Individual patient data meta-analysis and systematic review evaluating camostat mesilate to treat COVID-19

Why clinicians should know about it

• Picked for Infectious Diseases (top studies of the week, 19 July 2026).
• Picked for Microbiology (medical) (top studies of the week, 19 July 2026).
• Picked for Radiology, Radiation Oncology, Nuclear Medicine, Medical Physics and Imaging (top studies of the week, 19 July 2026).

Abstract

BACKGROUND: In the COVID-19 pandemic, several phase II and III randomized trials were launched to evaluate the effectiveness of camostat, an orally administered TMPRSS2 inhibitor previously approved for other indications, for treating SARS-CoV-2 infections. Owing to the rapidly changing landscape during the pandemic, many of these trials were unable to reach completion. Further, methods for synthesizing trials that were launched and not completed were critical. METHODS: This systematic review aimed to consolidate global evidence by identifying placebo controlled, randomized trials of camostat and analyzing their collective clinical and virologic impact on SARS-CoV-2 through an individual patient data meta-analysis (IPDMA). We harmonized data from the studies and utilized Bayesian statistical models to assess virologic outcomes (measured by the rate of change in viral shedding) and clinical outcomes (based on the time to the first of two consecutive symptom-free days), adjusting for age and sex. RESULTS: The IPDMA incorporated data from six countries, totaling 431 patients across the studies; 118 patients contributed data for the primary virologic outcome and 240 for the clinical symptom outcome. Camostat did not improve the rate of change in viral load (difference in rate of change = 0.11 Ct value/day higher, 95% credible interval 2.04 lower to 2.23 higher) or time to symptom resolution (hazard ratio = 0.87, 95% credible interval 0.51, 1.55) when compared to placebo. CONCLUSIONS: Despite its theoretically promising mode of action, camostat did not demonstrate a statistically significant virologic or clinical benefit in treating COVID-19, highlighting the complexity of drug repurposing in emergency health situations.

Abstract as published, via PubMed.