A Review of the Potential Roles of Antioxidant and Anti-Inflammatory Pharmacological Approaches for the Management of Mild-to-Moderate Symptomatic COVID-19

Abstract

In the past 2 years, the coronavirus disease 2019 (COVID-19) pandemic has driven investigational studies and controlled clinical trials on antiviral treatments and vaccines that have undergone regulatory approval. Now that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its variants may become endemic over time, there remains a need to identify drugs that treat the symptoms of COVID-19 and prevent progression toward severe cases, hospitalization, and death. Understanding the molecular mechanisms of SARS-CoV-2 infection is extremely important for the development of effective therapies against COVID-19. This review outlines the key pathways involved in the host response to SARS-CoV-2 infection and discusses the potential role of antioxidant and anti-inflammatory pharmacological approaches for the management of early mild-to-moderate COVID-19, using the examples of combined indomethacin, low-dose aspirin, omeprazole, hesperidin, quercetin, and vitamin C. The pharmacological targets of these substances are described here for their possible synergism in counteracting SARS-CoV-2 replication and progression of the infection from the upper respiratory airways to the blood, avoiding vascular complications and cytokine and bradykinin storms.

May the concurrent use of indomethacin and an antioxidant in the SARS‐CoV‐2 infection treatment induce an exacerbation of COVID‐19?

“…| 4061 be crucial to ensure their prompt recovery, without simplifying the therapeutic protocol with nature-derived compounds usually considered harmless, with a naïve attitude. 2 The correct pharmacology of COVID-19 must consider the complex etiopathogenesis of the SARS-CoV-2 infection, which is quite far from a simple, easily addressable flu infection.…”

“…To the Editor, Apparently, associating vitamins and plant-derived nutraceuticals with a conventional anti-inflammatory therapy against coronavirus disease 2019 (COVID-19) should deal to an improvement in the pharmacological effectiveness and in a prompt healing from the illness, at least according to some recent reports. 1,2 Yet, none of these studies, has dissected the effect of nutraceuticals from the one from a pharmaceutics, to better investigate the biochemical effect of plant-derived bioactive substances in the development of the COVID-19 pathogenesis.…”

“…Moreover, recent literature has reported that the effect of some vitamins, such as vitamin C, 2 is not completely harmless on the effect of some anti‐inflammatory drugs, such as indomethacin. 3 …”

“…Data on the gastrointestinal function of patients undergoing a merged NSAID + antioxidant therapy or treated with NSAIDs while they are daily up‐taking since long time nutraceutical formulas should be crucial to ensure their prompt recovery, without simplifying the therapeutic protocol with nature‐derived compounds usually considered harmless, with a naïve attitude. 2 …”

Potential Therapeutic Approach of Melatonin against Omicron and Some Other Variants of SARS-CoV-2

“…It has been used to treat sleep disorders, atherosclerosis, respiratory diseases, and viral infections [ 11 ]. Although it does not have direct virucidal effects on COVID-19 and its Omicron (B.529) variant, it demonstrates anti-viral actions based on its anti-inflammation, anti-oxidation, and immune-enhancing properties [ 21 ]. It is clearly documented from the chemical point of view that melatonin is highly specified as an antioxidative agent.…”