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Bhandari RB, Balkrishna A, Maheshkumar K, Arumugam VA. Traditional Formulations for Managing COVID-19: A Systematic Review. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:420-430. [PMID: 37972056 DOI: 10.1089/jicm.2023.0177] [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: 11/19/2023]
Abstract
Background: The advancing etiopathogenesis, diagnosis, and treatment of the global coronavirus disease 2019 (COVID-19) pandemic have prompted the medical community to consider Ayurveda, Siddha, and Unani as add-on preventive and therapeutic options. Objective: To explore the effect of standalone or integrative Traditional Formulations (TFs) on selected clinical symptoms and biomarkers of COVID-19. Search strategy: Out of 465 articles identified from PubMed, ScienceDirect, and Scopus, 17 randomized controlled trials (RCTs) with 1646 COVID-19 patients published from January 2020 to February 2022 were included in the study. Inclusion criteria: RCTs that compared the effect of standalone/integrative TFs in decoction, tablet, and powder forms with placebo plus standard care (SC)/placebo/SC as controls involving mild to severe symptomatic COVID-19 patients were included. Data extraction and analysis: Three reviewers independently assessed the titles and abstracts of each article based on the inclusion after deleting duplicates. The relevant full texts were retrieved and examined, and then their data were extracted and double-checked by three independent reviewers using prepared data extraction forms. The primary outcome variables were reverse transcription polymerase chain reaction, fever, cough, dyspnea, myalgia, headache, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and D-dimer. Results: The effect of different TFs or integrative TFs was more to inhibit severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) than the controls. There was an increase in fever and cough, a decrease in dyspnea, myalgia, headache, and ESR, no change in CRP, and a slight increase in D-dimer as an effect of TFs. Conclusions: Integrative or standalone TF may be the inexpensive preventive and therapeutic option to inhibit SARS-CoV-2 and its clinical symptoms.
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Affiliation(s)
- Rudra B Bhandari
- Department of Yoga Science, University of Patanjali, Haridwar, India
| | | | - Kuppusamy Maheshkumar
- Department of Physiology, Government Yoga and Naturopathy Medical College and Hospital, Chennai, India
| | - Velan A Arumugam
- University of Patanjali, Haridwar, India
- Department of Yoga, International Institute of Yoga and Naturopathy Medical College, Chengalpattu, Chennai, India
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Bhardwaj P, Ganapathy K, Pathania M, Naveen KH, Charan J, Dutta S, Gadepalli R, Srinivasan S, Gupta MK, Goel AD, Midha N, Kumar B, Sharma M, Sharma P, Banerjee M, Mitra P, Misra S, V V, Subramaniant G, R P, Dhar M, Saxena V, Dhamija P, Singh A, Subramanian S, Kanchibhotla D. Effectiveness of ayurvedic formulation, NAOQ19 along with standard care in the treatment of mild-moderate COVID-19 patients: A double blind, randomized, placebo-controlled, multicentric trial. J Ayurveda Integr Med 2023; 14:100778. [PMID: 37976809 PMCID: PMC10684801 DOI: 10.1016/j.jaim.2023.100778] [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: 07/07/2022] [Revised: 02/08/2023] [Accepted: 07/08/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Medicines in indigenous systems such as Ayurveda have strong antimicrobial activity but double-blind randomized control trials are infrequent in this system of medicine. The efficacy of a new ayurvedic formulation was evaluated during the pandemic. METHODS 150 mild-moderate COVID-19 patients were enrolled and randomized in 1:1 to NAOQ19 and placebo group. RT-PCR was done on Day 3, 5 and 7. CBC, CRP, LFT, and KFT were assessed at baseline and exit. Duration of hospital stay was noted and clinical assessment was also performed. RESULT The results demonstrated more people turning RT-PCR negative in the NAOQ19 group compared to the placebo group on day 3 (p-value = 0.033). The mean time duration to turn RT-PCR negative was significantly lower in the NAOQ19 group (4.6 days) compared to placebo group (5.2 days) (p-value = 0.018). There was significant reduction in hospital stay among patients in the NAOQ19 arm who were discharged earlier (5.6 days) compared to placebo group (6.4 days) (p-value = 0.046). Patients in NAOQ19 arm did not show any adverse life-threatening events. CONCLUSION The ayurvedic preparation given along with standard of care therapy reduced the duration of hospital stay and there was earlier conversion to RT-PCR negative.The integrated approach can help to reduce patient workload in the hospitals as well as limit the transmission of the virus in the community. STUDY REGISTRATION CTRI/2021/05/033790.
