Melatonin as adjuvant treatment for coronavirus disease 2019 pneumonia patients requiring hospitalization (MAC-19 PRO): a case series

{ 'indexed': {'date-parts': [[2022, 1, 30]], 'date-time': '2022-01-30T15:47:31Z', 'timestamp': 1643557651611}, 'reference-count': 0, 'publisher': 'ST Bio-life', 'issue': '3', 'license': [ { 'start': { 'date-parts': [[2020, 6, 15]], 'date-time': '2020-06-15T00:00:00Z', 'timestamp': 1592179200000}, 'content-version': 'unspecified', 'delay-in-days': 0, 'URL': 'http://creativecommons.org/licenses/by/4.0'}], 'content-domain': {'domain': [], 'crossmark-restriction': False}, 'short-container-title': ['Melatonin Res.'], 'abstract': '<jats:p>\xa0Treatment for coronavirus disease 2019 (COVID19) pneumonia remains empirical and ' 'the search for therapies that can improve outcomes continues. Melatonin has been shown to ' 'have anti-inflammatory, antioxidant, and immune-modulating effects that may address key ' 'pathophysiologic mechanisms in the development and progression of acute respiratory distress ' 'syndrome (ARDS), which has been implicated as the likely cause of death in COVID19. We aimed ' 'to describe the observable clinical outcomes and tolerability of high-dose melatonin (hdM) ' 'given as adjuvant therapy in patients admitted with COVID19 pneumonia. We conducted a ' 'retrospective descriptive case series of patients who: 1) were admitted to the Manila Doctors ' 'Hospital in Manila, Philippines, between March 5, 2020 and April 4, 2020; 2) presented with ' 'history of typical symptoms (fever, cough, sore throat, loss of smell and/or taste, myalgia, ' 'fatigue); 3) had admitting impression of atypical pneumonia; 4) had history and chest imaging ' 'findings highly suggestive of COVID19 pneumonia, and, 5) were given hdM as adjuvant therapy, ' 'in addition to standard and/or empirical therapy. One patient admitted to another hospital, ' 'who one of the authors helped co-manage, was included. He was the lone patient given hdM in ' 'that hospital during the treatment period. Main outcomes described were:\xa0time to clinical ' 'improvement, duration of hospital stay from hdM initiation, need for mechanical ventilation ' '(MV) prior to cardiopulmonary resuscitation, and final outcome (death or recovery/discharge). ' 'Of 10 patients given hdM at doses of 36-72mg/day per os (p.o.) in 4 divided doses as adjuvant ' 'therapy, 7 were confirmed COVID19 positive (+) by reverse transcription polymerase chain ' 'reaction (RT-PCR) and 3 tested negative\xa0 (-), which was deemed to be false (-) considering ' 'the patients’ typical history, symptomatology, chest imaging findings and elevated ' 'bio-inflammatory parameters.\xa0 In all 10 patients given hdM, clinical stabilization and/or ' 'improvement was noted within 4-5 days after initiation of hdM.\xa0All hdM patients, including ' '3 with moderately severe ARDS and 1 with mild ARDS, survived; none required MV. The 7 ' 'COVID19(+) patients were discharged at an average of 8.6 days after initiation of hdM. The 3 ' 'highly probable COVID19 patients on hdM were discharged at an average of 7.3 days after hdM ' 'initiation.\xa0Average hospital stay of those not given hdM (non-hdM) COVID19(+) patients who ' 'were admitted during the same period and recovered was 13 days. To provide perspective, ' 'although the groups are not comparable, 12 of the 34 (35.3%) COVID19(+) non-hdM patients ' 'admitted during the same period died, 7/34 (20.6%) required MV; while 6 of 15 (40%) non-hdM ' '(-) by RT-PCR but highly probable COVID19 pneumonia patients also died, 4/15\xa0 (26.7%) ' 'required MV. No significant side-effects were noted with hdM except for sleepiness, which was ' 'deemed favorable by all patients, most of whom had anxiety- and symptom-related sleeping ' 'problems previously. HdM may have a beneficial role in patients treated for COVID19 ' 'pneumonia, in terms of shorter time to clinical improvement, less need for MV, shorter ' 'hospital stay, and possibly lower mortality. HdM was well tolerated. This is the first report ' 'describing the benefits of hdM in patients being treated for COVID19 pneumonia.\xa0 Being a ' 'commonly available and inexpensive sleep-aid supplement worldwide, melatonin may play a role ' 'as adjuvant therapy in the global war against COVID19.\xa0</jats:p>', 'DOI': '10.32794/mr11250063', 'type': 'journal-article', 'created': {'date-parts': [[2020, 6, 15]], 'date-time': '2020-06-15T11:53:46Z', 'timestamp': 1592222026000}, 'page': '297-310', 'source': 'Crossref', 'is-referenced-by-count': 29, 'title': [ 'Melatonin as adjuvant treatment for coronavirus disease 2019 pneumonia patients requiring ' 'hospitalization (MAC-19 PRO): a case series'], 'prefix': '10.32794', 'volume': '3', 'author': [ {'given': 'Rafael Ricafranca', 'family': 'Castillo', 'sequence': 'first', 'affiliation': []}, {'given': 'Gino Rei A.', 'family': 'Quizon', 'sequence': 'first', 'affiliation': []}, {'given': 'Mario Joselito M.', 'family': 'Juco', 'sequence': 'first', 'affiliation': []}, {'given': 'Arthur Dessi E.', 'family': 'Roman', 'sequence': 'first', 'affiliation': []}, {'given': 'Donnah G', 'family': 'De Leon', 'sequence': 'first', 'affiliation': []}, {'given': 'Felix Eduardo R.', 'family': 'Punzalan', 'sequence': 'first', 'affiliation': []}, {'given': 'Rafael Bien L.', 'family': 'Guingon', 'sequence': 'first', 'affiliation': []}, {'given': 'Dante D.', 'family': 'Morales', 'sequence': 'first', 'affiliation': []}, {'given': 'Dun-Xian', 'family': 'Tan', 'sequence': 'first', 'affiliation': []}, {'given': 'Russe J', 'family': 'Reiter', 'sequence': 'first', 'affiliation': []}], 'member': '18079', 'published-online': {'date-parts': [[2020, 6, 15]]}, 'container-title': ['Melatonin Research'], 'original-title': [], 'deposited': { 'date-parts': [[2020, 6, 15]], 'date-time': '2020-06-15T11:53:51Z', 'timestamp': 1592222031000}, 'score': 1, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2020, 6, 15]]}, 'references-count': 0, 'journal-issue': {'issue': '3', 'published-online': {'date-parts': [[2020, 6, 15]]}}, 'URL': 'http://dx.doi.org/10.32794/mr11250063', 'relation': {}, 'ISSN': ['2641-0281'], 'issn-type': [{'value': '2641-0281', 'type': 'electronic'}], 'subject': ['General Medicine'], 'published': {'date-parts': [[2020, 6, 15]]}}