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@CovidAnalysis

COVID-19 early treatment: real-time analysis of 4,713 studies

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Analysis of 94 COVID-19 early treatments, approvals in 118 countries, database of 7,998 treatments  
Recently added (more..)  Paxlovid  Casirivimab/imdevimab  Astodrimer Sodium
Mozaffari
Retrospective 788,238 hospitalized COVID-19 patients in the US, showing a very high prevalence of drug-drug interactions with paxlovid, with higher..
Ryu
In Vitro and mouse study showing that fibrin drives thromboinflammation and neuropathology in COVID-19. Fibrin binds to the SARS-CoV-2 spike protein..
Shah
100 patients casirivimab/imdevimab late treatment: 14% higher mortality (p=1), no change in ventilation (p=1), 14% lower ICU admission (p=0.68), and 4% lower need for oxygen therapy (p=1)
Winchester
197 patient astodrimer sodium early treatment RCT: 19% improved recovery (p=0.41) and 24% improved viral clearance (p=0.3)
$0 $1,000 $2,000+ -25+% 0% 25% 50% Treatment cost (US$) Efficacy vs. cost for COVID-19 treatments Donidalorsen -151% >$2,000 Glenzocimab -60% >$2,000 PPIs -46% BMS mAbs -36% >$2,000 Acetaminophen -28% Lufotrelvir >$2,000 Trimodulin >$2,000 Losartan Sargramostim >$2,000 Cannabidiol Vitamin B9 Conv. Plasma $5,000 Remdesivir $3,120 Acebilustat >$2,000 Ibuprofen Aspirin Ambavirumab/r.. Molnupiravir mutagenic/teratogenic Favipiravir Paxlovid Famotidine Vitamin C NAC Vilobelimab $6,350 Sotrovimab $2,100 Colchicine HCQ Zinc Budesonide Probiotics Sleep Antiandro.. Metformin Nitric Oxide Azvudine Bebtelovimab Vitamin A Vitamin D Sunlight H. Peroxide Fluvox. H1RAs Exercise Curcumin Tixagevimab/c.. N. Sativa NaHCO₃ Casirivimab/i.. $2,100 Melatonin Ensovibep >$2,000 Bamlanivimab/e.. pH+ Quercetin Diet PVP-I Thermotherapy Ivermectin Regdanvimab $2,100 Lifestyle / free No prescription Prescription required High-cost Lowerrisk Higherrisk c19early.org September 2024 COVID-19 involves the interplay of 50+ host/viral proteins/factors, modulated by many treatments. 0.6% of 7,000+proposed treatments show efficacy with ≥3 studies.Protocols combine treatments, none are 100% effective.c19early analyzes over 4,700 studies for 94 treatments.
$0 $1,000 $2,000+ -20+% 0% 25% 50% Treatment cost (US$) Efficacy vs. cost for COVID-19 treatments Donidalorsen -151% Glenzocimab -60% PPIs -46% BMS mAbs -36% Acetaminophen -28% Lufotrelvir -22% Trimodulin Losartan Sargramostim CBD Vit. B9 C. Plasma Remdesivir Acebilustat Ibuprofen Aspirin Ambavirumab/r.. Molnupiravir mutagenic/teratogenic Favipiravir Paxlovid Famotidine Vitamin C NAC Vilobelimab Sotrovimab Colchicine HCQ Zinc Budesonide Probiotics Sleep Antiandro.. Metformin Nitric Oxide Azvudine Bebtelovimab Vitamin A Vitamin D Sunlight H. Peroxide Fluvox. H1RAs Exercise Curcumin Tixagevimab/c.. N. Sativa NaHCO₃ Casirivim.. Melatonin Ensovibep Bamlan.. pH+ Quercetin Diet PVP-I Thermotherapy Ivermectin Regdanvimab Lifestyle / free No prescription Prescription required High-cost Lowerrisk Higherrisk c19early.org September 2024 COVID-19 involves the interplay of50+ host/viral proteins/factors.0.6% of 7,000+ treatments showefficacy. Protocols combinetreatments. c19early analyzes4,700+ studies for 94 treatments.