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Affiliation(s)
| | | | | | - K H Naveen
- Department of CMFM, AIIMS Jodhpur, India
| | | | | | | | | | | | | | - Naresh Midha
- Department of General Medicine, AIIMS Jodhpur, India
| | - Bharat Kumar
- Department of General Medicine, AIIMS Jodhpur, India
| | | | | | | | | | | | | | | | - Praveen R
- Department of Respiratory Medicine, SMVMCH Puducherry, India
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Kumari D, Gautam J, Sharma V, Gupta SK, Sarkar S, Jana P, Singhal V, Babele P, Kamboj P, Bajpai S, Tandon R, Kumar Y, Dikshit M. Effect of herbal extracts and Saroglitazar on high-fat diet-induced obesity, insulin resistance, dyslipidemia, and hepatic lipidome in C57BL/6J mice. Heliyon 2023; 9:e22051. [PMID: 38027691 PMCID: PMC10663915 DOI: 10.1016/j.heliyon.2023.e22051] [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: 12/11/2022] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
We evaluated the effects of select herbal extracts (Tinospora cordifolia [TC], Tinospora cordifolia with Piper longum [TC + PL], Withania somnifera [WS], Glycyrrhiza glabra [GG], AYUSH-64 [AY-64], and Saroglitazar [S]) on various parameters in a diet-induced obesity mouse model. After 12 weeks of oral administration of the herbal extracts in high-fat diet (HFD)-fed C57BL/6J mice, we analyzed plasma biochemical parameters, insulin resistance (IR), liver histology, and the expression of inflammatory and fibrosis markers, along with hepatic lipidome. We also used a 3D hepatic spheroid model to assess their impact on profibrotic gene expression. Among the extracts, TC + PL showed a significant reduction in IR, liver weight, TNF-α, IL4, IL10 expression, and hepatic lipid levels (saturated triglycerides, ceramides, lysophosphocholines, acylcarnitines, diglycerides, and phosphatidylinositol levels). Saroglitazar reversed changes in body weight, IR, plasma triglycerides, glucose, insulin, and various hepatic lipid species (fatty acids, phospholipids, glycerophospholipids, sphingolipids, and triglycerides). With the exception of GG, Saroglitazar, and other extracts protected against palmitic acid-induced fibrosis marker gene expression in the 3D spheroids. TC + PL and Saroglitazar also effectively prevented HFD-induced insulin resistance, inflammation, and specific harmful lipid species in the liver.
