Melatonin as adjuvant treatment in COVID-19 patients. A meta-analysis of randomized and propensity matched studies
Krisztina Tóth, Eros Pilia, Giovanni Landoni, Davide Oreggia, Salvatore Giacomarra, Rosario Losiggio, Giacomo Maiucci, Iliyan Vlasakov, Andrey Yavorovskiy, Valery Likhvantsev, Andrea Székely, Daniel Remo, Covello
Signa Vitae, doi:10.22514/sv.2023.076
Melatonin is a neurohormone well-known as sleep disorder treatment. A few clinical trials have recently pointed out the biological plausibility of utilising melatonin in the treatment of coronavirus disease 2019 (COVID-19, SARS-CoV-2) patients. Melatonin wide range of activities include anti-inflammatory, antiviral and antioxidant effects. Our meta-analysis aimed to investigate the effect of melatonin on mortality in COVID-19 patients with different disease severity. We searched PubMed, EMBASE, Web of Science with no language restrictions updated on February 2023 for randomized and propensity matched studies, comparing melatonin plus standard COVID-19 therapy vs. standard COVID-19 therapy alone. Patients had to be hospitalised with a confirmed diagnosis of SARS-CoV-2 infection. Primary outcome was mortality at the longest follow-up available. We included 7 randomized and 1 propensity matched studies enrolling 1155 overall patients with a mean age of 61 ± 19.5 years. We found a reduced mortality rate in the overall population (127/575 (22%) vs. 209/580 (36%) Relative Risk: 0.62 (confidence interval (CI): 0.40, 0.96), I 2 = 86% p = 0.03, with the results confirmed when pooling the 5 studies which administered melatonin in non-intensivecare-unit patients (26/423 (6.1%) vs. 69/419 (16%) Relative Risk 0.30 (CI: 0.10, 0.86), I 2 = 40% p = 0.02). According to recent randomized and propensity matched evidence, melatonin might be a life-saving adjuvant therapy in COVID-19 patients. This effect was mainly driven by non-intensive care unit patients.
AC K NOW LED G ME N T Not applicable.
F U ND ING This research received no external funding.
CO NFL ICT OF IN T ERE ST The authors declare no conflict of interest. Giovanni Landoni is serving as one of the Editorial Board members of this journal. We declare that Giovanni Landoni had no involvement in the peer review of this article and has no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to OK.
S U PPL EM ENTAR Y MAT ERIA L Supplementary material associated with this article can be found, in the online version, at https://oss.signavitae. com/mre-signavitae/article/1691722790965526528/ attachment/Supplementary%20material.docx.
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