A pre-print published recently in Medrxiv has advanced the case to use indomethacin, a drug conventionally used in the treatment of rheumatoid arthritis, for faster symptomatic relief and preventing progression of pneumonia in COVID-19 patients.
A total of 104 patients who had tested COVID-19 positive received the drug, along with standard care in two centres — Narayana Medical College, Nellore, Andhra Pradesh, and Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra. The study was conceived by Rajan Ravichandran, senior nephrologist, MIOT Hospital, here, and executed along with R. Krishnakumar of the Department of Engineering Design at the Indian Institute of Technology-Madras, besides researchers from the participating hospitals. The authors have called for indomethacin to replace paracetamol if there is no contraindication for its use.
It was an open-labelled, single-arm, propensity score matching study for the efficacy and safety of indomethacin. “Though a double arm randomised clinical trial would have been ideal, we felt that ethically it would be unfair to deny patients indomethacin, given that we had seen such good results in our pilot study,” Dr. Ravichandran explained. “We did not refuse anyone the drug, but patients could opt out of the indomethacin arm,” he added.
The study was done in two groups. One, involving 82 mild and moderate patients, used the Propensity Score Match technique to compare indomethacin and paracetamol-based treatments. In the second group, severe patients (22) were treated with indomethacin in addition to remdesivir.
The authors wrote that patients treated with indomethacin had a reduction in the number of days to become fever-free, and reduction in cough and muscle pain by half compared to the paracetamol set. Only one patient of 82 in the indomethacin arm of the first group required supplementary oxygen, while 28 of 109 patients on paracetamol required supplementary oxygen. No one in the second group deteriorated enough to require mechanical ventilation. There was no evidence of adverse reaction to indomethacin or deterioration of renal or liver function, they recorded.
