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study COVID-19 treatment researchPVP-IPovidone-Iod.. (more..)
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All Studies   Meta Analysis    Recent:   
0 0.5 1 1.5 2+ Recovery -27% Improvement Relative Risk Recovery (b) -50% Viral clearance 0% Povidone-Iodine  Zarabanda et al.  LATE TREATMENT  RCT Is late treatment with povidone-iodine beneficial for COVID-19? RCT 24 patients in the USA Trial compares with saline spray, results vs. placebo may differ Trial underpowered to detect differences Zarabanda et al., Laryngoscope, November 2021 Favors povidone-iodine Favors saline spray

The Effect of Povidone-Iodine Nasal Spray on COVID-19 Nasopharyngeal Viral Load in Patients: A Randomized Control Trial

Zarabanda et al., Laryngoscope, doi:10.1002/lary.29935
Nov 2021  
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PVP-I for COVID-19
13th treatment shown to reduce risk in February 2021
*, now known with p = 0.000000004 from 21 studies.
Lower risk for mortality, cases, and viral clearance.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,000+ studies for 60+ treatments.
Very late treatment (7 days from onset) RCT comparing 11 & 13 PVP-I (0.5% and 2%), and 11 saline spray patients in the USA, showing no significant differences. There was no control group (saline is likely not a placebo, showing efficacy in other trials). There are large unadjusted differences between groups, e.g. 7.1 days from onset for PVP-I versus 4.8 for saline. Baseline Ct was higher for PVP-I, providing less room for improvement. Authors note that they cannot determine if earlier use is more beneficial.
Viral load measured by PCR may not accurately reflect infectious virus measured by viral culture. Porter show that viral load early in infection was correlated with infectious virus, but viral load late in infection could be high even with low or undetectable infectious virus. Assessing viral load later in infection may underestimate reductions in infectious virus with treatment.
Targeted administration to the respiratory tract provides treatment directly to the typical source of initial SARS-CoV-2 infection and replication, and allows for rapid onset of action, higher local drug concentration, and reduced systemic side effects (early treatment may be more beneficial).
risk of no recovery, 26.9% higher, RR 1.27, p = 1.00, treatment 3 of 13 (23.1%), control 2 of 11 (18.2%), 2%.
risk of no recovery, 50.0% higher, RR 1.50, p = 1.00, treatment 3 of 11 (27.3%), control 2 of 11 (18.2%), 0.5%.
risk of no viral clearance, no change, RR 1.00, p = 1.00, treatment 2 of 7 (28.6%), control 2 of 7 (28.6%), day 5, minus strand PCR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Zarabanda et al., 1 Nov 2021, Randomized Controlled Trial, USA, peer-reviewed, 13 authors, average treatment delay 7.0 days, this trial compares with another treatment - results may be better when compared to placebo.
This PaperPovidone-Iod..All
The Effect of Povidone‐Iodine Nasal Spray on Nasopharyngeal SARS‐CoV‐2 Viral Load: A Randomized Control Trial
MD David Zarabanda, MD Neelaysh Vukkadala, MD Katie M Phillips, Z Jason Qian, Kenji O Mfuh, Matthew J Hatter, MD Ivan T Lee, MD Vidya K Rao, MD Peter H Hwang, MD George Domb, Orcid ID Zara M Patel, MD PhD Benjamin A Pinsky, MD PhD Jayakar V Nayak
The Laryngoscope, doi:10.1002/lary.29935
Objectives To determine the effect of povidone-iodine (PVP-I) nasal sprays on nasopharyngeal (NP) viral load as assessed by cycle threshold on quantitative polymerase chain reaction (qPCR) of SARS-CoV-2 in outpatients. Study Design Three arm, triple blinded, randomized, placebo-controlled clinical trial. Methods Participants were randomized within 5 days of testing positive for COVID-19 to receive nasal sprays containing either placebo (0.9% saline), 0.5% PVP-I, or 2.0% PVP-I. NP swabs for qPCR analysis were taken at baseline, 1-hour post-PVP-I spray (2 sprays/nostril),
