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Cheema HA, Jafar U, Shahid A, Masood W, Usman M, Hermis AH, Naseem MA, Sahra S, Sah R, Lee KY. Colchicine for the treatment of patients with COVID-19: an updated systematic review and meta-analysis of randomised controlled trials. BMJ Open 2024; 14:e074373. [PMID: 38631824 PMCID: PMC11029412 DOI: 10.1136/bmjopen-2023-074373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES We conducted an updated systematic review and meta-analysis to investigate the effect of colchicine treatment on clinical outcomes in patients with COVID-19. DESIGN Systematic review and meta-analysis. DATA SOURCES We searched PubMed, Embase, the Cochrane Library, medRxiv and ClinicalTrials.gov from inception to January 2023. ELIGIBILITY CRITERIA All randomised controlled trials (RCTs) that investigated the efficacy of colchicine treatment in patients with COVID-19 as compared with placebo or standard of care were included. There were no language restrictions. Studies that used colchicine prophylactically were excluded. DATA EXTRACTION AND SYNTHESIS We extracted all information relating to the study characteristics, such as author names, location, study population, details of intervention and comparator groups, and our outcomes of interest. We conducted our meta-analysis by using RevMan V.5.4 with risk ratio (RR) and mean difference as the effect measures. RESULTS We included 23 RCTs (28 249 participants) in this systematic review. Colchicine did not decrease the risk of mortality (RR 0.99; 95% CI 0.93 to 1.05; I2=0%; 20 RCTs, 25 824 participants), with the results being consistent among both hospitalised and non-hospitalised patients. There were no significant differences between the colchicine and control groups in other relevant clinical outcomes, including the incidence of mechanical ventilation (RR 0.75; 95% CI 0.48 to 1.18; p=0.22; I2=40%; 8 RCTs, 13 262 participants), intensive care unit admission (RR 0.77; 95% CI 0.49 to 1.22; p=0.27; I2=0%; 6 RCTs, 961 participants) and hospital admission (RR 0.74; 95% CI 0.48 to 1.16; p=0.19; I2=70%; 3 RCTs, 8572 participants). CONCLUSIONS The results of this meta-analysis do not support the use of colchicine as a treatment for reducing the risk of mortality or improving other relevant clinical outcomes in patients with COVID-19. However, RCTs investigating early treatment with colchicine (within 5 days of symptom onset or in patients with early-stage disease) are needed to fully elucidate the potential benefits of colchicine in this patient population. PROSPERO REGISTRATION NUMBER CRD42022369850.
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Affiliation(s)
| | - Uzair Jafar
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Abia Shahid
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Waniyah Masood
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Usman
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Alaa Hamza Hermis
- Nursing College, Al-Mustaqbal University, 51001 Hillah, Babylon, Iraq
| | | | - Syeda Sahra
- Department of Infectious Diseases, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ranjit Sah
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune 411018, Maharashtra, India
| | - Ka Yiu Lee
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
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Liu TH, Wu JY, Huang PY, Tsai YW, Hsu WH, Chuang MH, Tang HJ, Lai CC. Clinical efficacy of N-acetylcysteine for COVID-19: A systematic review and meta-analysis of randomized controlled trials. Heliyon 2024; 10:e25179. [PMID: 38318025 PMCID: PMC10839595 DOI: 10.1016/j.heliyon.2024.e25179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 02/07/2024] Open
Abstract
Background The association between N-acetylcysteine (NAC) and COVID-19 remains undetermined; therefore, this meta-analysis assessed the clinical efficacy of NAC in the treatment of patients with COVID-19. Methods This study searched PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov for studies published from their inception to December 17, 2022. Only randomized controlled trials (RCTs) that assessed the clinical efficacy of NAC for patients with COVID-19 were included. Results Five RCTs involving 651 patients were included. There was no significant difference in mortality between the study group receiving NAC and the control group (15.6 % [50/320] vs. 32.3 %, [107/331]; risk ratio [RR]: 0.58; 95 % confidence interval [CI]: 0.24-1.40). In addition, the two groups did not differ with respect to the incidence of invasive mechanical ventilation (RR: 0.93; 95 % CI: 0.65-1.33), the risk of intensive care unit (ICU) admission (RR: 0.86; 95 % CI: 0.62-1.21), the length of hospital stay (mean difference [MD]: 0.17 days; 95 % CI: -0.67-1.01), and the length of ICU stay (MD: -0.77 days; 95 % CI: -2.97-1.42). Conclusions The administration of NAC did not improve the clinical outcomes of patients with COVID-19; its routine use is not recommended for patients with SARS-CoV-2 infections.
