Advancing combination treatment with glycyrrhizin and boswellic acids for hospitalized patients with moderate COVID-19 infection: a randomized clinical trial

{ 'indexed': {'date-parts': [[2022, 4, 6]], 'date-time': '2022-04-06T02:11:00Z', 'timestamp': 1649211060561}, 'reference-count': 57, 'publisher': 'Springer Science and Business Media LLC', 'issue': '2', 'license': [ { 'start': { 'date-parts': [[2022, 3, 1]], 'date-time': '2022-03-01T00:00:00Z', 'timestamp': 1646092800000}, 'content-version': 'tdm', 'delay-in-days': 0, 'URL': 'https://creativecommons.org/licenses/by/4.0'}, { 'start': { 'date-parts': [[2022, 3, 1]], 'date-time': '2022-03-01T00:00:00Z', 'timestamp': 1646092800000}, 'content-version': 'vor', 'delay-in-days': 0, 'URL': 'https://creativecommons.org/licenses/by/4.0'}], 'funder': [{'DOI': '10.13039/501100009169', 'name': 'Assiut University', 'doi-asserted-by': 'crossref'}], 'content-domain': {'domain': ['link.springer.com'], 'crossmark-restriction': False}, 'short-container-title': ['Inflammopharmacol'], 'published-print': {'date-parts': [[2022, 4]]}, 'abstract': '<jats:title>Abstract</jats:title><jats:p>Recent evidence points to a potential therapeutic ' 'role for glycyrrhizin(GR) and boswellic acids (BA) in the treatment of COVID-19 but ' 'conclusive evidence is lacking. Our aim is to investigate the efficacy of GR\u2009+\u2009BA ' 'versus placebo for the treatment of hospitalized patients with moderate SARS-CoV-2 or ' 'COVID-19 variants infection. The current study is a randomized, double-blind, ' 'placebo-controlled, single-center trial. Patients with SARS-CoV-2 or COVID-19 variants ' 'diagnosed by PCR test who were admitted to Sohag University hospital were eligible if they ' 'were at least 18\xa0years of age and had moderate symptoms. Patients were randomly assigned ' 'to receive oral GR capsule (60\xa0mg) and BA (200\xa0mg) twice daily for 14\xa0days or a ' 'matching placebo. All patients also received treatment with the institutional protocol for ' 'COVID-19. The primary outcome was mortality and time to recovery. Secondary outcome was ' 'clinical status score, 14\xa0days after receiving study drugs. Adverse events from use of ' 'study drugs have been evaluated for up to 14\xa0days. The trial is registered at ' 'ClinicalTrials.gov (Identifier NCT04487964). During the 6-month enrollment period ' '(June-November, 2021) only 50 patients (54% women; median age 60\xa0years, IQR 54–65) met ' 'eligibility and were randomly assigned. Evaluation of the primary outcome at 14\xa0days ' 'showed that there were five deaths in the placebo group and no deaths in the GR\u2009+\u2009' 'BA group. With regard to recovery time, it was significantly shorter ' '(<jats:italic>p</jats:italic>\u2009=\u20090.0001) in the group receiving GR\u2009+\u2009BA ' 'capsule compared to the placebo group (median 7.0; IQR 6.0–8.0\xa0days vs. median 12.5; IQR ' '12–20\xa0days). Clinical status on the ordinal score scale as a secondary outcome showed a ' 'significant difference between the GR\u2009+\u2009BA group (median (IQR) score, 2 [2–3]) and ' 'placebo groups (mean (IQR) score, 3 [3–5.5]). There was a significant decrease in CRB ' '(<jats:italic>p</jats:italic>\u2009=\u20090.000041) in GR\u2009+\u2009BA compared with the ' 'placebo group. In conclusion, this safe, inexpensive, antiviral, immunomodulating and ' 'anti-inflammatory combination may be considered for use in mild to moderate infections of ' 'SARS-CoV-2 or COVID-19 variants. The study is limited by the small sample size; therefore, ' 'larger randomized trials are required.</jats:p>', 'DOI': '10.1007/s10787-022-00939-7', 'type': 'journal-article', 'created': {'date-parts': [[2022, 3, 1]], 'date-time': '2022-03-01T17:03:13Z', 'timestamp': 1646154193000}, 'page': '477-486', 'update-policy': 'http://dx.doi.org/10.1007/springer_crossmark_policy', 'source': 'Crossref', 'is-referenced-by-count': 0, 'title': [ 'Advancing combination treatment with glycyrrhizin and boswellic acids for hospitalized ' 'patients with moderate COVID-19 infection: a randomized clinical trial'], 'prefix': '10.1007', 'volume': '30', 'clinical-trial-number': [ { 'clinical-trial-number': 'nct04487964', 'registry': '10.18810/clinical-trials-gov'}], 'author': [ { 'ORCID': 'http://orcid.org/0000-0002-6462-0917', 'authenticated-orcid': False, 'given': 'Adel A.', 'family': 'Gomaa', 'sequence': 'first', 'affiliation': []}, {'given': 'Hamdy S.', 'family': 'Mohamed', 'sequence': 'additional', 'affiliation': []}, {'given': 'Rasha B.', 'family': 'Abd-ellatief', 'sequence': 'additional', 'affiliation': []}, {'given': 'Mohamed A.', 'family': 'Gomaa', 'sequence': 'additional', 'affiliation': []}, {'given': 'Doaa S.', 'family': 'Hammam', 'sequence': 'additional', 'affiliation': []}], 'member': '297', 'published-online': {'date-parts': [[2022, 3, 1]]}, 'reference': [ { 'issue': '7', 'key': '939_CR1', 'doi-asserted-by': 'publisher', 'first-page': '206', 'DOI': '10.1007/s00894-021-04816-y', 'volume': '27', 'author': 'S Ahmad', 'year': '2021', 'unstructured': 'Ahmad S, Waheed Y, Abro A, Abbasi SW, Ismail S (2021) Molecular ' 'screening of glycyrrhizin-based inhibitors against ACE2 host receptor of ' 'SARS-CoV-2. 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