Efficacy of a Low Dose of Melatonin as an Adjunctive Therapy in Hospitalized Patients with COVID-19: A Randomized, Double-blind Clinical Trial
Gholamreza Farnoosh, Mostafa Akbariqomi, Taleb Badri, Mahdi Bagheri, Morteza Izadi, Ali Saeedi-Boroujeni, Ehsan Rezaie, Hadi Esmaeili Gouvarchin Ghaleh, Hossein Aghamollaei, Mahdi Fasihi-Ramandi, Kazem Hassanpour, Gholamhossein Alishiri
Archives of Medical Research, doi:10.1016/j.arcmed.2021.06.006
Background. Melatonin has been known as an anti-inflammatory agent and immune modulator that may address progressive pathophysiology of coronavirus disease 2019 .Aim of the study. To evaluate the clinical efficacy of adjuvant, use of melatonin in patients with COVID-19. Methods. This single-center, double-blind, randomized clinical trial included 74 hospitalized patients with confirmed mild to moderate COVID-19 at Baqiyatallah Hospital in Tehran, Iran, from April 25, 2020-June 5, 2020. Patients were randomly assigned in a 1:1 ratio to receive standard of care and standard of care plus melatonin at a dose of 3 mg three times daily for 14 d. Clinical characteristics, laboratory, and radiological findings were assessed and compared between two study groups at baseline and post-intervention. Safety and clinical outcomes were followed up for four weeks. Results. A total of 24 patients in the intervention group and 20 patients in the control group completed the treatment. Compared with the control group, the clinical symptoms such as cough, dyspnea, and fatigue, as well as the level of CRP and the pulmonary involvement in the intervention group had significantly improved (p < 0.05). The mean time of hospital discharge of patients and return to baseline health was significantly shorter in the intervention group compared to the control group (p < 0.05). No deaths and adverse events were observed in both groups. Conclusions. Adjuvant use of melatonin has a potential to improve clinical symptoms of COVID-19 patients and contribute to a faster return of patients to baseline health.
ARTICLE IN PRESS
Declaration of Competing Interests All authors have no conflict of interest to declare.
References
Akbariqomi, Hosseini, Rashidiani, Clinical characteristics and outcome of hospitalized COVID-19 patients with diabetes: A single-center, retrospective study in Iran, Diabetes Res Clin Pract
Biancatelli, Berrill, Mohammed, Melatonin for the treatment of sepsis: the scientific rationale, J Thorac Dis
Davoodi, Abedi, Salehifar, Febuxostat therapy in outpatients with suspected COVID-19: A clinical trial, Int J Clin Pract
Farnoosh, Efficacy of a Low Dose of Melatonin as an Adjunctive Therapy in Hospitalized Patients with COVID-19: A Randomized, Double-blind Clinical Trial, Archives of Medical Research
Habtemariam, Daglia, Sureda, Melatonin and respiratory diseases: a review, Curr Top Med Chem
Huang, Liao, Chen, Melatonin possesses an anti-influenza potential through its immune modulatory effect, J Funct Foods
Ibrahim, Potential repurposed SARS-CoV-2 (COVID-19) infection drugs, RSC Adv
Kleszczyński, Slominski, Steinbrink, Clinical Trials for Use of Melatonin to Fight against COVID-19 Are Urgently Needed, Nutrients
Li, Li, Zhang, Expression of the SARS-CoV-2 cell receptor gene ACE2 in a wide variety of human tissues, Infect Dis Poverty
Li, Li, Zhou, Melatonin for the prevention and treatment of cancer, Oncotarget
Liu, Li, Xu, Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19, J Clin Virol
Mousavizadeh, Ghasemi, Genotype and phenotype of COVID-19: Their roles in pathogenesis, J Microbiol Immunol Infect
Nikpouraghdam, Farahani, Alishiri, Epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients in IRAN: A single center study, J Clin Virol
Potempa, Rajab, Hart, Insights into the use of C-Reactive protein as a diagnostic index of disease severity in COVID-19 infections, Am J Trop Med Hyg
Ragab, Salah Eldin, Taeimah, The COVID-19 cytokine storm; what we know so far, Front Immunol
Shneider, Kudriavtsev, Vakhrusheva, Can melatonin reduce the severity of COVID-19 pandemic?, Int Rev Immunol
Tan, Hardeland, Potential utility of melatonin in deadly infectious diseases related to the overreaction of innate immune response and destructive inflammation: focus on COVID-19, Melatonin Res
Wang, Horby, Hayden, A novel coronavirus outbreak of global health concern, Lancet
Wang, Zhang, Du, Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial, Lancet
Wu, Wang, Kuo, An update on current therapeutic drugs treating COVID-19, Curr Pharmacol Reports
Zhang, Wang, Ni, COVID-19: Melatonin as a potential adjuvant treatment, Life Sci
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