AYUSH interventions for COVID-19 - a living systematic review and meta-analysis [First report]

Abstract

BackgroundIn India, alternative and complementary therapies (AYUSH medicines) are utilized in COVID-19 management extensively. This study was planned to assess the prophylactic and therapeutic effectiveness of AYUSH interventions on COVID-19 through a living systematic review and meta-analysis approach.MethodsDifferent databases like Pubmed; the Cochrane central register of controlled trials; WHO COVID-19 database; the central trial registry - India; Digital Helpline for Ayurveda Research Articles and AYUSH research portal, and pre-print repositories were searched with appropriate search strategies from 1st December 2019 to 1st April 2021. Randomized clinical trials, Non-Randomized Studies of Interventions conducted on the AYUSH system of medicine aimed at either prevention or treatment were included. Clinical improvement, WHO ordinal scale, viral clearance, incidences of COVID-19 infection, and mortality will be considered as primary outcomes. Secondary outcomes will be the use of O2 therapy or mechanical ventilator, admission to high dependency unit or emergency unit, duration of hospitalization, the time to symptom resolution, and adverse events. Data will be synthesized, and the risk of bias will be assessed with RevMan 5.4 tool. The risk of bias of included studies was evaluated by RoB-2 and ROBINS-I tools, and the certainty of the evidence ranked through the GRADE approach.ResultsOf 2,977 studies retrieved, only 12 studies were included in the systematic review. In a moderately certain trial on standalone AYUSH versus Standard care, viral clearance was hastened in the standalone AYUSH group. Add-on AYUSH had shortened time to symptom resolution by about two days compared to standard care with moderate certainty. However, Add-on AYUSH intervention may hasten clinical improvements but has little to no effects on viral clearance. AYUSH prophylaxis may reduce the risk of COVID-19 with low certainty.ConclusionRational use of integrated or standalone AYUSH interventions in mild to moderate COVID-19 patients may provide therapeutic benefits. The effect of AYUSH prophylaxis in the reduction of incidence of COVID-19 in high-risk populations is uncertain. The effect estimates may be changed with additional evidence in upcoming updates.

Impact of Ayush Alternative Medicine Interventions in the COVID-19 Pandemic

“…Viral Clearance: Add-on AYUSH Interventions vs. Standard Care Viral clearance was determined using polymerase chain reaction cutoff points in three randomized controlled trials (n=163) of supplementary AYUSH interventions [12]. The proportion of patients who received either AYUSH supplements or conventional therapy did not change significantly between the two groups [RR 1.19 (95% CI: 0.59 to 2.42)] or at 99 cases per 1,000 (from 214 reduced to 741 more).…”