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Affiliation(s)
- Ting-Hui Liu
- Department of Psychiatry, Chi Mei Medical Center, Tainan City, Taiwan
| | - Jheng-Yan Wu
- Department of Nutrition, Chi Mei Medical Center, Tainan City, Taiwan
| | - Po-Yu Huang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan City, Taiwan
| | - Ya-Wen Tsai
- Center for Integrative Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Wan-Hsuan Hsu
- Department of Internal Medicine, Chi Mei Medical Center, Tainan City, Taiwan
| | - Min-Hsiang Chuang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan City, Taiwan
| | - Hung-Jen Tang
- Department of Nutrition, Chi Mei Medical Center, Tainan City, Taiwan
| | - Chih-Cheng Lai
- Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
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Hejazi S, Jahani Z, Elyasi S, Salarbashi D, Kabiri M. The Efficacy of Colchicine as an Adjunct Therapy in Non-hospitalized COVID-19 Patients: A Randomized Placebo-Controlled Trial. RECENT ADVANCES IN ANTI-INFECTIVE DRUG DISCOVERY 2024; 19:254-263. [PMID: 37711106 DOI: 10.2174/2772434418666230914113010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/10/2023] [Accepted: 08/18/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The therapeutic potential of oral colchicine administration may help combat COVID-19 infection due to reduced disease severity and mortality risk. OBJECTIVE This randomized trial aimed to assess the effect of colchicine treatment on the inflammatory and hematologic markers as well as clinical features in non-hospitalized patients with mild-to-moderate COVID-19 disease. METHODS In the present placebo-controlled randomized trial, 80 non-hospitalized COVID-19 patients were enrolled and followed for 14 days. Subjects randomly received oral colchicine or placebo tablets once a day for two weeks. The fever and cough clinical signs, as well as Creactive protein (CRP) and lymphopenia, were evaluated through the follow-up. RESULTS No significant between-group differences were observed in terms of the duration of clinical symptoms, CRP, and lymphopenia at 0, 7, and 14 days of intervention. Although the proportion of participants with fever, cough, positive CRP, and lymphopenia was higher reduced in the colchicine group than the placebo during treatment, no significant differences were found between groups. Due to no adverse effects detected in this trial, colchicine therapy was well-tolerated and safe. CONCLUSION Our findings revealed that colchicine adjuvant therapy had no beneficial effect on clinical and para-clinical parameters in non-hospitalized COVID-19 patients during 14 days of intervention. The present trial does not support colchicine as a potential treatment against COVID-19 disease.