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Affiliation(s)
- Deepika Kumari
- Non-communicable Disease Centre, Translational Health Science and Technology Institute (THSTI), NCR Biotech Science Cluster, 3rd Milestone, Faridabad, 121001, Haryana, India
| | - Jyoti Gautam
- Non-communicable Disease Centre, Translational Health Science and Technology Institute (THSTI), NCR Biotech Science Cluster, 3rd Milestone, Faridabad, 121001, Haryana, India
| | - Vipin Sharma
- Non-communicable Disease Centre, Translational Health Science and Technology Institute (THSTI), NCR Biotech Science Cluster, 3rd Milestone, Faridabad, 121001, Haryana, India
| | - Sonu Kumar Gupta
- Non-communicable Disease Centre, Translational Health Science and Technology Institute (THSTI), NCR Biotech Science Cluster, 3rd Milestone, Faridabad, 121001, Haryana, India
| | - Soumalya Sarkar
- Non-communicable Disease Centre, Translational Health Science and Technology Institute (THSTI), NCR Biotech Science Cluster, 3rd Milestone, Faridabad, 121001, Haryana, India
| | - Pradipta Jana
- Non-communicable Disease Centre, Translational Health Science and Technology Institute (THSTI), NCR Biotech Science Cluster, 3rd Milestone, Faridabad, 121001, Haryana, India
| | - Vikas Singhal
- Non-communicable Disease Centre, Translational Health Science and Technology Institute (THSTI), NCR Biotech Science Cluster, 3rd Milestone, Faridabad, 121001, Haryana, India
| | - Prabhakar Babele
- Non-communicable Disease Centre, Translational Health Science and Technology Institute (THSTI), NCR Biotech Science Cluster, 3rd Milestone, Faridabad, 121001, Haryana, India
| | - Parul Kamboj
- Non-communicable Disease Centre, Translational Health Science and Technology Institute (THSTI), NCR Biotech Science Cluster, 3rd Milestone, Faridabad, 121001, Haryana, India
| | - Sneh Bajpai
- Non-communicable Disease Centre, Translational Health Science and Technology Institute (THSTI), NCR Biotech Science Cluster, 3rd Milestone, Faridabad, 121001, Haryana, India
| | | | - Yashwant Kumar
- Non-communicable Disease Centre, Translational Health Science and Technology Institute (THSTI), NCR Biotech Science Cluster, 3rd Milestone, Faridabad, 121001, Haryana, India
| | - Madhu Dikshit
- Central Drug Research Institute, Sitapur Rd, Sector 10, Jankipuram Extension, Lucknow, Uttar Pradesh, 226031, India.
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Singh H, Yadav B, Rai AK, Srivastava S, Saiprasad A, Jameela S, Singhal R, Muralidharan S, Mohan R, Chaudhary S, Rana R, Khanduri S, Sharma BS, Chandrasekhararao B, Srikanth N, Dhiman KS. Ashwagandha (Withania somnifera) and Shunthi (Zingiber officinale) in mild and moderate COVID-19: An open-label randomized controlled exploratory trial. Complement Ther Med 2023; 76:102966. [PMID: 37482107 DOI: 10.1016/j.ctim.2023.102966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/02/2023] [Accepted: 07/19/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Ayurveda interventions have been used for prophylaxis and care during the COVID-19 pandemic in India and have shown promising results in promoting early clinical recovery from COVID-19. OBJECTIVE To assess the efficacy and safety of Ashwagandha [Withania somnifera (L.) Dunal] tablet and Shunthi (Zingiber officinale Roscoe) capsule in mild and moderate COVID-19 compared to conventional standard care. METHODS A randomized controlled exploratory trial was conducted at a designated COVID-19 care center in India with 60 participants having mild or moderate COVID-19. Ashwagandha, two tablets (250 mg each), and Shunthi, two capsules (500 mg each) twice daily for 15 days, were given orally to the participants in the Ayurveda group (AG) and the control group (CG) received conventional standard care. The outcome measures included clinical recovery rate, the proportion of participants with negative RT-PCR assay for COVID-19 on day 7 and day 15, mean time to attain clinical recovery, change in pro-inflammatory markers, serum IgG for COVID-19, HRCT chest findings, disease progression and incidence of adverse events (AE). RESULTS A total of 60 participants were enrolled, and the data of 48 participants (AG = 25 and CG = 23) were considered for the statistical analysis. The mean time for clinical recovery was reduced by almost 50 % in the AG (6.9 days) compared to CG (13.0 days) (p < 0.001). The proportion of participants who attained viral clearance in AG was 76.0 % compared to 60.8 % in the CG (RR= 1.24, 95 % CI: 0.841, 1.851, p-value = 0.270). Changes in the pro-inflammatory markers, serum IgG for COVID-19, and HRCT chest findings were comparable in both groups, and no AE or disease progression was reported. CONCLUSIONS The Ayurveda interventions, Ashwagandha and Shunthi, can effectively reduce the duration of clinical recovery and improve time for viral clearance in mild and moderate COVID-19. These interventions were observed to be safe and well-tolerated during the duration of the trial. TRIAL REGISTRATION Clinical Trial Registry of India - CTRI/2020/08/027224.
