The search for novel therapies to address the ongoing coronavirus (COVID-19) pandemic is ongoing. No proven therapies have been identified to prevent progression of the virus. Preliminary data suggest that inhaled nitric oxide (iNO) could have benefit in preventing viral progression and reducing reliance on supplemental oxygen and ventilator support. Expanded access allows for iNO to be delivered via the portable INOpulse delivery system for the treatment of COVID-19.
NO is a naturally produced molecule that is critical to the immune response to defend against
pathogens and infections. In vitro studies have shown that NO inhibits the replication of
severe acute respiratory syndrome-related coronavirus (SARS-CoV) and improves survival for
cells infected with SARS-CoV. Additionally, in a clinical study of patients infected with
SARS-CoV, iNO demonstrated improvements in arterial oxygenation, a reduction in ventilation
support and an improvement in lung infiltrates observed on chest radiography. Based on the
genetic similarities between the two coronaviruses, the data in SARS-CoV support the
potential for iNO to provide meaningful benefit for patients infected with COVID-19.
The clinical spectrum of the COVID-19 infection ranges from mild signs of upper respiratory
tract infection to severe pneumonia and death. Preventing disease progression in patients
with mild or moderate disease would improve morbidity/mortality and significantly reduce the
impact on limited healthcare resources.
Expanded access allows for iNO to be delivered via the INOpulse delivery system for the
treatment of COVID-19. INOpulse technology provides targeted pulsatile delivery of iNO via
portable INOpulse delivery system.
Drug: iNO (inhaled nitric oxide) delivered via the INOpulse Delivery System
Patients will be treated by means of an INOpulse device and cannula. The active study drug, nitric oxide for inhalation (iNO), will be provided in size 0.074 liter aluminum cartridge at a concentration of 6.0 mg/L (4880 ppm).
1. Signed Informed Consent Form (and assent as appropriate) prior to the initiation of
any study mandated procedures or assessments.
2. At least 18 years old
3. Patients with proven or high suspicion of SARS-CoV-2 infection and on supplemental
oxygen ≤ 10 L/minute
4. Suspected or proven pneumonia on chest imaging
5. Female patients of childbearing potential must have a negative pre-treatment pregnancy
test (serum or urine). All female patients should take adequate precaution to avoid
6. Willing and able to comply with treatment schedule and study procedures.
1. Participating in any other clinical trial of an experimental treatment for COVID-19
2. Gas exchange and ventilation requiring the use of any continuous positive airway
pressure (CPAP), or any system of Non Invasive Ventilation (NIV), with Positive
End-Expiratory Pressure (PEEP) ≤ 10 cmH2O prior to initiation of iNO
3. Pregnancy, or positive pregnancy test in a pre-dose examination
4. Open tracheostomy
5. Clinical contra-indication, as deemed by the attending physician
6. Use of a nitric oxide donor agent such as nitroglycerin or drugs known to increase
methemoglobin such as lidocaine, prilocaine, benzocaine or dapsone at screening
7. Known history or clinical evidence of heart failure, left ventricular dysfunction
(LVEF < 40 %)
8. Patients reporting hemoptysis
Ashika Ahmed, MD, Study Director