Use of indomethacin in COVID-19 patients: experience from two medical centres

Background : Indomethacin is a widely used drug belonging to the class of the non-steroidal anti-inflammatory drug (NSAID), which has also a proven anti-viral effect. This academic study describes our experience in treating hospitalised symptomatic COVID-19 positive patients with it. Materials and Methods : Patients with COVID-19 (detected by the real-time reverse transcription polymerase chain reaction) admitted to our department were provided the option of receiving Indomethacin 25mg (bid) or 75mg SR (sustained release), (OD) along with proton pump inhibitor, along with the standard care of treatment of the Indian Council of Medical Research (ICMR). Patients who did not agree to the Indomethacin option were offered standard care of treatment which included paracetamol. Development of hypoxia was considered as the endpoint. Time period to become afebrile and resolution of cough and myalgia; was considered as the secondary endpoint. Propensity Score Matching was used for the purpose of comparison between these two arms. A separate group of patients with COVID-19 having severe disease, who were admitted with hypoxemia were given Indomethacin 75mg SR; admission to the intensive care unit or need for mechanical ventilation were considered as the endpoints. Results : Twenty-eight of 72 patients in paracetamol arm developed hypoxia and required oxygen; whereas, only one patient out of 72 in the Indomethacin arm, developed hypoxia in the mild-moderate Covid patients. None of the patients in severe disease group treated with indomethacin needed mechanical ventilation. More rapid symptomatic relief was observed in indomethacin group than paracetamol group. Also, no systemic adversity including renal/liver functions observed. Conclusion : In our experience Indomethacin is very effective and safe for treating COVID-19 patients.