Azvudine Evusheld Sodium Bicarbonate Paxlovid Regdanvimab Vitamin B12 Sunlight Phthalocyanine Montelukast Alkalinization Fluvoxamine Famotidine Molnupiravir Quercetin Diet Bamlanivimab/e.. Hydrogen Peroxide Budesonide Probiotics Casirivimab/i.. Sleep Curcumin Povidone-Iodine Nigella Sativa Melatonin Antihistamine H1RAs Acetaminophen ↑risk Exercise Vitamin D Antiandrogens Vitamin C PPIs ↑risk Colchicine Ivermectin Metformin Zinc HCQ 2020 2021 2023 2024 Pooled outcomes Specific outcome RCT pooled RCT specific Statistically significant ≥10% improvement ≥3 studies c19early.org September 2024 Time when COVID-19 studies showed efficacy
Azvudine Evusheld Sodium Bicarb.. Paxlovid Regdanvimab Vitamin B12 Sunlight Phthalocyanine Montelukast Alkalinization Fluvoxamine Famotidine Molnupiravir Quercetin Diet Bamlanivimab/e.. Hydrogen Peroxide Budesonide Probiotics Casirivimab/i.. Sleep Curcumin Povidone-Iodine Nigella Sativa Melatonin H1RAs Acetaminophen ↑risk Exercise Vitamin D Antiandrogens Vitamin C PPIs ↑risk Colchicine Ivermectin Metformin Zinc HCQ 2020 2021 2023 2024 Pooled outcomes Specific outcome RCT pooled RCT specific Statistically significant ≥10% improvement ≥3 studies c19early.org September 2024 Time when COVID-19 studies showed efficacy
Timeline for when studies showed efficacy - details and limitations. 0.6% of treatments show efficacy.
Top journals that accept positive studies for low cost treatments: PLOS ONE, Nutrients, International Journal of Infectious Diseases, Scientific Reports, Journal of Clinical Medicine, Frontiers in Pharmacology, more...
September 2024
c19early.org
Cost per life saved from NNT in
studies to date
Melatonin
9
48%
  $8
Vitamin D
69
36%
  $11
Alkalinization
8
46%
  $11
Zinc
21
30%
  $15
Vitamin C
43
19%
  $18
Colchicine
43
28%
  $26
Ivermectin
53
47%
  $26
HCQ
247
26%
  $27
Aspirin
64
11%
  $33
Vitamin A
5
30%
  $45
Curcumin
8
63%
  $59
Famotidine
21
18%
  $94
Quercetin
5
61%
  $127
Metformin
66
35%
  $133
Probiotics
9
60%
  $145
Antiandrogens
32
37%
  $179
Nigella Sativa
5
57%
  $187
Fluvoxamine
10
44%
  $411
Budesonide
12
26%
  $574
Azvudine
16
36%
  $1,248
Favipiravir
40
11%
  $1,935
Tixagev../c..
10
42%
  $74,506
Regdanvimab
7
63%
  $139,860
Paxlovid
36
25%
  $206,705
Bamlaniv../e..
13
54%
  $301,549
Sotrovimab
11
49%
  $355,740
Casirivimab/..
10
26%
  $452,469
Bebtelovimab
4
60%
  $737,601
Remdesivir
64
2%
  $1,558,440
Molnupiravir
22
17%
  $2,400,867
Conv. Plasma
51
-1%
N/A
Acetaminophen
14
-24%
N/A
PPIs
20
-40%
N/A
Brensocatib
1
-41%
N/A
Treatment cost times median NNT - details and limitations. 0.6% of treatments show efficacy.
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All clinical results for selected treatments. 0.6% of treatments show efficacy.
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0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Iota-carragee.. 80% [22-95%] 1 $1 394 very limited data Cost Studies Patients Improvement Relative Risk Chlorhexidine 79% [66-87%] 3 $1 509 limited data Proxalutamide 78% [70-83%] 4 $500 1,953 limited data Indomethacin 74% [-20-94%] 4 $5 605 limited data Cetylpyridin.. 68% [-620-99%] 1 $1 23 very limited data Regdanvimab 63% [51-71%] 11 $2,100 7,430 Ivermectin 60% [52-67%] 105 $1 220,423 Chlorpheniram.. 56% [46-64%] 3 $5 806 very limited data Thermotherapy 56% [9-78%] 4 $0 217 very limited data Povidone-Iod.. 51% [38-61%] 21 $1 3,249 Diet 50% [41-58%] 28 $0 693,236 Quercetin 49% [21-68%] 11 $5 1,436 Alkalinization 49% [36-59%] 14 $1 6,383 HH-120 49% [-60-84%] 2 $500 345 very limited data Bemnifosbuvir 47% [-57-82%] 3 $500 359 very limited data Bamlaniv../e.. 47% [25-62%] 21 $1,250 35,320 variant dependent Ensovibep 46% [-173-89%] 2 $2,100 885 limited data Adintrevimab 43% [-169-88%] 2 $2,100 2,483 intramuscular Melatonin 43% [30-54%] 18 $1 14,301 Bromhexine 43% [-5-69%] 7 $5 875 very limited data Casirivimab/i.. 43% [24-57%] 31 $2,100 59,449 variant dependent Sodium Bicarb.. 