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Affiliation(s)
- Harbans Singh
- Department of Ayurveda, Central Ayurveda Research Institute, Patiala, Punjab, India
| | - Babita Yadav
- Department of Ayurveda, Central Council for Research in Ayurvedic Sciences, Ministry of Ayush, Govt. of India, India
| | - Amit K Rai
- Department of Ayurveda, Central Council for Research in Ayurvedic Sciences, Ministry of Ayush, Govt. of India, India.
| | - Sumit Srivastava
- Department of Ayurveda, Shri Dhanwantry Ayurvedic College and Hospital, Chandigarh, India
| | - Ajv Saiprasad
- Department of Ayurveda, Regional Ayurveda Research Institute, Vijayawada, Andhra Pradesh, India
| | - Sophia Jameela
- Department of Ayurveda, Central Council for Research in Ayurvedic Sciences, Ministry of Ayush, Govt. of India, India
| | - Richa Singhal
- Former Statistical Investigator, Biostatistical Unit, Central Council for Research in Ayurvedic Sciences, Ministry of Ayush, Govt. of India, India
| | - Sanuj Muralidharan
- Department of Ayurveda, Shri Dhanwantry Ayurvedic College and Hospital, Chandigarh, India
| | - Rijin Mohan
- Department of Ayurveda, Shri Dhanwantry Ayurvedic College and Hospital, Chandigarh, India
| | - Shikha Chaudhary
- Department of Ayurveda, Shri Dhanwantry Ayurvedic College and Hospital, Chandigarh, India
| | - Rakesh Rana
- Biostatistical Unit, Central Council for Research in Ayurvedic Sciences, Ministry of Ayush, Govt. of India, India
| | - Shruti Khanduri
- Department of Ayurveda, Central Council for Research in Ayurvedic Sciences, Ministry of Ayush, Govt. of India, India
| | - Bhagwan S Sharma
- Department of Ayurveda, Central Council for Research in Ayurvedic Sciences, Ministry of Ayush, Govt. of India, India
| | - Bhogavalli Chandrasekhararao
- Department of Ayurveda, Central Council for Research in Ayurvedic Sciences, Ministry of Ayush, Govt. of India, India
| | - Narayanam Srikanth
- Department of Ayurveda, Central Council for Research in Ayurvedic Sciences, Ministry of Ayush, Govt. of India, India
| | - Kartar S Dhiman
- Former Director-General, Central Council for Research in Ayurvedic Sciences, Ministry of Ayush, Govt. of India, India
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Thakar A, Panara K, Goyal M, Kumari R, Sungchol K. AYUSH (Indian System of Medicines) Therapeutics for COVID-19: A Living Systematic Review and Meta-Analysis (First Update). JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:139-155. [PMID: 36322891 DOI: 10.1089/jicm.2022.0559] [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: 06/16/2023]
Abstract
Background: In India, alternative and complementary therapies (Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy [AYUSH] medicines) are extensively utilized in COVID-19 management, and some were investigated clinically. This study assessed the effectiveness of AYUSH therapeutic on COVID-19 through a living systematic review and meta-analysis approach. Methods: Databases like PubMed; the Cochrane central register of controlled trials; WHO COVID-19 database; the central trial registry-India; Digital Helpline for Ayurveda Research Articles and AYUSH research portal, and preprint repositories were searched till August 1, 2021. Randomized controlled trials or analytical observational studies were included only. Primary outcomes selected were clinical improvement, WHO ordinal scale, viral clearance, and mortality, whereas secondary outcomes were the use of O2 therapy or mechanical ventilator, admission to high dependency unit or emergency unit, duration of hospitalization, the time to symptom resolution, and adverse events. The risk of bias was evaluated by Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB-2) and Risk of Bias in Nonrandomized Studies-of Interventions (ROBINS-I) tools; data were synthesized through RevMan 5.4 tool, and the certainty of the evidence was ranked through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: