Work done by Indian nephrologist cited
Early treatment of COVID-19 can help to prevent hospitalisation and complications, shows a study done in Italy.
The study, which covered the period between November 2020 and August 2021, was done by Professor Serafino Fazio and his team and published in Medical Science Monitor. It was made available online on December 8.
It recommends early treatment instead of a “wait and watch” approach towards mild or moderate infections. Many countries continue advising home isolation and paracetamol for symptomatic relief during the onset of the disease.
The Italian researchers studied 157 patients, including those with co-morbidites, who were administered a set of medicines, along with low-dose aspirin and food supplements. These patients were given azithromycin, steroids and heparin, if needed.
Professor Fazio’s article quotes the studies published by the Chennai-based nephrologist and renal transplant surgeon, Rajan Ravichandran, who had used indomethacin to treat COVID-19 patients. Incidentally, the Italian team followed his lead and used the drug. Dr. Rajan said indomethacin is used to treat inflammation in transplant patients.
Dr. Rajan published two case studies in April 2020 when he had started treating COVID-19 patients with indomethacin. He also conducted a randomised control study, which too was published.
The Italian study, he said, is important as it recommends starting treatment within 2-3 days of the onset of symptoms instead of the standard norm of waiting and administering only paracetamol.
“The Italian study has shown that if you start early, they [the patients] don’t get pneumonia and inflammation of the lungs. When the lungs get inflamed, they desaturate, requiring a higher dose of steroids. Of late, the use of paracetamol has been questioned as it leads to reduced anti-oxidants in the lungs, thus increasing the susceptibility to COVID-19 pneumonia,” Dr. Rajan said.
The study is important, he said, given that during the first and second waves of the pandemic only paracetamol and remdesivir were administered. Steroids came into play later. The authors have discussed the antiviral and anti-inflammatory action of indomethacin and the need to start empirical treatment even before the RT-PCR test results come in, he said.
“Steroids actually worsen the replication of the virus, though they reduce inflammation of the body, which produces pneumonia and other complications. Whereas indomethacin has anti-viral and anti-inflammatory action,” he said. The Italian study identified two groups and included 39 patients with hypertension;18 patients with diabetics; and 10 persons with ischaemic heart disease.
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