43% [24-57%] 7 $1 1,092 Nigella Sativa 43% [24-57%] 14 $5 3,333 Tixagev../c.. 43% [26-56%] 17 $855 29,530 variant dependent Propolis 41% [-13-69%] 3 $1 410 very limited data Curcumin 41% [30-51%] 27 $5 14,886 Exercise 39% [34-44%] 66 $0 1,936,481 H1RAs 39% [23-52%] 15 $5 71,705 Fluvoxamine 39% [21-52%] 21 $4 38,283 Montelukast 39% [14-56%] 9 $2 2,943 limited data Hydrogen Per.. 38% [5-59%] 7 $1 835 very limited data Phthalocyanine 38% [20-51%] 4 $5 5,245 Xiannuoxin 38% [-46-73%] 2 $106 1,027 very limited data Sunlight 37% [22-50%] 5 $0 19,665 Vitamin D 37% [31-42%] 122 $1 195,710 Vitamin A 36% [6-56%] 14 $2 22,297 Nitazoxanide 35% [-8-61%] 14 $4 3,632 Selenium 34% [-40-69%] 4 $1 21,452 Bebtelovimab 34% [-24-65%] 6 $1,200 13,329 intravenous Azvudine 33% [18-44%] 22 $25 12,652 Spironolactone 31% [15-44%] 12 $5 28,019 Nitric Oxide 31% [-1-52%] 12 $11 2,236 Metformin 30% [26-34%] 93 $10 282,079 Antiandrogens 30% [21-38%] 49 $5 120,172 Sleep 30% [22-38%] 15 $0 429,001 Vitamin B12 30% [5-48%] 4 $1 11,407 Probiotics 28% [18-37%] 27 $5 19,448 Budesonide 28% [18-36%] 15 $4 28,194 Zinc 28% [18-36%] 45 $1 55,380 Hydroxychlor.. 28% [24-31%] 419 $1 537,076 Colchicine 27% [18-36%] 56 $1 33,066 Andrographol.. 27% [-8-50%] 7 $5 1,245 Ensitrelvir 26% [-14-52%] 3 $500 1,450 very limited data Sotrovimab 26% [10-39%] 24 $2,100 54,452 variant dependent Vilobelimab 26% [-4-48%] 1 $6,350 368 intravenous N-acetylcys.. 25% [14-35%] 24 $1 26,243 Lactoferrin 24% [-24-53%] 8 $5 1,419 Vitamin C 21% [14-27%] 72 $1 88,913 Leritrelvir 21% [3-35%] 2 $1,000 1,399 very limited data UDCA 18% [9-26%] 18 $15 43,512 Camostat 17% [-3-34%] 15 $1 1,920 Famotidine 17% [8-24%] 30 $5 114,119 Paxlovid 16% [12-20%] 69 $1,390 158,683 independent trials refused Favipiravir 15% [5-24%] 70 $20 34,275 worse w/longer followup Vitamin K 14% [0-25%] 2 $1 7,806 very limited data Molnupiravir 12% [4-20%] 44 $707 151,248 mutagenic/teratogenic Deuremidevir 11% [-1-21%] 2 $112 1,432 very limited data Ambavir../r.. 11% [-154-69%] 3 $1,380 1,531 intravenous Aspirin 11% [5-16%] 74 $1 187,088 Peg.. Lambda 7% [-138-63%] 4 $500 2,143 subcutaneous Ibuprofen 0% [-9-9%] 13 $1 54,707 Acebilustat 0% [-1462-94%] 1 $2,000 120 very limited data Remdesivir -0% [-9-8%] 76 $3,120 202,278 worse w/longer followup Conv. Plasma -1% [-5-3%] 53 $5,000 30,630 intravenous Ravulizumab -5% [-45-24%] 2 $2,000 481 intravenous Vitamin B9 -11% [-47-15%] 11 $1 54,354 Cannabidiol -12% [-86-33%] 8 $25 16,883 Sargramostim -13% [-85-31%] 4 $2,000 870 very limited data Losartan -15% [-127-42%] 5 $5 665 very limited data Trimodulin -17% [-116-37%] 1 $2,000 166 intravenous Lufotrelvir -22% [-198-50%] 1 $2,000 58 intravenous Pacritinib -28% [-210-47%] 1 $2,000 200 very limited data Acetaminoph.. -28% [-41--17%] 27 $1 543,459 BMS mAbs -36% [-492-69%] 1 $2,100 210 subcutaneous Brensocatib -41% [-88--6%] 1 $2,000 404 very limited data PPIs -46% [-68--27%] 37 $5 221,083 Glenzocimab -60% [-236-24%] 1 $2,000 62 intravenous Siltuximab -64% [-252-23%] 1 $2,000 149 intravenous rNAPc2 -65% [-304-32%] 1 $2,000 156 very limited data Emvododstat -132% [-628-26%] 1 $2,000 187 very limited data Goflikicept -135% [-492-7%] 1 $2,000 247 subcutaneous Donidalorsen -151% [-602-11%] 1 $2,000 103 intravenous/subcutaneous Astodrimer So.. -205% [-7302-87%] 1 $10 197 very limited data All studies (pooled effects, all stages) c19early.org September 2024 Favors treatment Favors control