Of 3609 studies retrieved, 17 were included in the systematic review, and 3 AYUSH therapeutics were meta-analyzed. Meta-analysis suggested that add-on AYUSH-64 likely provides therapeutic benefits by reducing time to symptom resolution (mean difference [MD] 2.35 days lower [95% confidence interval, CI; 4.05 lower to 0.65 lower]) and hastening clinical improvement (365 more per 1000 [95% CI; 4 more to 1000 more]) in mild-to-moderate COVID-19 patients. Kabasura Kudineer adjuvant to standard care is likely to reduce symptom resolution (MD; 1.93 days lower [95% CI; 2.28 lower to 1.58 lower]) and hospital stay (MD; 4.2 days lower [95% CI; 4.97 lower to 3.43 lower]) in mild-to-moderate COVID-19 patients. Co-administration of Guduchi (Tinospora cordifolia [Willd.] Miers.) to standard care may reduce the duration of hospitalization (MD; 3.93 days, lower [95% CI; 8.83 lower to 0.97 higher]) in mild-to-moderate COVID-19 patients. Furthermore, all three agents seemed safe in adjunct usage to standard care. The certainty of evidence for most outcomes was moderate to low, primarily due to the high risk of bias or imprecision owing to the small sample size. Conclusion: Rational use of integrated or standalone AYUSH interventions in mild-to-moderate COVID-19 patients is safe and may provide therapeutic benefits. The effect estimates may be changed with additional evidence in upcoming updates.
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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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Savaliya C, Pandya S, Thumar K, Nagore D. Safety and efficacy of COROPROTECT kit as an add-on therapy in the management of mild-to-moderate COVID-19: A randomized, placebo-controlled trial. Ayu 2023; 44:9-16. [PMID: 38505111 PMCID: PMC10946664 DOI: 10.4103/ayu.ayu_92_22] [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: 04/19/2022] [Revised: 12/14/2023] [Accepted: 12/26/2023] [Indexed: 03/21/2024] Open
Abstract
Background The constructive role of Ayurveda in managing COVID-19 has been widely discussed, with identified herbs showing immunomodulatory and anti-viral potential. However, clinical trials examining their safety and efficacy are limited. Aim The aim of this study is to determine the efficacy of COROPROTECT kit, a proprietary Ayurvedic formulation, in COVID-19. Materials and method Randomized, placebo-controlled trial with 312 mild to moderate hospitalized COVID-19 patients. Groups received COROPROTECT or placebo for 10 days alongside standard care. Results The outcome measures included the number of days taken to reverse the reverse transcriptase-polymerase chain reaction (RT-PCR) status, reduction in symptoms and inflammatory markers. Fisher exact test was used to analyze the changes between categorical variables, whereas the comparative effect of therapy in both groups on inflammatory markers and safety biochemical parameters was analyzed using Student's t test. A total of 300 patients completed the study without any adverse events. The COROPROTECT kit group exhibited a statistically significant higher percentage of patients testing negative on days 4, 7, and 10 compared to the placebo group. A within group analysis showed that trial group to significantly reduced the levels of C-reactive protein (P = 0.03), lactate dehydrogenase (P < 0.001), and interleukin-6 (P = 0.01). Subjects of the trial group experienced complete relief from cough (69.33%), breathlessness (65.33%), and fatigue (62.67%) within 4 days. In contrast, the placebo group had 20%-40% of participants with mild symptoms persisting until day 10. Conclusion This study suggests potential future implications, indicating a faster RT-PCR negativity, reduced COVID-19 severity, and inflammatory markers, along with early symptomatic recovery. The COROPROTECT kit proved safe, facilitating an accelerated clinical recovery compared to conventional care.
