An open label randomized clinical trial of Indomethacin for mild and moderate hospitalised Covid-19 patients
Rajan Ravichandran, Surapaneni Krishna Mohan, Suresh Kumar Sukumaran, Devakumar Kamaraj, Sumetha Suga Daivasuga, Samson Oliver Abraham Samuel Ravi, Sivakumar Vijayaraghavalu, Ramarathnam Krishna Kumar
Scientific Reports, doi:10.1038/s41598-022-10370-1
Indomethacin, a non-steroidal anti-inflammatory drug (NSAID), has been presented as a broadspectrum antiviral agent. This randomised clinical trial in a hospital setting evaluated the efficacy and safety of this drug in RT-PCR-positive coronavirus disease 2019 (COVID-19) patients. A total of 210 RT-PCR-positive COVID-19 patients who provided consent were allotted to the control or case arm, based on block randomisation. The control arm received standard of care comprising paracetamol, ivermectin, and other adjuvant therapies. The patients in the case arm received indomethacin instead of paracetamol, with other medications retained. The primary endpoint was the development of hypoxia/desaturation with SpO 2 ≤ 93, while time to become afebrile and time for cough and myalgia resolution were the secondary endpoints. The results of 210 patients were available, with 103 and 107 patients in the indomethacin and paracetamol arms, respectively. We monitored patient profiles along with everyday clinical parameters. In addition, blood chemistry at the time of admission and discharge was assessed. As no one in either of the arms required high-flow oxygen, desaturation with a SpO 2 level of 93 and below was the vital goal. In the indomethacin group, none of the 103 patients developed desaturation. On the other hand, 20 of the 107 patients in the paracetamol arm developed desaturation. Patients who received indomethacin also experienced more rapid symptomatic relief than those in the paracetamol arm, with most symptoms disappearing in half the time. In addition, 56 out of 107 in the paracetamol arm had fever on the seventh day, while no patient in the indomethacin group had fever. Neither arm reported any adverse event. The fourteenth-day follow-up revealed that the paracetamol arm patients had faced several discomforts; indomethacin arm patients mostly complained only of tiredness. Indomethacin is a safe and effective drug for treating patients with mild and moderate covid-19. SARS-Cov-2, a member of the coronavirus family, has been ravaging the world for the past 18 months. Although an effective treatment has eluded the medical community, there have been several registered trials on finding new or repurposed drugs. Several studies have discussed the mechanism of the virus-host interaction and possible treatments 1 , but safe and effective treatment for the disease is yet to emerge. Drug repurposing seems to be an immediate solution, and various drugs have been suggested for the COVID-19 treatment 2,3 . The drugs required to combat the pathogen may fall into one or more of the following categories: antivirals, anti-inflammatory agents, and supportive therapies 4,5 . According to V'Kovski 1 the antiviral action can be based
www.nature.com/scientificreports/ group was seven days. The median days for the resolution of cough and myalgia for the indomethacin group was four days, while it was seven days for the paracetamol group. We did not observe any adverse effects.
Supplementary data Anonymised patient data are given in supplementary data file 1. If further data is required, please contact the corresponding author.
Author contributions Author RR: Conception and lead resource and lead clinician. Authors KS, DK, SSD: Clinical study conduction, coordination and data collection. Author SS: Clinical help to A. Author SO: Test technician. Author SV: Protocol Design and data interpretation. Author KR: Data-analysis, interpretation, and manuscript preparation-Dr. Ramarathnam Krishna Kumar.
Competing interests The authors declare no competing interests.
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