0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Iota-carragee.. 80% 1 very limited data Studies, Improvement Relative Risk Chlorhexidine 79% 3 limited data Proxalutamide 78% 4 limited data Indomethacin 74% 4 limited data Cetylpyridin.. 68% 1 very limited data Regdanvimab 63% 11 Ivermectin 60% 105 Chlorphenira.. 56% 3 very limited data Thermotherapy 56% 4 very limited data Povidone-Iod.. 51% 21 Diet 50% 28 Quercetin 49% 11 Alkalinization 49% 14 HH-120 49% 2 very limited data Bemnifosbuvir 47% 3 very limited data Bamlaniv../e.. 47% 21 variant dependent Ensovibep 46% 2 limited data Adintrevimab 43% 2 intramuscular Melatonin 43% 18 Bromhexine 43% 7 very limited data Casirivimab/.. 43% 31 variant dependent Sodium Bicar.. 43% 7 Nigella Sativa 43% 14 Tixagev../c.. 43% 17 variant dependent Propolis 41% 3 very limited data Curcumin 41% 27 Exercise 39% 66 H1RAs 39% 15 Fluvoxamine 39% 21 Montelukast 39% 9 limited data Hydrogen Per.. 38% 7 very limited data Phthalocyanine 38% 4 Xiannuoxin 38% 2 very limited data Sunlight 37% 5 Vitamin D 37% 122 Vitamin A 36% 14 Nitazoxanide 35% 14 Selenium 34% 4 Bebtelovimab 34% 6 intravenous Azvudine 33% 22 Spironolactone 31% 12 Nitric Oxide 31% 12 Metformin 30% 93 Antiandrogens 30% 49 Sleep 30% 15 Vitamin B12 30% 4 Probiotics 28% 27 Budesonide 28% 15 Zinc 28% 45 Hydroxychlor.. 28% 419 Colchicine 27% 56 Andrographol.. 27% 7 Ensitrelvir 26% 3 very limited data Sotrovimab 26% 24 variant dependent Vilobelimab 26% 1 intravenous N-acetylcys.. 25% 24 Lactoferrin 24% 8 Vitamin C 21% 72 Leritrelvir 21% 2 very limited data UDCA 18% 18 Camostat 17% 15 Famotidine 17% 30 Paxlovid 16% 69 independent trials refused Favipiravir 15% 70 worse w/longer followup Vitamin K 14% 2 very limited data Molnupiravir 12% 44 mutagenic/teratogenic Deuremidevir 11% 2 very limited data Ambavir../r.. 11% 3 intravenous Aspirin 11% 74 Peg.. Lambda 7% 4 subcutaneous Ibuprofen 0% 13 Acebilustat 0% 1 very limited data Remdesivir -0% 76 worse w/longer followup Conv. Plasma -1% 53 intravenous Ravulizumab -5% 2 intravenous Vitamin B9 -11% 11 Cannabidiol -12% 8 Sargramostim -13% 4 very limited data Losartan -15% 5 very limited data Trimodulin -17% 1 intravenous Lufotrelvir -22% 1 intravenous Pacritinib -28% 1 very limited data Acetaminoph.. -28% 27 BMS mAbs -36% 1 subcutaneous Brensocatib -41% 1 very limited data PPIs -46% 37 Glenzocimab -60% 1 intravenous Siltuximab -64% 1 intravenous rNAPc2 -65% 1 very limited data Emvododstat -132% 1 very limited data Goflikicept -135% 1 subcutaneous Donidalorsen -151% 1 intravenous/subcutaneous Astodrimer S.. -205% 1 very limited data All studies (pooled effects, all stages) c19early.org September 2024 Rotate device for details Favors treatment Favors control
Random effects meta-analysis of all studies (pooled effects, all stages). Treatments with ≤3 studies with distinct authors or with <50 control events are shown in grey. Pooled results across all stages and outcomes depend on the distribution of stages and outcomes tested - for example late stage treatment may be less effective and if the majority of studies are late stage this may obscure the efficacy of early treatment. Please see the specific stage and outcome analyses. Protocols typically combine multiple treatments which may be complementary and synergistic, and the SOC in studies often includes other treatments. 0.6% of proposed treatments show efficacy in clinical studies.
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Random effects meta-analysis of early treatment studies (pooled effects). Treatments with ≤3 studies with distinct authors or with <50 control events are shown in grey. Pooled results across all outcomes are affected by the distribution of outcomes tested, please see detail pages for specific outcome analysis. Protocols typically combine multiple treatments which may be complementary and synergistic, and the SOC in studies often includes other treatments. 0.6% of proposed treatments show efficacy in clinical studies.