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Affiliation(s)
- Chetan Savaliya
- Research and Development Department, Gplife Healthcare Pvt., Ltd., Surat, Gujarat, India
| | - Shridhar Pandya
- Research and Development Department, Gplife Healthcare Pvt., Ltd., Surat, Gujarat, India
| | - Kamalesh Thumar
- Research and Development Department, Gplife Healthcare Pvt., Ltd., Surat, Gujarat, India
| | - Dheeraj Nagore
- Director, Mprex Healthcare Pvt., Ltd., Pune, Maharashtra, India
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Kasarla SS, Borse SP, Kumar Y, Sharma N, Dikshit M. In vitro effect of Withania somnifera, AYUSH-64, and remdesivir on the activity of CYP-450 enzymes: Implications for possible herb−drug interactions in the management of COVID-19. Front Pharmacol 2022; 13:973768. [PMID: 36313313 PMCID: PMC9597875 DOI: 10.3389/fphar.2022.973768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/29/2022] [Indexed: 11/22/2022] Open
Abstract
Ayurvedic medicines Withania somnifera Dunal (ashwagandha) and AYUSH-64 have been used for the prevention and management of COVID-19 in India. The present study explores the effect of Ashwagandha and AYUSH-64 on important human CYP enzymes (CYP3A4, CYP2C8, and CYP2D6) to assess their interaction with remdesivir, a drug used for COVID-19 management during the second wave. The study also implies possible herb−drug interactions as ashwagandha and AYUSH-64 are being used for managing various pathological conditions. Aqueous extracts of ashwagandha and AYUSH-64 were characterized using LC-MS/MS. A total of 11 and 24 phytoconstituents were identified putatively from ashwagandha and AYUSH-64 extracts, respectively. In addition, in silico studies revealed good ADME properties of most of the phytoconstituents of these herbal drugs and suggested that some of these might possess CYP-450 inhibitory activity. In vitro CYP-450 studies with human liver microsomes showed moderate inhibition of CYP3A4, 2C8, and 2D6 by remdesivir, while ashwagandha had no inhibitory effect alone or in combination with remdesivir. AYUSH-64 also exhibited a similar trend; however, a moderate inhibitory effect on CYP2C8 was noticed. Thus, ashwagandha seems to be safe to co-administer with the substrates of CYP3A4, CYP2C8, and CYP2D6. However, caution is warranted in prescribing AYUSH-64 along with CYP2C8 substrate drugs. Furthermore, preclinical and clinical PK studies would be helpful for their effective and safer use in the management of various ailments along with other drugs.
