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Thakar A, Panara K, Goyal M, Kumari R, Sungchol K. Ayush [Indian System of Medicines] Prophylaxis Against COVID-19: A Living Systematic Review and Meta-Analysis (Second Update). JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:602-619. [PMID: 38422192 DOI: 10.1089/jicm.2023.0357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Background: Ayush (Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy) system of medicine has been extensively used in India for the prevention and management of coronavirus disease 2019 (COVID-19). The present report is the second update of a living systematic review and meta-analysis and has been intended to assess the preventive potential and safety of Ayush drugs against COVID-19. Methods: A search of databases such as PubMed, the Cochrane central register of controlled trials, the World Health Organization (WHO) COVID-19 database, the clinical trial registry-India, the AYUSH research portal, and preprint repositories was performed till March 1, 2023. Randomized controlled trials or analytical observational studies were included. Incidences of COVID-19 infections and mortality were taken as primary outcome measures; and symptomatic severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) infection, incidences of hospital admissions, and adverse events were taken as secondary outcomes. The risk of bias was evaluated by version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB-2) and the Risk of Bias in Non-Randomized Studies-of Interventions (ROBINS-I) tool. Data were synthesized through the RevMan 5.4 tool, and the certainty of the evidence was ranked through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: Out of 2350 articles, 15 studies were included in the review. The pooled estimate of Guduchi [Tinospora cordifolia (Thunb.) Miers], Chyawanprasha, and Ayuraksha kit was obtained. Meta-analysis of the data suggested that Guduchi may reduce the incidences of COVID-19 infections (risk ratio [RR]: 0.67 [95% confidence interval, CI: 0.48-0.95]) and the symptom development among the infected (RR: 0.88 [95% CI: 0.73-1.08]), however, no change was observed in hospital admissions (RR: 0.96 [95% CI: 0.20-4.53]). It is uncertain that Chyawanprasha reduces the incidence of COVID-19 infection (RR: 0.28; [95% CI: 0.07-1.08]). Ayuraksha kit as chemoprophylaxis may reduce the incidences of COVID-19 infections (RR: 0.49; [95% CI: 0.32-0.77]). The certainty of the evidence was low to moderate mainly due to the serious risk of bias. Conclusion: Prophylactic use of Ayush medicines for populations at risk may help to prevent COVID-19 infection by reducing incidence and severity. However, considering the certainty and fewer studies, high-quality studies are still desired to confirm the efficacy and safety of Ayush chemoprophylaxis for COVID-19. Nevertheless, this update will serve as a torchbearer for policymakers, physicians, and other stakeholders for their decision-making through evidence-based medicine.
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Affiliation(s)
- Anup Thakar
- Department of Panchakarma, Institute of Teaching and Research in Ayurveda, Jamnagar, India
| | - Kalpesh Panara
- Department of Dravyaguna, Institute of Teaching and Research in Ayurveda, Jamnagar, India
| | - Mandip Goyal
- Department of Kayachikitsa, Institute of Teaching and Research in Ayurveda, Jamnagar, India
| | - Ritu Kumari
- Department of Panchakarma, Institute of Teaching and Research in Ayurveda, Jamnagar, India
| | - Kim Sungchol
- SE/HSD Department of Health Systems Development, WHO, SEARO, New Delhi, India
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Verma M, Rawat N, Rani R, Singh M, Choudhary A, Abbasi S, Kumar M, Kumar S, Tanwar A, Misir BR, Khanna S, Agrawal A, Faruq M, Rai S, Tripathi R, Kumar A, Pujani M, Bhojani M, Pandey AK, Nesari T, Prasher B. Adhatoda vasica and Tinospora cordifolia extracts ameliorate clinical and molecular markers in mild COVID-19 patients: a randomized open-label three-armed study. Eur J Med Res 2023; 28:556. [PMID: 38049897 PMCID: PMC10696694 DOI: 10.1186/s40001-023-01507-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 11/04/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND SARS-CoV-2 infections caused mild-to-moderate illness. However, a sizable portion of infected people experience a rapid progression of hyper-inflammatory and hypoxic respiratory illness that necessitates an effective and safer remedy to combat COVID-19. METHODS A total of 150 COVID-19-positive patients with no to mild symptoms, between the age groups 19-65 years were enrolled in this randomized, open-labeled three-armed clinical trial. Among them, 136 patients completed the study with RT-PCR negative reports. The patients received herbal drugs orally (Group A (Adhatoda vasica; AV; 500 mg; n = 50); Group B (Tinospora cordifolia; TC; 500 mg; n = 43), and Group C (AV + TC; 250 mg each; n = 43)) for 14 days. Clinical symptoms, vital parameters, and viral clearance were taken as primary outcomes, and biochemical, hematological parameters, cytokines, and biomarkers were evaluated at three time points as secondary outcomes. RESULTS We found that the mean viral clearance time was 13.92 days (95% confidence interval [CI] 12.85-14.99) in Group A, 13.44 days (95% confidence interval [CI] 12.14-14.74) in Group B, and 11.86 days (95% confidence interval [CI] 10.62-13.11) days in Group C. Over a period of 14 days, the mean temperature in Groups A, and B significantly decreased linearly. In Group A, during the trial period, eosinophils, and PT/INR increased significantly, while monocytes, SGOT, globulin, serum ferritin, and HIF-1α, a marker of hypoxia reduced significantly. On the other hand, in Group B hsCRP decreased at mid-treatment. Eosinophil levels increased in Group C during the treatment, while MCP-3 levels were significantly reduced. CONCLUSIONS All the patients of the three-armed interventions recovered from COVID-19 and none of them reported any adverse effects from the drugs. Group C patients (AV + TC) resulted in a quicker viral clearance as compared to the other two groups. We provide the first clinical report of AV herbal extract acting as a modifier of HIF-1α in COVID-19 patients along with a reduction in levels of ferritin, VEGF, and PT/INR as the markers of hypoxia, inflammation, and thrombosis highlighting the potential use in progression stages, whereas the TC group showed immunomodulatory effects. Trial registration Clinical Trials Database -India (ICMR-NIMS), CTRI/2020/09/028043. Registered 24th September 2020, https://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=47443&EncHid=&modid=&compid=%27,%2747443det%27.
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Grants
- GAP-0183 Ministry of AYUSH, Government of India
- GAP-0183 Ministry of AYUSH, Government of India
- GAP-0183 Ministry of AYUSH, Government of India
- GAP-0183 Ministry of AYUSH, Government of India
- GAP-0183 Ministry of AYUSH, Government of India
- GAP-0183 Ministry of AYUSH, Government of India
- GAP-0183 Ministry of AYUSH, Government of India
- GAP-0183 Ministry of AYUSH, Government of India
- GAP-0183 Ministry of AYUSH, Government of India
- GAP-0183 Ministry of AYUSH, Government of India
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Affiliation(s)
- Mukta Verma
- Centre of Excellence for Applied Development of Ayurveda Prakriti and Genomics, CSIR-Institute of Genomics & Integrative Biology, Delhi, India
- All India Institute of Ayurveda, New Delhi, India
| | - Neha Rawat
- Centre of Excellence for Applied Development of Ayurveda Prakriti and Genomics, CSIR-Institute of Genomics & Integrative Biology, Delhi, India
- All India Institute of Ayurveda, New Delhi, India
| | - Ritu Rani
- Centre of Excellence for Applied Development of Ayurveda Prakriti and Genomics, CSIR-Institute of Genomics & Integrative Biology, Delhi, India
- CSIR-Institute of Genomics & Integrative Biology, Delhi, India
| | - Manju Singh
- Centre of Excellence for Applied Development of Ayurveda Prakriti and Genomics, CSIR-Institute of Genomics & Integrative Biology, Delhi, India
- CSIR-Institute of Genomics & Integrative Biology, Delhi, India
| | - Aditi Choudhary
- Centre of Excellence for Applied Development of Ayurveda Prakriti and Genomics, CSIR-Institute of Genomics & Integrative Biology, Delhi, India
- CSIR-Institute of Genomics & Integrative Biology, Delhi, India
| | - Sarfaraz Abbasi
- CSIR-Institute of Genomics & Integrative Biology, Delhi, India
| | - Manish Kumar
- CSIR-Institute of Genomics & Integrative Biology, Delhi, India
| | - Sachin Kumar
- ESIC Medical College and Hospital, Faridabad, Haryana, India
| | - Ankur Tanwar
- Centre of Excellence for Applied Development of Ayurveda Prakriti and Genomics, CSIR-Institute of Genomics & Integrative Biology, Delhi, India
- All India Institute of Ayurveda, New Delhi, India
| | - Bishnu Raman Misir
- Centre of Excellence for Applied Development of Ayurveda Prakriti and Genomics, CSIR-Institute of Genomics & Integrative Biology, Delhi, India
- CSIR-Institute of Genomics & Integrative Biology, Delhi, India
| | - Sangeeta Khanna
- CSIR-Institute of Genomics & Integrative Biology, Delhi, India
| | - Anurag Agrawal
- Trivedi School of Biosciences, Ashoka University, Sonipat, Haryana, India
| | - Mohammed Faruq
- CSIR-Institute of Genomics & Integrative Biology, Delhi, India
| | - Shalini Rai
- All India Institute of Ayurveda, New Delhi, India
| | | | - Anil Kumar
- All India Institute of Ayurveda, New Delhi, India
| | - Mukta Pujani
- ESIC Medical College and Hospital, Faridabad, Haryana, India
| | | | | | | | - Bhavana Prasher
- Centre of Excellence for Applied Development of Ayurveda Prakriti and Genomics, CSIR-Institute of Genomics & Integrative Biology, Delhi, India.