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Random effects meta-analysis of all mortality results (all stages). Treatments with ≤3 studies with distinct authors or with <25 control events are shown in grey. Pooled results across all stages depend on the distribution of stages tested - for example late stage treatment may be less effective and if the majority of studies are late stage this may obscure the efficacy of early treatment. Please see the specific stage analyses. Protocols typically combine multiple treatments which may be complementary and synergistic, and the SOC in studies often includes other treatments. 0.6% of proposed treatments show efficacy in clinical studies.
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Random effects meta-analysis of early treatment mortality results. Treatments with ≤3 studies with distinct authors or with <25 control events are shown in grey. Protocols typically combine multiple treatments which may be complementary and synergistic, and the SOC in studies often includes other treatments. 0.6% of proposed treatments show efficacy in clinical studies.
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Random effects meta-analysis of prophylaxis studies (pooled effects). Treatments with ≤3 studies with distinct authors or with <50 control events are shown in grey. Pooled results across all outcomes are affected by the distribution of outcomes tested, please see detail pages for specific outcome analysis. Protocols typically combine multiple treatments which may be complementary and synergistic, and the SOC in studies often includes other treatments. 0.6% of proposed treatments show efficacy in clinical studies.
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Random effects meta-analysis of prophylaxis mortality results. Treatments with ≤3 studies with distinct authors or with <25 control events are shown in grey. Protocols typically combine multiple treatments which may be complementary and synergistic, and the SOC in studies often includes other treatments. 0.6% of proposed treatments show efficacy in clinical studies.
LATE TREATMENT
Physician / TeamLocationPatients HospitalizationHosp. MortalityDeath
Dr. David Uip (*) Brazil 2,200 38.6% (850) Ref. 2.5% (54) Ref.
EARLY TREATMENT - 40 physicians/teams
Physician / TeamLocationPatients HospitalizationHosp. ImprovementImp. MortalityDeath ImprovementImp.
Dr. Roberto Alfonso Accinelli
0/360 deaths for treatment within 3 days		 Peru 1,265 0.6% (7) 77.5%
Dr. Mohammed Tarek Alam
patients up to 84 years old		 Bangladesh 100 0.0% (0) 100.0%
Dr. Oluwagbenga Alonge Nigeria 310 0.0% (0) 100.0%
Dr. Raja Bhattacharya
up to 88yo, 81% comorbidities		 India 148 1.4% (2) 44.9%
Dr. Flavio Cadegiani Brazil 3,450 0.1% (4) 99.7% 0.0% (0) 100.0%
Dr. Alessandro Capucci Italy 350 4.6% (16) 88.2%
Dr. Shankara Chetty South Africa 8,000 0.0% (0) 100.0%
Dr. Deborah Chisholm USA 100 0.0% (0) 100.0%
Dr. Ryan Cole USA 400 0.0% (0) 100.0% 0.0% (0) 100.0%
Dr. Marco Cosentino
vs. 3-3.8% mortality during period; earlier treatment better		 Italy 392 6.4% (25) 83.5% 0.3% (1) 89.6%
Dr. Jeff Davis USA 6,000 0.0% (0) 100.0%
Dr. Dhanajay India 500 0.0% (0) 100.0%
Dr. Bryan Tyson & Dr. George Fareed USA 20,000 0.0% (6) 99.9% 0.0% (4) 99.2%
Dr. Raphael Furtado Brazil 170 0.6% (1) 98.5% 0.0% (0) 100.0%
Rabbi Yehoshua Gerzi Israel 860 0.1% (1) 99.7% 0.0% (0) 100.0%
Dr. Heather Gessling USA 1,500 0.1% (1) 97.3%
Dr. Ellen Guimarães Brazil 500 1.6% (8) 95.9% 0.4% (2) 83.7%
Dr. Syed Haider USA 4,000 0.1% (5) 99.7% 0.0% (0) 100.0%
Dr. Mark Hancock USA 24 0.0% (0) 100.0%
Dr. Sabine Hazan USA 1,000 0.0% (0) 100.0%
Dr. Mollie James USA 3,500 1.1% (40) 97.0% 0.0% (1) 98.8%
Dr. Roberta Lacerda Brazil 550 1.5% (8) 96.2% 0.4% (2) 85.2%
Dr. Katarina Lindley USA 100 5.0% (5) 87.1% 0.0% (0) 100.0%
Dr. Ben Marble USA 150,000 0.0% (4) 99.9%
