Implications for Systemic Approaches to COVID-19: Effect Sizes of Remdesivir, Tocilizumab, Melatonin, Vitamin D3, and Meditation

Abstract

Introduction COVID-19 poses a chronic threat to inflammatory systems, reinforcing the need for efficient anti-inflammatory strategies. The purpose of this review and analysis was to determine the efficacy of various interventions upon the inflammatory markers most affected by COVID-19. The focus was on the markers associated with COVID-19, not the etiology of the virus itself. Methods Based on 27 reviewed papers, information was extracted on the effects of COVID-19 upon inflammatory markers, then the effects of standard treatments (Remdesivir, Tocilizumab) and adjunctive interventions (vitamin D 3 , melatonin, and meditation) were extracted for those markers. These data were used to approximate effect sizes for the disease or interventions via standardized mean differences (SMD). Results The data that were available indicated that adjunctive interventions affected 68.4% of the inflammatory markers impacted by COVID-19, while standard pharmaceutical medication affected 26.3%. Discussion Nonstandard adjunctive care appeared to have comparable or superior effects in comparison to Remdesivir and Tocilizumab on the inflammatory markers most impacted by COVID-19. Alongside standards of care, melatonin, vitamin D 3 , and meditation should be considered for treatment of SARS-COV-2 infection and COVID-19 disease.

Evaluating Risk: Benefit Ratio of Fat-Soluble Vitamin Supplementation to SARS-CoV-2-Infected Autoimmune and Cancer Patients: Do Vitamin–Drug Interactions Exist?

“…Vitamin D and immunomodulatory agents such as monoclonal antibodies and some antiviral drugs might hold a possible synergistic effect in restoring the CYP450 enzymes [ 205 ]. This goes in line with a study that concluded that combinations of vitamin D and remdesivir, enhanced treatment results in the fight against COVID-19 infection [ 208 ]. Furthermore, a study demonstrated that the use of monoclonal antibodies as anakinra, infliximab, canakinumab, sarilumab, and tocilizumab restored CYP450 enzyme levels back to normal [ 205 ].…”

Melatonin: highlighting its use as a potential treatment for SARS-CoV-2 infection

“…Yet, no organization/agency has proposed the use of melatonin even though it is much less expensive (sometimes a 100-fold less costly than the proposed prescription medications), and based on the outcomes of recent published trials [95,96], it has efficacy in treating this condition. After an analysis of 27 publications related to the ability of drugs to successfully treat COVID-19, the authors concluded that melatonin is at least twice as effective as remdesivir or tocilizumab in reducing the inflammatory markers of a coronavirus 2019 infection [132]. Both remdesivir (Veklury) and tocilizumab (Actemra) are FDA authorized for use to treat select COVID patients suffering with a severe infection; both drugs have notable side effects and are given intravenously [133,134].…”

“…This applies especially to impoverished regions of the world where the populace has fewer financial resources to devote to the treatment of this disease and where health care is not readily available. Additionally, although this paper considers melatonin as a sole treatment for SARS-CoV-2 infections, it has also been suggested as a co-treatment with vaccines to improve their efficacy [15,[142][143][144] and in combination with other drugs [132]; this latter suggestion would be especially applicable when the medications have different but complimentary mechanisms of action to those of melatonin. Finally, to avoid or to reduce the likelihood of pervasive viral infections (e.g., by the highly deadly zoonotic Nipah virus currently invading India or the Omicron variation of SARS-CoV-2)) in the future, the profession should be more proactive as opposed to being reactive.…”

The potential role of ischaemia–reperfusion injury in chronic, relapsing diseases such as rheumatoid arthritis, Long COVID, and ME/CFS: evidence, mechanisms, and therapeutic implications

“…There is little doubt that many individuals may be deficient in their dietary supply of one or more vitamins [ 979 ]. In particular, there is evidence for the importance of vitamins B 12 [ 980–983 ], D 3 [ 906 , 983–986 ], and K 2 [ 987–990 ] in benefitting outcome from acute COVID. However, in some cases where ‘vitamin D’ is not explicitly measured as D 3 the evidence is equivocal [ 991–993 ].…”