The Efficacy and Safety of Nafamostat Mesylate in the Treatment of COVID-19: A Meta-Analysis

Nafamostat mesylate, a synthetic serine protease inhibitor, has demonstrated early antiviral activity against SARS-CoV-2 and anticoagulant properties that may be beneficial in COVID-19. We conducted a meta-analysis evaluating the efficacy and safety of nafamostat mesylate for COVID-19 treatment. PubMed, Embase, Cochrane Library, Scopus, Web of Science, medRxiv and bioRxiv were searched up to July 2023 for studies comparing outcomes between nafamostat mesylate treatment and no nafamostat mesylate treatment in COVID-19 patients. Mortality, disease progression and adverse events were analyzed. Six studies involving 16,195 patients were included. Meta-analysis revealed no significant difference in mortality (OR=0.88, 95%CI: 0.20-3.75, P=0.86) or disease progression (OR=2.76, 95%CI: 0.31-24.68, P=0.36) between groups. However, nafamostat mesylate was associated with increased hyperkalemia risk (OR=7.15, 95%CI: 2.66 to 19.24, P<0.0001). Nafamostat mesylate does not improve mortality or morbidity in hospitalized COVID-19 patients compared to no nafamostat mesylate treatment. The significant hyperkalemia risk is a serious concern requiring monitoring and preventative measures. Further research is needed in different COVID-19 populations.