Dr. Edimilson Migowski Brazil 2,000 0.3% (7) 99.1% 0.1% (2) 95.9%
Dr. Abdulrahman Mohana Saudi Arabia 2,733 0.0% (0) 100.0%
Dr. Carlos Nigro Brazil 5,000 0.9% (45) 97.7% 0.5% (23) 81.3%
Dr. Benoit Ochs Luxembourg 800 0.0% (0) 100.0%
Dr. Ortore Italy 240 1.2% (3) 96.8% 0.0% (0) 100.0%
Dr. Valerio Pascua
one death for a patient presenting on the 5th day in need of supplemental oxygen		 Honduras 415 6.3% (26) 83.8% 0.2% (1) 90.2%
Dr. Sebastian Pop Romania 300 0.0% (0) 100.0%
Dr. Brian Proctor USA 869 2.3% (20) 94.0% 0.2% (2) 90.6%
Dr. Anastacio Queiroz Brazil 700 0.0% (0) 100.0%
Dr. Didier Raoult France 8,315 2.6% (214) 93.3% 0.1% (5) 97.6%
Dr. Karin Ried
up to 99yo, 73% comorbidities, av. age 63		 Turkey 237 0.4% (1) 82.8%
Dr. Roman Rozencwaig
patients up to 86 years old		 Canada 80 0.0% (0) 100.0%
Dr. Vipul Shah India 8,000 0.1% (5) 97.5%
Dr. Silvestre Sobrinho Brazil 116 8.6% (10) 77.7% 0.0% (0) 100.0%
Dr. Unknown Brazil 957 1.7% (16) 95.7% 0.2% (2) 91.5%
Dr. Vladimir Zelenko USA 2,200 0.5% (12) 98.6% 0.1% (2) 96.3%
Mean improvement with early treatment protocols 238,381 HospitalizationHosp. 94.4% MortalityDeath 94.9%
Physician results with early treatment protocols compared to no early treatment. These results are subject to selection and ascertainment bias and more accurate analysis requires details of the patient populations and followup, however results are consistently better across many teams, and consistent with the extensive controlled trial evidence that shows a significant reduction in risk with many early treatments, and improved results with the use of multiple treatments in combination.
Paxlovid
Mozaffari
Retrospective 788,238 hospitalized COVID-19 patients in the US, showing a very high prevalence of drug-drug interactions with paxlovid, with higher..
Low
2,524 patients long COVID: 30% higher PASC (p=0.34)
Miscellaneous
Ryu
In Vitro and mouse study showing that fibrin drives thromboinflammation and neuropathology in COVID-19. Fibrin binds to the SARS-CoV-2 spike protein..
Dai
Review of the interplay between airway cilia and coronavirus infection, and the implications for prevention and treatment of respiratory viral..
Casirivimab/imdevimab
Shah
100 patients late treatment: 14% higher mortality (p=1), no change in ventilation (p=1), 14% lower ICU admission (p=0.68), and 4% lower need for oxygen therapy (p=1)
Astodrimer Sodium
Winchester
197 patient early treatment RCT: 19% improved recovery (p=0.41) and 24% improved viral clearance (p=0.3)
Vitamin D
Kow
Meta analysis: 28% lower mortality (p=0.04)
Favipiravir
Hobbs
3,622 patient late treatment RCT: 86% lower mortality (p=0.11), 1% lower combined mortality/hospitalization (p=0.51), and 17% improved recovery (p=0.003)
Shiraki
Reproductive toxicity analysis of antiviral drugs in C. elegans, showing increased incidence of arrested embryos with molnupiravir, favipiravir,..
Montelukast
Zengin
75 patients late treatment: 14% lower mortality (p=1), 90% higher ICU admission (p=0.46), and 3% shorter hospitalization (p=0.81)
HCQ
Brouqui
1,276 patients late treatment: 15% improved viral clearance (p=0.04)
Ursodeoxycholic acid
Moon
74,074 patients prophylaxis PSM: 33% lower severe cases (p=0.04) and 20% fewer cases (p<0.0001)
Molnupiravir
Chen
Analysis of molnupiravir induced liver injury. Molnupiravir treatment may disrupt metabolic homeostasis and cause liver injury by increasing levels..
Shen
In Vitro and Ex Vivo study showing significant potential drug-drug interactions between remdesivir and molnupiravir. Author found that remdesivir..
Shiraki
Reproductive toxicity analysis of antiviral drugs in C. elegans, showing increased incidence of arrested embryos with molnupiravir, favipiravir,..
Remdesivir
Shen
In Vitro and Ex Vivo study showing significant potential drug-drug interactions between remdesivir and molnupiravir. Author found that remdesivir..