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Affiliation(s)
- Sepideh Hejazi
- Lung Diseases Research Center, Mashhad University of Medical Sciences, Ghaem Hospital, Mashhad, Iran
| | - Zohreh Jahani
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Ghaem Hospital, Mashhad, Iran
| | - Sepideh Elyasi
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Davoud Salarbashi
- Infectious Diseases Research Centre, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Mona Kabiri
- Nanotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
- Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Danjuma MI, Sayed R, Aboughalia M, Hassona A, Elsayed BS, Elshafei M, Elzouki A. Does colchicine reduce mortality in patients with COVID-19 clinical syndrome? An umbrella review of published meta-analyses. Heliyon 2023; 9:e20155. [PMID: 37767472 PMCID: PMC10520783 DOI: 10.1016/j.heliyon.2023.e20155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 07/25/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Background Despite significant improvements in both treatment and prevention strategies, as well as multiple commissioned reviews, there remains uncertainty regarding the survival benefit of repurposed drugs such as colchicine in patients with Coronavirus Disease 2019 (COVID-19) clinical syndrome. Methods In this umbrella review, we carried out a comprehensive search of PubMed, EMBASE, Cochrane Database of Systematic Reviews, Science Citation Index, and the Database of Abstracts of Reviews of Effectiveness between January 1, 2020 and January 31, 2023 for systematic reviews and meta-analyses evaluating the mortality-reducing benefits of colchicine in patients with COVID-19. This was to ascertain the exact relationship between colchicine exposure and mortality outcomes in these cohorts of patients. We utilized A Measurement Tool to Assess systematic Reviews-2 (AMSTAR-2) to conduct an exhaustive methodological quality and risk of bias assessment of the included reviews. Results We included eighteen meta-analyses (n = 199,932 participants) in this umbrella review. Colchicine exposure was associated with an overall reduction of about 32% in the risk of mortality (odds ratio 0.68, confidence interval [CI] 0.58-0.78; I2 = 94%, p = 0.001). Further examination of pooled estimates of mortality outcomes by the quality effects model (corrected for the methodological quality and risk of bias of the constituent reviews) reported similar point estimates (OR 0.73; CI 0.59 to 0.91; I2 = 94%). Conclusion In a pooled umbrella evaluation of published meta-analyses of COVID-19 patient cohorts, exposure to colchicine was associated with a reduction in overall mortality. Although it remains uncertain if this effect could potentially be attenuated or augmented by COVID-19 vaccination.
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Affiliation(s)
- Mohammed I. Danjuma
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
- Department of Internal Medicine, Weill Cornell College of Medicine, New York, Doha, Qatar
- NHS Grampian (Dr. Grays Hospital), Scotland, UK
| | - Rana Sayed
- Department of Internal Medicine, Qatar University College of Medicine, Doha, Qatar
| | - Maryam Aboughalia
- Department of Internal Medicine, Qatar University College of Medicine, Doha, Qatar
| | - Aseel Hassona
- Department of Internal Medicine, Qatar University College of Medicine, Doha, Qatar
| | - Basant Selim Elsayed
- Department of Internal Medicine, Qatar University College of Medicine, Doha, Qatar
| | | | - Abdelnaser Elzouki
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
- Department of Internal Medicine, Weill Cornell College of Medicine, New York, Doha, Qatar
- Department of Internal Medicine, Qatar University College of Medicine, Doha, Qatar
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Danjuma MI, Kaul R, Alyaarabi T, Elsayed B, Elshafei M. Colchicine and mortality outcomes in patients with coronavirus disease (COVID-19). Eur J Intern Med 2023; 112:126-127. [PMID: 36804360 PMCID: PMC9933322 DOI: 10.1016/j.ejim.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 02/18/2023]
Affiliation(s)
- Mohammed I Danjuma
- Department of Internal Medicine, Hamad Medical Corporation, Doha Qatar; Department of Internal Medicine, Weill Cornell College of Medicine, New York, and Doha Qatar.
