Efficacy and Safety of Indomethacin in Covid -19 patients

Rajan, Rajesh; Purna, P.; Vijayaragavan, Sivakumar; Kalavakollu, Ravi Teja; Gaidhane, Shilpa; Kumar, R. Suresh

doi:10.1101/2020.12.14.20245266

Cited by 9 publications

(12 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The results are similar to our earlier study based on propensity score matching [27]. The median time for becoming afebrile, cough reduction and myalgia relief in the indomethacin arm was four and three and four days respectively.…”

Section: Discussionsupporting

confidence: 89%

See 1 more Smart Citation

Indomethacin Use for Mild & Moderate hospitalised Covid-19 patients: An open label randomized clinical trial

Rajan

Surapaneni²,

Sukumaran³

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

Background Indomethacin has shown to be a broad spectrum anti-viral agent apart from it being a non-steroidal anti-inflammatory drug (NSAID). This randomized clinical trial in a hospital setting is to evaluate the efficacy and safety of this drug in RT-PCR positive Covid patients. Materials and Methods RT-PCR positive Covid-19 patients, who gave the consent for the trial, were allotted to a control, or case, arm based on block randomization procedure. The control arm received the standard care consisting of paracetamol, ivermectin and other adjuvant therapy. The case arm had indomethacin instead of paracetamol, retaining the other medications. The endpoint was the development of hypoxia/desaturation. Secondary endpoints were time to become afebrile and time to resolution of cough and myalgia. The results of 210 patients were available at this point, with 102 patients in the indomethacin arm and 108 in the paracetamol arm. The complete patient profile along with everyday clinical parameters were monitored. Blood chemistry at the time of admission and discharge were also carried out. Results As no one required high-flow oxygen, desaturation with an SpO2 level of 93 and below was considered an important goal. In the indomethacin group, no one out of the 102 patients developed desaturation. On the other hand, 20 of the 108 patients in the paracetamol arm developed desaturation. Patients who received indomethacin also experienced more rapid symptomatic relief compared to those in the paracetamol arm, with most symptoms disappearing in half the time. A total of 56 patients out of 108 in the paracetamol arm had fever on the seventh day, while no one recorded fever in the indomethacin arm. No adverse event was reported in either arms. A fourteenth day follow up revealed that the paracetamol arm patients had several discomforts including myalgia, joint pain and tiredness while the indomethacin arm patients complained only of tiredness. Conclusion Indomethacin is a safe and effective drug for the treatment of mild and moderate Covid-19 patients.

show abstract

Section: Discussionsupporting

confidence: 89%

“…Rajan et al [21] conducted one of the first indomethacin trials. Using the data from an open-label single-arm data for indomethacin, they showed the effect of indomethacin as a treatment option by matching propensity score with retrospectively collected data on paracetamol.…”

Section: Introductionmentioning

confidence: 99%

Indomethacin Use for Mild & Moderate hospitalised Covid-19 patients: An open label randomized clinical trial

Rajan

Surapaneni²,

Sukumaran³

et al. 2021

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…Notably, there is evidence that aspirin may reduce plasma levels of pro-inflammatory cytokines (37), and lower the risk of in-hospital mortality in a large cohort of patients hospitalized with COVID-19 (38), supporting the use of this drug in the early stages of COVID-19 at home when needed. In the future, other NSAIDs, such as indomethacin, which also lowers IL-6 in SARS-CoV-2 patients (39), could be proposed as an alternative treatment for early COVID-19 symptoms at home, as anticipated by a recent small Indian study (40).…”

Section: Discussionmentioning

confidence: 99%

A HOME-TREATMENT ALGORITHM BASED ON ANTI-INFLAMMATORY DRUGS TO PREVENT HOSPITALIZATION OF PATIENTS WITH EARLY COVID-19: A MATCHED-COHORT STUDY (COVER 2)