Trimodulin
Agafina
166 patient late treatment RCT: 17% higher mortality (p=0.7), 2% lower progression (p=1), and 9% longer ventilation (p=0.62)
Recent studies (see the individual treatment pages for all studies):
Sep 30
 Mozaffari et al., Clinical Therapeutics, doi:10.1016/j.clinthera.2024.08.004 Prevalence of Potential Drug Interactions With Direct-Acting Antivirals for COVID-19 Among Hospitalized Patients
Retrospective 788,238 hospitalized COVID-19 patients in the US, showing a very high prevalence of drug-drug interactions with paxlovid, with higher prevalence for older patients, patients with more comorbidities, and patients at high-risk..
Sep 6
 Winchester et al., Pharmaceutics, doi:10.3390/pharmaceutics16091173 Astodrimer Sodium Nasal Spray versus Placebo in Non-Hospitalised Patients with COVID-19: A Randomised, Double-Blinded, Placebo-Controlled Trial
19% improved recovery (p=0.41) and 24% improved viral clearance (p=0.3). RCT 222 non-hospitalized low risk COVID-19 patients showing lower SARS-CoV-2 viral load, faster viral clearance, and improvements in symptoms, particularly anosmia, with astodrimer sodium nasal spray compared to placebo. The reduction in ..
Sep 3
 Kow et al., Inflammopharmacology, doi:10.1007/s10787-024-01564-2 The impact of vitamin D administration on mortality in COVID-19 patients: a systematic review and meta-analysis of randomized controlled trials
28% lower mortality (p=0.04). Systematic review and meta analysis of 19 RCTs with 2,495 patients, showing significantly lower mortality with vitamin D treatment.
Sep 2
 Isa et al., The Lancet Infectious Diseases, doi:10.1016/S1473-3099(24)00421-3 Effect of timing of casirivimab and imdevimab administration relative to mRNA-1273 COVID-19 vaccination on vaccine-induced SARS-CoV-2 neutralising antibody responses: a prospective, open-label, phase 2, randomised controlled trial
37% more symptomatic cases (p=0.65). RCT 293 healthy adults focusing on the timing of casirivimab and imdevimab administration relative to mRNA-1273, but also showing the incidence of COVID-19 for each group, with higher incidence in the casirivimab and imdevimab groups (wit..
Sep 1
 Shah et al., Journal of the Association of Physicians of India, doi:10.59556/japi.72.0646 A Retrospective Cohort Observational Study to Assess the Efficacy of Monoclonal Antibody in Coronavirus Disease 2019 Patients
14% higher mortality (p=1), no change in ventilation (p=1), 14% lower ICU admission (p=0.68), and 4% lower need for oxygen therapy (p=1). PSM retrospective 100 hospitalized COVID-19 patients in India showing no benefit with casirivimab/imdevimab treatment. There were no significant differences between groups in need for oxygen therapy, high-flow nasal cannula, noninvasive v..
Aug 31
 Hobbs et al., Journal of Infection, doi:10.1016/j.jinf.2024.106248 Favipiravir for COVID-19 in adults in the community in PRINCIPLE, an open-label, randomised, controlled, adaptive platform trial of short- and longer-term outcomes
86% lower mortality (p=0.11), 1% lower combined mortality/hospitalization (p=0.51), and 17% improved recovery (p=0.003). RCT 3,622 (concurrent and eligible) COVID-19 outpatients in the UK showing significantly faster recovery with favipiravir, and significantly greater full recovery at 3, 6, and 12 months. Authors note: "From 16 Dec 2021, a minority..
Aug 27
 Moon et al., Virology Journal, doi:10.1186/s12985-024-02464-1 Association between ursodeoxycholic acid use and COVID-19 in individuals with chronic liver disease: a nationwide case-control study in South Korea
33% lower severe cases (p=0.04) and 20% fewer cases (p<0.0001). Retrospective 74,074 individuals with chronic liver disease in South Korea, showing lower risk of COVID-19 infection and related severe outcomes with ursodeoxycholic acid (UDCA) use. The risk reduction was dose-dependent, with greater ben..
Aug 23
 Chen et al., Biomedical Chromatography, doi:10.1002/bmc.5996 Mass spectrometry‐based metabolomics reveals metabolism of molnupiravir may lead to metabolic disorders and hepatotoxicity
Analysis of molnupiravir induced liver injury. Molnupiravir treatment may disrupt metabolic homeostasis and cause liver injury by increasing levels of certain metabolites and activating inflammatory pathways.
Aug 15
 Parikh et al., Pathogens and Immunity, 10.20411/pai.v9i2.715 Comparison Study of the Bio-Plex and Meso Scale Multiplexed SARS-CoV-2 Serology Assays Reveals Evidence of Diminished Host Antibody Responses to SARS-CoV-2 after Monoclonal Antibody Treatment
Comparison of two multiplex serology assays for detecting SARS-CoV-2 antibodies in 455 samples from 304 participants in the ACTIV-2/A5401 trial of bamlanivimab for non-hospitalized COVID-19 patients. Authors found diminished host antibody..
