The clinical benefit of prostacyclin treatment in mechanically ventilated patients with SARS-CoV-2 infection is not attributed to anti-inflammatory effects
In brief
Iloprost shows no impact on cytokine levels in ventilated COVID-19 patients
In a post-hoc analysis of 80 mechanically ventilated COVID-19 patients with endotheliopathy, a 72-hour iloprost infusion did not alter any of the 54 measured inflammatory or T-cell cytokines compared with placebo. The result suggests the drug's clinical benefit is unrelated to anti-inflammatory effects, highlighting the need to target patient selection and combine therapies.
- Journal
- Cytokine (Q1)
- Published
- 3 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Martin Vigstedt, Sarah McGarrity, Peter Søe-Jensen, Morten H Bestle, Niels E Clausen, Klaus T Kristiansen, et al.
- PMID
- 42691796
- DOI
- 10.1016/j.cyto.2026.157207
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (top studies of the week, 1 November 2026): Iloprost in ventilated COVID-19 patients
Abstract
BACKGROUND: Treatment with the synthetic prostacyclin analog iloprost has been shown to attenuate endothelial glycocalyx shedding and organ failure in patients with critical Covid-19. The treatment is currently being investigated in a broader setting of patients with acute respiratory failure. We here investigated the effect on inflammatory and T-cell-derived cytokine and growth-factor responses in patients with critical Covid-19. METHODS: Post-hoc analysis of a randomized controlled trial (n = 80) in mechanically ventilated patients with SARS-CoV-2 infection and concomitant endotheliopathy, defined as soluble thrombomodulin plasma-levels ≥4 ng/mL. Patients received 72 h iloprost infusion (1 ng/kg/min) or placebo. Blood samples were collected at baseline and 24 h after inclusion. Fifty-four cytokines and growth factors, distributed into six biomarker classes, were measured using the Meso Scale Discovery V-PLEX platform. RESULTS: Iloprost treatment, compared with placebo, did not result in statistically significant changes of any of the fifty-four measured biomarkers at 24 h, when adjusting for multiple testing. Likewise, linear mixed-effects models did not identify significant effects of iloprost on any of the six predefined biomarker classes at 24 h. CONCLUSIONS: In mechanically ventilated patients with SARS-CoV-2 infection and endotheliopathy, iloprost treatment had no detectable effect on inflammatory and T-cell-derived cytokine and growth-factor responses. The findings corroborate that the clinical benefit of iloprost is not attributed to anti-inflammatory effects. We suggest that future studies focus on patient selection for targeted treatment, and on combined treatment with anti-inflammatory and endothelium-stabilizing interventions, in patients with respiratory failure, hyperinflammation, and endotheliopathy.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.