Randomized-Controlled Trial to Compare the Efficacy of Andrographis paniculata Powder and Favipiravir for the Treatment of Mild COVID-19

Puriwatthanapong et al., Journal of Thai Traditional & Alternative Medicine, 21:3, Dec 2023

https://c19early.org/puriwatthanaponga.html

RCT 231 mild COVID-19 outpatients in Thailand comparing Andrographis paniculata (AP) extract in two forms versus favipiravir, showing no significant differences between groups. Patients were randomized to either aerial parts AP extract (n=77), AP leaf extract (n=77), or favipiravir (n=77) for 5 days. There was no control group. There were no significant differences between groups in progression to pneumonia, clinical severity changes, or viral clearance at days 5 and 10. Authors suggest that AP extracts may be as effective as favipiravir for mild COVID-19 and note AP's lower cost.

Potential risks of favipiravir include the creation of dangerous variants, and mutagenicity, carcinogenicity, teratogenicity, and embryotoxicity1-6.

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Study covers andrographolide and favipiravir.

1. Zhirnov et al., Favipiravir: the hidden threat of mutagenic action, Journal of microbiology, epidemiology and immunobiology, doi:10.36233/0372-9311-114.elpub.ru, doi.org.

2. Waters et al., Human genetic risk of treatment with antiviral nucleoside analog drugs that induce lethal mutagenesis: the special case of molnupiravir, Environmental and Molecular Mutagenesis, doi:10.1002/em.22471.wiley.com, doi.org.

3. Hadj Hassine et al., Lethal Mutagenesis of RNA Viruses and Approved Drugs with Antiviral Mutagenic Activity, Viruses, doi:10.3390/v14040841.mdpi.com, doi.org.

4. Shum, C., An investigational study into the drug-associated mutational signature in SARS-CoV-2 viruses, The University of Hong Kong, PhD Thesis, hub.hku.hk/handle/10722/344396.hku.hk.

5. Shiraki et al., Convenient screening of the reproductive toxicity of favipiravir and antiviral drugs in Caenorhabditis elegans, Heliyon, doi:10.1016/j.heliyon.2024.e35331.sciencedirect.com, doi.org.

6. Cenikli et al., Does Favipiravir interact with DNA? Design of electrochemical DNA nanobiosensor to investigate the interaction between DNA and Favipiravir used in the treatment of COVID-19, Talanta, doi:10.1016/j.talanta.2025.128084.sciencedirect.com, doi.org.

Puriwatthanapong et al., 29 Dec 2023, Randomized Controlled Trial, Thailand, peer-reviewed, 14 authors.

This Paper Favipiravir All

กระทรวงสาธารณสุ ข 18180 § ผู ้ รั บผิ ดชอบบทความ: sirada.pur@gmail.com 526

ริ วั ฒนพงศ์, สั นต์, ใจยอดศิ ลป์, พอ ใจยอดศิ ลป์, พระษาหาร, ลมโนชญ์, เศรษฐผล, นทร์, Sirada Puriwatthanapong, Sant Chaiyodsilp, Thammarat Bunsoong, Paul Chaiyodsilp, Yathip Tipasaharn, Kamik Kulmanote, Methi Sicharoen, Wasini Mekvitoon, Chompunuch Settapol, Jariya Songrak, Kobkaew Burapha, Wirawan Polchan, Cholpatsorn Euathanikkanon, Jate Wantang

บทคั ดย่ อ บทน� ำและวั ตถุ ประสงค์ : เพื ่ อเปรี ยบเที ยบ ประสิ ทธิ ผลและความปลอดภั ยของฟ้ าทะลายโจรกั บยาฟาวิ พิ รา เวี ยร์ ซึ ่ งขณะท� าวิ จั ยได้ ก� าหนดเป็ นยามาตรฐานที ่ ใช้ รั กษาโควิ ด-19 ในประเทศไทย แตกต่ างกั นหรื อไม่ อย่ างไรในผู ้ ป่ วย ที ่ มี อาการน้ อยหรื อไม่ มี อาการ วิ ธี กำรศึ กษำ: เป็ นการวิ จั ยแบบสุ ่ มและมี กลุ ่ มเปรี ยบเที ยบ โดยคั ดเลื อกผู ้ เข้ าร่ วมวิ จั ยที ่ มี อายุ ช่ วง 18 ปี ถึ งต� ่ า กว่ า 60 ปี ที ่ ได้ รั บการวิ นิ จฉั ยว่ าเป็ นโควิ ด-19 ด้ วยการตรวจ real time PCR test

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