Consolaro

Suter

Rubis

et al. 2021

Preprint

View full text Add to dashboard Cite

Background and Aim: While considerable success has been achieved in the management of patients hospitalized with severe coronavirus disease 2019 (COVID-19), far less progress has been made with early outpatient treatment. We assessed whether the implementation of a home treatment algorithm, designed based upon on a pathophysiologic and pharmacologic rationale, during the initial, mild phase of COVID-19, could effectively reduce hospital admissions. Methods: This fully academic, matched-cohort study evaluated outcomes in 108 consecutive consenting patients with mild COVID-19 managed at home by their family doctors from January 2021 to May 2021, according to the proposed treatment algorithm and in 108 age-, sex-, and comorbidities-matched patients who were given other therapeutic schedules (ClinicalTrials.gov: NCT04854824). The primary outcome was COVID-19-related hospitalization. Analyses were by intention-to-treat. Results: One (0.9%) patient in the recommended cohort and 12 (11.1%) in the control cohort were admitted to hospital (P=0.0136). The proposed algorithm reduced, by 85%, the cumulative length of hospital stays (from 141 to 19 days) and related costs (from Euro 60.316 to Euro 9.058). Only 9.8 patients needed to be treated with the recommended algorithm to prevent one hospitalization event. The rate of resolution of major symptoms was numerically, but not significantly, higher in the recommended compared to the control cohort (97.2% versus 93.5%, respectively; P=0.322). Other symptoms lingered in a lower proportion of patients in the recommended than in the control cohort (20.4% versus 63.9%, respectively; P<0.001), and for a shorter period. Conclusion: The adoption of the proposed outpatient treatment algorithm during the early, mild phase of COVID-19 reduced the incidence of subsequent hospitalization and related costs.

show abstract

“…No patients in the second group required mechanical ventilation, and no adverse effects were seen with indomethacin administration. Hence, the authors suggested that indomethacin added to standard care offers more rapid symptomatic relief and prevents progression of pneumonia and therefore, replacement of paracetamol with indomethacin should be taken into consideration [ 22 ].…”

Section: Evidence For Use Of Indomethacin In Covid-19mentioning

confidence: 99%

Indomethacin: an exploratory study of antiviral mechanism and host-pathogen interaction in COVID-19

Shekhar

Kaur

Sarma

et al. 2021

Expert Review of Anti-infective Therapy

View full text Add to dashboard Cite

Introduction COVID-19, a dreadful pandemic that has impacted human life like no other pathogenic invasion, has claimed the lives of over 100 million people. The need for effective treatment strategies is still a subject of intense research considering the rapidly evolving genome and continental diversity. Indomethacin is administered mostly as co-treatment for affected patients as a non-steroidal anti-inflammatory drug (NSAID). However, the underlying mechanism of action is unresolved. This study explores the basal mechanism of indomethacin and potency in alleviating the damage caused by SARS-CoV-2 and discusses the experimental and clinical efficacy in recent studies. Areas covered The literature search and system biology-based network formation were employed to describe the potent effects and risks associated with indomethacin in in-vitro, in-vivo, and clinical studies. This study also highlights the plausible mechanism of antiviral action of indomethacin with its apparent viral protein targets. The SARS-CoV-2 protein, the interacting host proteins, and the effect of indomethacin on this interactome as a standalone treatment or as part of a co-therapy strategy are particularly emphasized using network modeling. Expert opinion Indomethacin has demonstrated excellent clinical endpoint characteristics in several studies, and we recommend that it be utilized in the treatment of mild-to-moderate COVID patients.

show abstract

Efficacy and Safety of Indomethacin in Covid -19 patients

Cited by 9 publications

References 23 publications

Indomethacin Use for Mild & Moderate hospitalised Covid-19 patients: An open label randomized clinical trial

Indomethacin Use for Mild & Moderate hospitalised Covid-19 patients: An open label randomized clinical trial

A HOME-TREATMENT ALGORITHM BASED ON ANTI-INFLAMMATORY DRUGS TO PREVENT HOSPITALIZATION OF PATIENTS WITH EARLY COVID-19: A MATCHED-COHORT STUDY (COVER 2)

Indomethacin: an exploratory study of antiviral mechanism and host-pathogen interaction in COVID-19

Contact Info

Product

Resources

About