/ARDS) or ARDS with coagulopathy, both of which are frequently seen in patients with COVID-19.CommentCOVID-19 patients are more susceptible to thromboembolic events, including disseminated intravascular coagulation (DIC). Various studies have emphasized the role of neutrophil elastase (NE) in the development of DIC in patients with ARDS and sepsis. It has been shown that NE inhibition by sivelestat mitigates ALI through amelioration of injuries in alveolar epithelium and vascular endothelium, as well as reversing the neutrophil-mediated increased vascular permeability.What Is New And ConclusionsSivelestat, a selective NE inhibitor, has not been evaluated for its possible therapeutic effects against SARS-CoV-2 infection. Based on its promising beneficial effects in underlying complications of COVID-19, sivelestat could be considered as a promising modality for better management of COVID-19-induced ALI/ARDS or coagulopathy.© 2020 John Wiley & Sons Ltd.

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