| | - Ridhima Kaul
- Department of Internal Medicine, Weill Cornell College of Medicine, New York, and Doha Qatar
| | - Tamader Alyaarabi
- Department of Internal Medicine, Qatar University College of Medicine
| | - Basant Elsayed
- Department of Internal Medicine, Qatar University College of Medicine
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Colchicine reduces the activation of NLRP3 inflammasome in COVID-19 patients. Inflamm Res 2023; 72:895-899. [PMID: 36917217 PMCID: PMC10013297 DOI: 10.1007/s00011-023-01718-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/08/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVE To evaluate whether colchicine treatment was associated with the inhibition of NLRP3 inflammasome activation in patients with COVID-19. METHODS We present a post hoc analysis from a double-blinded placebo-controlled randomized clinical trial (RCT) on the effect of colchicine for the treatment of COVID-19. Serum levels of NOD-like receptor protein 3 (NLRP3) inflammasome products-active caspase-1 (Casp1p20), IL-1β, and IL-18-were assessed at enrollment and after 48-72 h of treatment in patients receiving standard-of-care (SOC) plus placebo vs. those receiving SOC plus colchicine. The colchicine regimen was 0.5 mg tid for 5 days, followed by 0.5 mg bid for another 5 days. RESULTS Thirty-six patients received SOC plus colchicine, and thirty-six received SOC plus placebo. Colchicine reduced the need for supplemental oxygen and the length of hospitalization. On Days 2-3, colchicine lowered the serum levels of Casp1p20 and IL-18, but not IL-1β. CONCLUSION Treatment with colchicine inhibited the activation of the NLRP3 inflammasome, an event triggering the 'cytokine storm' in COVID-19. TRIAL REGISTRATION NUMBERS RBR-8jyhxh.
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Perricone C, Scarsi M, Brucato A, Pisano P, Pigatto E, Becattini C, Cingolani A, Tiso F, Prota R, Tomasoni LR, Cutolo M, Tardella M, Rozza D, Zerbino C, Andreoni M, Poletti V, Bartoloni E, Gerli R. Treatment with COLchicine in hospitalized patients affected by COVID-19: The COLVID-19 trial. Eur J Intern Med 2023; 107:30-36. [PMID: 36396522 PMCID: PMC9618432 DOI: 10.1016/j.ejim.2022.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/12/2022] [Accepted: 10/20/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate whether the addition of colchicine to standard of care (SOC) results in better outcomes in hospitalized patients with COVID-19. DESIGN This interventional, multicenter, randomized, phase 2 study, evaluated colchicine 1.5 mg/day added to SOC in hospitalized COVID-19 patients (COLVID-19 trial) and 227 patients were recruited. The primary outcome was the rate of critical disease in 30 days defined as need of mechanical ventilation, intensive care unit (ICU), or death. RESULTS 152 non-anti-SARS-CoV-2-vaccinated patients (colchicine vs controls: 77vs75, mean age 69.1±13.1 vs 67.9±15 years, 39% vs 33.3% females, respectively) were analyzed. There was no difference in co-primary end-points between patients treated with colchicine compared to controls (mechanical ventilation 5.2% vs 4%, ICU 1.3% vs 5.3%, death 9.1% vs 6.7%, overall 11 (14.3%) vs 10 (13.3%) patients, P=ns, respectively). Mean time to discharge was similar (colchicine vs controls 14.1±10.4 vs 14.7±8.1 days). Older age (>60 years, P=0.025), P/F<275 mmHg (P=0.005), AST>40 U/L (P<0.001), pre-existent heart (P=0.02), lung (P=0.003), upper-gastrointestinal (P=0.014), lower-gastrointestinal diseases (P=0.009) and cancer (P=0.008) were predictive of achieving the primary outcome. Diarrhoea (9.1% vs 0%, p=0.0031) and increased levels of AST at 6 days (76.9±91.8 vs 33.5±20.7 U/l, P=0.016) were more frequent in the colchicine group. CONCLUSION Colchicine did not reduce the rate and the time to the critical stage. Colchicine was relatively safe although adverse hepatic effects require caution. We confirm that older (>60 years) patients with comorbidities are characterized by worse outcome.
