A small study from India, but buttressed with a prospective larger study, soon to be published has advanced the case for the use of indomethacin, a powerful anti-inflammatory drug, in low doses, for effective treatment of milder COVID-19 cases.
The case was made in a letter published in International Journal of Medical Reviews and Case Reports (2020) by Ravichandran Rajan, of the Madras Institute of Nephrology; Srinivasan Subramanian of Voluntary Health Services Hospital; and Chritine Clark of the Royal Pharmaceutical Society, UK.
Lead author and senior nephrologist Rajan Ravichandran says currently, paracetamol is widely used for symptomatic treatment in COVID-19, but with poor results. “In the paper, we describe our experience in using indomethacin, a low-priced drug, in a small number of patients with COVID-19, including those classified as ‘high-risk’. The results were very encouraging, and that became the basis for a project supported by IIT-Madras, studying the impact of indomethacin in a larger subset of patients, 100, in two hospitals.”
A 2006 Pubmed article by Carla Amici and colleagues from the University of Rome Tor Vergata, Italy, identified indomethacin as a potent inhibitor of coronavirus (SARS-CoV) replication and suggested that having both anti-inflammatory and antiviral activity, it could be beneficial in SARS therapy.
Dr. Ravichandran adds that indomethacin is a powerful anti-inflammatory drug, one that gives relief even with low doses. The drug helps control the dry, persistent cough that is a common feature among COVID-19 patients.
He says the drug has been used for over 35 years, and with much success. In addition to being an anti-inflammatory, it has anti-viral properties, he argues. “We have also observed its efficiency when we deal with the impact of the cytomegalovirus among post-transplant patients who have poor immunity. It has an effect on suppressing the cytokine release syndrome, and ameliorating the side effects thereof.”
The paper describes 17 patients who tested positive for COVID-19 and were treated at home with two doses of indomethacin. All of them were given indomethacin 25mg twice daily. In 14 patients, fever, cough and musculoskeletal pain resolved after two doses. One patient required escalation of dose to 75mg and became asymptomatic after five days. Two patients developed low levels of oxygen saturation and were started on steroids. “Of the 15 patients who became asymptomatic, four were renal transplant recipients, one on maintenance dialysis, two were over 80 years of age, three had type 2 diabetes mellitus, and one was obese.”
“Our approach is to start treatment with a low dose of indomethacin as early as possible in the course of the disease to reduce the severity of symptoms — fever, coughing and musculoskeletal pain. We believe this can reduce the need for hospitalisation and the risk of spreading the disease,” Dr. Ravichandran says.
The preliminary results of the larger study, being conducted in Chennai and Nellore, are also showing positive responses from patients, he says. Only people with adequate oxygen saturation are being taken up for such intervention, he adds.