Aug 14
 Lai et al., Age and Ageing, doi:10.1093/ageing/afae180 Efficacy of COVID-19 Oral antivirals in hospitalised oldest-old with high morbidity burden: a target trial emulation study
10% lower mortality (p=0.007). Target trial emulation study of 13,642 (molnupiravir) and 9,553 (paxlovid) elderly hospitalized patients in Hong Kong showing lower mortality with treatment.
Aug 14
 Lee et al., JMIR Public Health and Surveillance, doi:10.2196/59274 Ursodeoxycholic acid is associated with better clinical outcomes in COVID-19 patients: A population-based cohort study (Preprint)
Retrospective 1,675,593 patients in the Jeonbuk CDM cohort and 8,528,533 patients in the NHIS cohort, showing ursodeoxycholic acid (UDCA) intake associated with significantly lower risk of COVID-19 infection and severe COVID-19.
Aug 13
 dos Santos et al., Journal of Chromatography A, doi:10.1016/j.chroma.2024.465265 Countercurrent chromatography isolation of green propolis biomarkers: potential blockers of SARS-CoV-2 RBD and ACE2 interaction
In Vitro study showing potential inhibition of SARS-CoV-2 spike protein and ACE2 interaction by artepillin C and baccharin from Brazilian green propolis. Artepillin C showed 67.3% inhibition of Spike:ACE2 interaction at 10 μM, while bacch..
Aug 13
 Wang et al., bioRxiv, doi:10.1101/2024.08.12.607496 Pemivibart is less active against recent SARS-CoV-2 JN.1 sublineages
In Vitro study showing pemivibart has reduced neutralizing activity against recent SARS-CoV-2 JN.1 sublineages, particularly KP.3.1.1 which had a 32.7-fold higher IC50 compared to the original JN.1. Structural analyses suggest the Q493E m..
Aug 13
 Agafina et al., European Journal of Medical Research, doi:10.1186/s40001-024-02008-x Efficacy and safety of trimodulin in patients with severe COVID-19: results from a randomised, placebo-controlled, double-blind, multicentre, phase II trial (ESsCOVID)
17% higher mortality (p=0.7), 2% lower progression (p=1), and 9% longer ventilation (p=0.62). RCT 166 severe COVID-19 patients on non-invasive ventilation or high-flow oxygen showing no significant difference in clinical deterioration or mortality with trimodulin treatment compared to placebo. In a post hoc analysis of a subgroup ..
Aug 12
 Bang et al., Journal of Infection and Public Health, doi:10.1016/j.jiph.2024.102512 Sotrovimab lost neutralization efficacy against SARS-CoV-2 subvariants but remained clinically effective: Were monoclonal antibodies against COVID-19 rejected too early?
Retrospective 14 outpatients treated with sotrovimab showing that while sotrovimab lost in vitro neutralization efficacy against omicron subvariants BA.1 and BA.2, it remained clinically effective in reducing viral load in patients who di..
Aug 12
 Nair et al., The Journal of Infectious Diseases, doi:10.1093/infdis/jiae385 Persistence of an infectious form of SARS-CoV-2 post protease inhibitor treatment of permissive cells in vitro
In Vitro study showing the persistence of an infectious form of SARS-CoV-2 after treatment with 3CLpro inhibitors nirmatrelvir and ensitrelvir, which may explain the rebound often seen with paxlovid. 3CLpro is crucial for processing viral..
Aug 11
 Van Tin et al., Cells, doi:10.3390/cells13161331 Spike Protein of SARS-CoV-2 Activates Cardiac Fibrogenesis through NLRP3 Inflammasomes and NF-κB Signaling
In Vitro study showing that the SARS-CoV-2 spike protein can activate cardiac fibroblasts through ACE2-dependent mechanisms, leading to cardiac fibrosis via the NLRP3 inflammasome and NF-κB signaling pathways. The results suggest that COV..
Aug 11
 Focosi, D., Current Topics in Microbiology and Immunology, doi:10.1007/82_2024_268 Monoclonal Antibody Therapies Against SARS-CoV-2: Promises and Realities
Review of monoclonal antibodies for SARS-CoV-2. Author notes that the omicron variant has reset achievements to date.
We aim to cover the most promising early treatments for COVID-19. We use pre-specified effect extraction criteria that prioritizes more serious outcomes, for details see methods. For specific outcomes and different treatment stages see the individual pages. Not all treatments are covered here, effectiveness has been reported for many other treatments in studies. Of the 4,713 studies, 2,380 present results comparing with a control group, 2,178 are treatment studies, and 202 analyze outcomes based on serum levels. There are 86 animal studies, 167 in silico studies, 283 in vitro studies, 323 reviews, and 217 meta analyses.
Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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