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Affiliation(s)
- Carlo Perricone
- Reumatologia, Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italy
| | | | - Antonio Brucato
- Università degli Studi di Milano, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Paola Pisano
- Asl Cagliari, Dipartimento di Area Medica, Struttura Complessa Medicina Interna, Italy
| | - Erika Pigatto
- Ospedale Classificato Villa Salus, Mestre (VE), Italy
| | - Cecilia Becattini
- Medicina Interna, Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italy
| | | | - Francesco Tiso
- Medicina d'urgenza, Ospedale Alto Vicentino - AULSS 7 Pedemontana, Santorso (VI), Italy
| | - Roberto Prota
- Azienda Ospedaliera Ordine Mauriziano, Torino, Italy
| | | | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology, Division of Rheumatology, Department of Internal Medicine, University of Genova, IRCCS Polyclinic Hospital San Martino, Genoa, Italy
| | - Marika Tardella
- Ospedale Carlo Urbani - Università Politecnica delle Marche, Ancona, Italy
| | - Davide Rozza
- Centro Studi SIR, Società Italiana di Reumatologia, Milan, Italy
| | | | - Massimo Andreoni
- Malattie Infettive, Dipartimento Processi Assistenziali Integrati, Policlinico Tor Vergata, Rome, Italy
| | - Venerino Poletti
- Dipartimento Toracico, Azienda AUSL Romagna, Ospedale G.B. Morgagni, Forlì, Italy; Department of Respiratory Diseases and Allergy, Aarhus University, Aarhus, Denmark
| | - Elena Bartoloni
- Reumatologia, Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italy
| | - Roberto Gerli
- Reumatologia, Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italy.
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Efficacy and safety of nitazoxanide in treating SARS-CoV-2 infection: a systematic review and meta-analysis of blinded, placebo-controlled, randomized clinical trials. Eur J Clin Pharmacol 2022; 78:1813-1821. [PMID: 36066651 PMCID: PMC9446612 DOI: 10.1007/s00228-022-03380-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/30/2022] [Indexed: 12/15/2022]
Abstract
Purpose Nitazoxanide is a broad-spectrum antiparasitic that has been tested for COVID-19 due to its anti-inflammatory effects and in vitro antiviral activity. This study synthesized the best evidence on the efficacy and safety of nitazoxanide in COVID-19. Methods Searches for studies were performed in peer-reviewed and grey-literature from January 1, 2020 to May 23, 2022. The following elements were used to define eligibility criteria: (1) Population: individuals with COVID-19; (2) Intervention: nitazoxanide; (3) Comparison: placebo; (4) Outcomes: primary outcome was death, and secondary outcomes were viral load, positive RT-PCR status, serum biomarkers of inflammation, composite measure of disease progression (ICU admission or invasive mechanical ventilation), and any adverse events; (5) Study type: blinded, placebo-controlled, randomized clinical trials (RCTs). Treatment effects were reported as relative risk (RR) for dichotomous variables and standardized mean difference (SMD) for continuous variables with 95% confidence intervals (CI). Results Five blinded, placebo-controlled RCTs were included and enrolled individuals with mild or moderate SARS-CoV-2 infection. We found no difference between nitazoxanide and placebo in reducing viral load (SMD = − 0.16; 95% CI − 0.38 to 0.05) and the frequency of positive RTP-PCR results (RR = 0.92; 95% CI 0.81 to 1.06). In addition, there was no decreased risk for disease progression (RR = 0.63; 95% CI 0.38 to 1.04) and death (RR = 0.81; 95% CI 0.36 to 1.78) among patients receiving nitazoxanide. Patients with COVID-19 treated with nitazoxanide had decreased levels of white blood cells (SMD = − 0.15; 95% − 0.29 to − 0.02), lactate dehydrogenase (LDH) (SMD − 0.32; 95% − 0.52 to − 0.13), and D-dimer (SMD − 0.49; 95% CI − 0.68 to − 0.31) compared to placebo, but the magnitude of effect was considered small to moderate. Conclusion This systematic review showed no evidence of clinical benefits of the use of nitazoxanide to treat patients with mild or moderate COVID-19. In addition, we found a reduction in WBC, LDH, and D-dimer levels among nitazoxanide-treated patients, but the effect size was considered small to moderate. Supplementary Information The online version contains supplementary material available at 10.1007/s00228-022-03380-5.
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