- CSIR-Institute of Genomics & Integrative Biology, Delhi, India.
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Sharma S, Kumari K, Sethuraman G, Abdelwahab MM, Sivaperumal Yadav S, Nandini V. An Ayurvedic Medication (Chyawanprash) as a Prophylaxis for Non-Communicable Disease and Communicable Disease: A Protocol for Systematic Review and Meta-Analysis. Cureus 2023; 15:e47555. [PMID: 38021581 PMCID: PMC10665970 DOI: 10.7759/cureus.47555] [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] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Globally, non-communicable diseases (NCDs) and communicable diseases (CDs) are on the rise, posing a significant public health threat. A holistic ayurvedic preparation called chyawanprash (CP) has shown positive outcomes in NCDs and CDs. Hence, we aimed to report the outcomes in a systematic manner. To determine the safety, efficacy, healthcare utilization, and quality of life of CP as an optional therapy for NCD and CD management. This systematic review will adhere to PRISMA-P and Cochrane guidelines for methodological considerations. It will evaluate CP efficacy in diverse populations, considering Ayurvedic and non-Ayurvedic comparators. The study design will encompass randomized controlled trials (RCTs) published from 2010 to 2023 in healthcare settings, controlled environments, and communities. We will also analyze primary outcomes related to immunity biomarkers, vital signs, and secondary outcomes such as quality of life. Data sources and search strategy will involve systematic searches in databases such as Cochrane, PubMed, Google Scholar, Web of Science, and Scopus using MeSH terms and Boolean operators. Screening and data extraction will follow a standardized form with four independent reviewers. Quality assessment will use the Cochrane risk of bias tool. The systematic review will provide an exhaustive summary of the effectiveness and safety of CP to address the growing burden of NCDs and CDs. Registration: CRD42023418994.
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Affiliation(s)
- Shubham Sharma
- Public Health, Indian Institute of Public Health Gandhinagar, Gandhinagar, IND
| | - Khushboo Kumari
- Public Health, Indian Council of Medical Research, Rajendra Memorial Research Institute of Medical Sciences, Patna, IND
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Verster JC, Kraneveld AD, Garssen J. The Assessment of Immune Fitness. J Clin Med 2022; 12:jcm12010022. [PMID: 36614822 PMCID: PMC9821524 DOI: 10.3390/jcm12010022] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Immune fitness (i.e., adequate functioning of the immune system) is essential to maintain health, prevent and resolve disease, and improve quality of life. This article provides an overview of how to assess immune fitness. It discusses how a single-item rating scale can be used to assess immune fitness. The scale can be used in conjunction with a single "yes" or "no" question asking whether the individual is experiencing reduced immune fitness. Retrospective assessments can be complemented with the Immune Status Questionnaire (ISQ) to provide more insight into the type and frequency of experiencing specific immune-related complaints. Momentary assessments of immune fitness can be complemented with biomarker measurements in body fluids. As individuals may be unaware of systemic inflammation (e.g., biomarker concentrations outside the normal range), it remains critical to combine immune fitness assessments with biomarker measurements of immune functioning.
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Affiliation(s)
- Joris C. Verster
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584CG Utrecht, The Netherlands
- Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC 3122, Australia
- Correspondence: ; Tel.: +31-302-536-909
| | - Aletta D. Kraneveld
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584CG Utrecht, The Netherlands
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584CG Utrecht, The Netherlands
- Global Centre of Excellence Immunology, Nutricia Danone Research, 3584CT Utrecht, The Netherlands
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