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All Studies   Meta Analysis    Recent:   
0 0.5 1 1.5 2+ Oxygen therapy -2700% Improvement Relative Risk Recovery time -75% Recovery time (b) -117% Recovery time (c) -167% Acetaminophen  Ravichandran et al.  LATE TREATMENT Is late treatment with acetaminophen beneficial for COVID-19? Retrospective 144 patients in India Study compares with indomethacin, results vs. placebo may differ Higher need for oxygen therapy (p<0.0001) and slower recovery (p<0.0001) c19early.org Ravichandran et al., J. Indian Med. As.., Jul 2021 Favors acetaminophen Favors indomethacin

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

Ravichandran et al., J. Indian Med. Assoc., 119:7, ISRCTN11970082
Jul 2021  
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1st treatment shown to increase risk in November 2020
 
*, now known with p = 0.00000029 from 28 studies, but still recommended in 46 countries.
* From meta analysis with ≥3 clinical studies.
4,000+ studies for 60+ treatments. c19early.org
PSM retrospective 72 indomethacin and 72 paracetamol patients in India, showing higher progression and worse recovery with acetaminophen.
Acetaminophen is also known as paracetamol, Tylenol, Panadol, Calpol, Tempra, Calprofen, Doliprane, Efferalgan, Grippostad C, Dolo, Acamol, Fevadol, Crocin, and Perfalgan.
Study covers acetaminophen and indomethacin.
risk of oxygen therapy, 2700.0% higher, RR 28.00, p < 0.001, treatment 28 of 72 (38.9%), control 1 of 72 (1.4%), propensity score matching.
recovery time, 75.0% higher, relative time 1.75, p < 0.001, treatment median 7.0 IQR 1.0 n=72, control median 4.0 IQR 1.0 n=72, fever.
recovery time, 116.7% higher, relative time 2.17, p < 0.001, treatment median 6.5 IQR 3.25 n=72, control median 3.0 IQR 2.0 n=72, myalgia.
recovery time, 166.7% higher, relative time 2.67, p < 0.001, treatment median 8.0 IQR 2.0 n=72, control median 3.0 IQR 2.0 n=72, cough.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Ravichandran et al., 31 Jul 2021, retrospective, India, peer-reviewed, 6 authors, this trial compares with another treatment - results may be better when compared to placebo, trial ISRCTN11970082.
This PaperAcetaminophenAll
Use of Indomethacin in COVID-19 Patients -Experience from Two Medical Centres
Rajan Ravichandran, Prasanna Purna, Sivakumar Vijayaraghavalu, Ravi Teja Kalavakollu, Shilpa Gaidhane, Krishna Ramarathnam, Kumar
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.
References
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Tay, The trinity of Covid-19: immunity, inflammation and intervention, Nat Rev Immunol, doi:10.1038/s41577-020-0311-8
Xu, Gao, Wu, Selinger, Zhou, Indomethacin has a potent antiviral activity against SARS CoV-2 in vitro and canine coronavirus in vivo, doi:BioRxiV202010.1101/2020.04.01.017624
Zhao, Yang, Yang, Zhang, Huang et al., Cathepsin L plays a key role in SARS-CoV-2 infection in humans and humanized mice and is a promising target for new drug development, Sig Transduct Target Ther
Late treatment
is less effective
Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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