Anderson, David, Scholz, Efficacy of skin and nasal povidone-iodine preparation against mupirocin-resistant methicillin-resistant Staphylococcus aureus and S. aureus within the anterior nares, Antimicrob Agents Chemother, doi:10.1128/AAC.04624-14
Anderson, Sivalingam, Kang, Povidone-Iodine Demonstrates Rapid In Vitro Virucidal Activity Against SARS-CoV-2, The Virus Causing COVID-19 Disease, Infect Dis Ther, doi:10.1007/s40121-020-00316-3
Baden, Sahly, Essink, Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine, N Engl J Med, doi:10.1056/NEJMoa2035389
Cevik, Tate, Lloyd, Maraolo, Schafers et al., SARS-CoV-2, SARS-CoV, and MERS-CoV viral load dynamics, duration of viral shedding, and infectiousness: a systematic review and meta-analysis, The Lancet Microbe, doi:10.1016/S2666-5247(20)30172-5
Corman, Landt, Kaiser, Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR, Eurosurveillance, doi:10.2807/1560-7917.ES.2020.25.3.2000045
Doty, Shaman, Dann, Development of the University of Pennsylvania Smell Identification Test: a standardized microencapsulated test of olfactory function, Physiol Behav, doi:10.1016/0031-9384(84)90269-5
Fajnzylber, Regan, Coxen, SARS-CoV-2 viral load is associated with increased disease severity and mortality, Nat Commun, doi:10.1038/s41467-020-19057-5
Forum, More on Betadine from JAMA
Frank, Brown, Capriotti, Westover, Pelletier et al., In Vitro Efficacy of a Povidone-Iodine Nasal Antiseptic for Rapid Inactivation of SARS-CoV-2, JAMA Otolaryngol -Head Neck Surg, doi:10.1001/jamaoto.2020.3053
Gluck, Martin, Bosse, Reimer, Mueller, A clinical study on the tolerability of a liposomal povidone-iodine nasal spray: Implications for further development, ORL, doi:10.1159/000097758
Guenezan, Garcia, Strasters, Povidone Iodine Mouthwash, Gargle, and Nasal Spray to Reduce Nasopharyngeal Viral Load in Patients With COVID-19, JAMA Otolaryngol Neck Surg, doi:10.1001/jamaoto.2020.5490
Hogan, Huang, Sahoo, Strand-Specific Reverse Transcription PCR for Detection of Replicating SARS-CoV-2, Emerg Infect Dis, doi:10.3201/eid2702.204168
Hogan, Sahoo, Huang, Comparison of Panther Fusion and a laboratory-developed test targeting the envelope gene for detection of SARS-CoV-2, J Clin Virol, doi:10.1016/j.jcv.2020.104383
Kirk-Bayley, Challacombe, Sunkaraneni, Combes, The Use of Povidone Iodine Nasal Spray and Mouthwash During the Current COVID-19 Pandemic May Protect Healthcare Workers and Reduce Cross Infection, SSRN Electron J, doi:10.2139/ssrn.3563092
Lee, Nakayama, Wu, ACE2 localizes to the respiratory cilia and is not increased by ACE inhibitors or ARBs, Nat Commun, doi:10.1038/s41467-020-19145-6
Mangram, Horan, Pearson, Silver, Jarvis, Guideline for Prevention of Surgical Site Infection, 1999, Infect Control Hosp Epidemiol, doi:10.1086/501620
Polack, Thomas, Kitchin, Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine, N Engl J Med, doi:10.1056/NEJMoa2034577
Sungnak, Huang, Bécavin, SARS-CoV-2 entry factors are highly expressed in nasal epithelial cells together with innate immune genes, Nat Med, doi:10.1038/s41591-020-0868-6
Urbaniak, Plous, Research Randomizer
Yan, Faraji, Prajapati, Boone, Deconde, Association of chemosensory dysfunction and Covid-19 in patients presenting with influenza-like symptoms, Int Forum Allergy Rhinol, doi:10.1002/alr.22579
Zacharioudakis, Prasad, Zervou, Association of SARS-CoV-2 Genomic Load with COVID-19 Patient Outcomes, Ann Am Thorac Soc, doi:10.1513/AnnalsATS.202008-931RL
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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