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0 0.5 1 1.5 2+ Mortality 54% Improvement Relative Risk c19early.org/j Sánchez-González et al. Melatonin LATE TREATMENT Is late treatment with melatonin beneficial for COVID-19? Retrospective 448 patients in Spain Lower mortality with melatonin (p=0.0009) Sánchez-González Favors melatonin Favors control
What if melatonin could help COVID-19 severe patients?
Sánchez-González
Sánchez-González, What if melatonin could help COVID-19 severe patients?,
Jul 2021   Source   PDF  
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Retrospective 2,463 hospitalized patients in Spain, 265 treated with melatonin, showing lower mortality with treatment in PSM analysis, however these results are subject to immortal time bias. Authors excluded from the sample patients that died during the first 72 hours of admission without taking melatonin, and patients that started on melatonin in the last 7 days of their admittance, having completed 75% of their stay. This study is excluded in the after exclusion results of meta analysis: immortal time bias may significantly affect results.
risk of death, 54.4% lower, RR 0.46, p < 0.001, treatment 24 of 224 (10.7%), control 53 of 224 (23.7%), NNT 7.7, odds ratio converted to relative risk, PSM.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Sánchez-González et al., 20 Jul 2021, retrospective, Spain, peer-reviewed, 4 authors.
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Abstract: https://doi.org/10.5664/jcsm.9554 LETTERS TO THE EDITOR What if melatonin could help patients with severe COVID-19?   Miguel Angel Sanchez-Gonzalez, MD, PhD1,2; Ignacio Mahıllo-Fernandez, PhD3; Felipe Villar-Alvarez, MD, PhD4; Lucıa Llanos, MD, PhD5 Psychiatry Department, Fundacion Jimenez Dıaz University Hospital, Health Research Institute (IIS-FJD, UAM), Madrid, Spain; 2Department of Anatomy, Histology, and Neuroscience, School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain; 3Biostatistics Unit, Fundacion Jimenez Dıaz University Hospital, Health Research Institute (IIS-FJD, UAM), Madrid, Spain; 4Pulmonology Department, Fundacion Jimenez Dıaz University Hospital, Health Research Institute (IIS-FJD, UAM), CIBERES, Universidad Autonoma de Madrid, Madrid, Spain; 5Clinical Research Unit, Fundacion Jimenez Dıaz University Hospital, Health Research Institute (IIS-FJD, UAM), Madrid, Spain 1 Copyright 2022 American Academy of Sleep Medicine. All rights reserved. In March 2020, a protocol recommending the prescription of melatonin, among other sleep- and biorhythms-promoting measures, to hospitalized patients with coronavirus disease 2019 (COVID-19) with sleep problems or delirium was sent from the consultationliaison psychiatrist to the medical staff of the Fundaci on Jimenez Dıaz University Hospital (FJDUH) in Madrid, Spain. Several authors have suggested a potential benefit of melatonin use in COVID-19.1–4 In addition to its circadian function, melatonin is thought to have several health-promoting properties, including immune response modulation and anti-inflammatory and antioxidant properties.5 We here report a retrospective analysis showing an association of melatonin with survival in a sample of 2,463 Table 1—Unmatched and matched groups of melatonin and non-melatonin patient characteristics, and comparison of mortality and hospital stay between matched groups. Variable Demographics and clinical history Agea Female CVD DM Hypertension Lung disease Dyslipidemia Smoking habit Treatment-related ICU/IRCU stay Dexamethasone Tocilizumab Cyclosporine Methylprednisolone Anakinra Nasal cannula oxygen High-flow oxygen Clinical evolution Hospital stay, d Mortality Melatonin (n = 224) Unmatched Comparisons Matched Comparisons Non-Melatonin (n = 1,952) P Value Non-Melatonin (n = 224) P Value Effectb (95% CI) 69.0 (22.5) 96 (42.9%) 61 (27.2%) 53 (23.7%) 113 (50.4%) 54 (24.1%) 95 (42.4%) 14 (6.2%) 74.0 (28.0) 917 (47.0%) 594 (30.4%) 378 (19.4%) 1,052 (53.9%) 443 (22.7%) 738 (37.8%) 152 (7.8%) .054 .271 .362 .150 .363 .694 .204 .492 70.0 (25.0) 97 (43.3%) 62 (27.7%) 39 (17.4%) 112 (50.0%) 58 (25.9%) 80 (35.7%) 20 (8.9%) .982 > .99 > .99 .128 > .99 .743 .175 .372 — — — — — — — — 53 (23.7%) 42 (18.8%) 67 (29.9%) 138 (61.6%) 183 (81.7%) 11 (4.9%) 184 (82.1%) 34 (15.2%) 112 (5.7%) 109 (5.6%) 177 (9.1%) 677 (34.7%) 1,167 (59.8%) 13 (0.7%) 1,272 (65.2%) 82 (4.2%) <.001 <.001 <.001 <.001 <.001 <.001 <.001 <.001 43 (19.2%) 32 (14.3%) 71 (31.7%) 145 (64.7%) 192 (85.7%) 7 (3.1%) 171 (76.3%) 26 (11.6%) .300 .252 .759 .557 .306 .470 .162 .332 — — — — — — — — 13.7 (23.1) 24 (10.7%) 5.9 (6.7) 340 (17.4%) <.001 .014 8.9 (10.9) 53 (23.7%) <.001 <.001 4.8 (2.3–6.2) 0.39 (0.23–0.65) a Expressed as median (interquartile range). bMedian differences for hospital stay and odds ratio..
Late treatment
is less effective
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