Melatonin as adjuvant treatment for coronavirus disease 2019 pneumonia patients requiring hospitalization (MAC-19 PRO): a case series
Castillo et al.
, Melatonin as adjuvant treatment for coronavirus disease 2019 pneumonia patients requiring hospitalization..
, Melatonin Research, doi:10.32794/mr11250063
Report on the use of high-dose melatonin in 10 pneumonia patients, showing clinical stabilization and/or improvement for all patients within 4-5 days. All patients survived, including 3 with moderately severe ARDS and one with mild ARDS. None required mechanical ventilation.
This study is excluded in meta
unadjusted results with no group details.
risk of death, 93.5% lower, RR 0.06, p = 0.08, treatment 0 of 7 (0.0%), control 12 of 34 (35.3%), NNT 2.8, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm), COVID+.
risk of mechanical ventilation, 89.4% lower, RR 0.11, p = 0.32, treatment 0 of 7 (0.0%), control 7 of 34 (20.6%), NNT 4.9, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm), COVID+.
hospitalization time, 33.8% lower, relative time 0.66, treatment 7, control 34, COVID+.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Castillo et al., 15 Jun 2020, retrospective, Philippines, peer-reviewed, 10 authors, study period 5 March, 2020 - 4 April, 2020.
Abstract: Melatonin Research (Melatonin Res.)
Melatonin as adjuvant treatment for coronavirus disease 2019 pneumonia
patients requiring hospitalization (MAC-19 PRO): a case series
Rafael R. Castillo*1,2,4, Gino Rei A. Quizon^ 1, Mario Joselito M. Juco1, Arthur Dessi E.
Roman1, Donnah G. de Leon1, Felix Eduardo R. Punzalan1,3, Rafael Bien L. Guingon1,
Dante D. Morales1,5, Dun-Xian Tan6, Russel J. Reiter7; on behalf of the MAC-19 PRO
Department of Internal Medicine, Manila Doctors Hospital, Manila, Philippines
Cardiovascular Medicine, Adventist University of the Philippines, College of Medicine,
University of the Philippines, College of Medicine; Manila, Philippines
CardioMetabolic Research Unit (CaMeRU), FAME Leaders Academy, Makati, Philippines
Section of Cardiology, Makati Medical Center, Makati, Philippines
S.T. Bio-Life; San Antonio, Texas, USA
Department of Cell Systems and Anatomy, UT Health San Antonio, San Antonio, Texas,
Joint first author
*Correspondence: email@example.com, firstname.lastname@example.org, Tel: +63 917
Running Title: Adjuvant melatonin treatment in COVID19 pneumonia
Received: April 30, 2020; Accepted: June 3, 2020
Treatment 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: time 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 (-), which was
deemed to be false (-) considering the patients’ typical history, symptomatology, chest imaging
Melatonin Res. 2020, Vol 3 (3) 297-310; doi: 10.32794/mr11250063
Melatonin Research (Melatonin Res.)
findings and elevated bio-inflammatory parameters. In all 10 patients given hdM, clinical
stabilization and/or improvement was noted within 4-5 days after initiation of hdM. All hdM
is less effective
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