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Affiliation(s)
- Siva Swapna Kasarla
- Translational Health Science and Technology Institute (THSTI), Faridabad, India
- Spatial Metabolomics Group, Leibniz-Institut für Analytische Wissenschaften-ISAS-e V, Dortmund, Germany
| | - Swapnil P. Borse
- AYUSH - Center of Excellence (AYUSH-CoE), Center for Complementary and Integrative Health [CCIH], Interdisciplinary School of Health Sciences (ISHS), Savitribai Phule Pune University Pune (SPPU), Pune, India
- *Correspondence: Swapnil P. Borse, ; Yashwant Kumar, ; Madhu Dikshit,
| | - Yashwant Kumar
- Translational Health Science and Technology Institute (THSTI), Faridabad, India
- *Correspondence: Swapnil P. Borse, ; Yashwant Kumar, ; Madhu Dikshit,
| | - Neha Sharma
- Translational Health Science and Technology Institute (THSTI), Faridabad, India
- Department of Pharmaceutical Analysis, Delhi Pharmaceutical Science and Research University, Pushp Vihar, New Delhi, India
| | - Madhu Dikshit
- Translational Health Science and Technology Institute (THSTI), Faridabad, India
- CSIR- Central Drug Research Institute, Lucknow, Uttar Pradesh, India
- *Correspondence: Swapnil P. Borse, ; Yashwant Kumar, ; Madhu Dikshit,
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Srikanth N, Kumar A, Chandrasekhararao B, Singhal R, Yadav B, Khanduri S, Jameela S, Rai AK, Tripathi A, Rana R, Ahmad A, Sharma BS, Jaiswal A, Kotecha R. Disease Characteristics, Care-Seeking Behavior, and Outcomes Associated With the Use of AYUSH-64 in COVID-19 Patients in Home Isolation in India: A Community-Based Cross-Sectional Analysis. Front Public Health 2022; 10:904279. [PMID: 35900336 PMCID: PMC9310753 DOI: 10.3389/fpubh.2022.904279] [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: 03/25/2022] [Accepted: 05/30/2022] [Indexed: 12/01/2022] Open
Abstract
Background During the second wave of the COVID-19 pandemic in India, the Ministry of Ayush conducted a community study to provide therapeutic care to patients with asymptomatic, mild, and moderate COVID-19 in home isolation based on the empirical evidence generated on the efficacy of AYUSH-64 in COVID-19. Objective To document disease characteristics, care-seeking behavior, and outcomes in patients with asymptomatic, mild, or moderate COVID-19 in home isolation who used AYUSH-64 for COVID-19. Methods Cross-sectional analysis of the data generated through a community study conducted in India from 08 May to 31 August 2021 was performed to study the disease characteristics, care-seeking behavior during home isolation, clinical outcomes, adverse events, and the association between various risk factors and clinical recovery during the study period. The data were collected through semi-structured questionnaires, available in electronic data collection format at the baseline, 7, 14, and 21 days. A logistic regression was performed to explore the relationship between relevant variables and clinical recovery. Results Data from 64,642 participants were analyzed for baseline assessment, and final analysis was done for 49,770 participants. The mean age of the enrolled participants was 38.8 ± 11.7 years, and 8.4% had co-morbidities. AYUSH-64 was utilized as an add-on to the standard care by 58.3% of participants. Comparable clinical outcomes were observed in participants utilizing AYUSH-64 either as a standalone or as an add-on to standard care, in terms of clinical recovery, disease progression, the requirement for oxygen supplementation, hospitalization, ICU admission, and need for ventilator support. Younger age, having no co-morbidities or substance abuse, and having been vaccinated were associated with early clinical recovery than those who were older and not vaccinated. Conclusions The study findings suggest that AYUSH-64 use, either standalone or as an adjunct to standard care, in asymptomatic, mild, or moderate COVID-19 is associated with good clinical outcomes. Ayush services and interventions can be effectively integrated into the mainstream public health architecture to serve public health goals.
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Affiliation(s)
| | - Adarsh Kumar
- Central Council for Research in Ayurvedic Sciences, New Delhi, India
| | | | - Richa Singhal
- Central Council for Research in Ayurvedic Sciences, New Delhi, India
| | - Babita Yadav
- Central Council for Research in Ayurvedic Sciences, New Delhi, India
| | - Shruti Khanduri
- Central Council for Research in Ayurvedic Sciences, New Delhi, India
| | - Sophia Jameela
- Central Council for Research in Ayurvedic Sciences, New Delhi, India
| | - Amit Kumar Rai
- Central Council for Research in Ayurvedic Sciences, New Delhi, India
| | - Arunabh Tripathi
- Central Council for Research in Ayurvedic Sciences, New Delhi, India
| | - Rakesh Rana
- Central Council for Research in Ayurvedic Sciences, New Delhi, India
| | - Azeem Ahmad
- Central Council for Research in Ayurvedic Sciences, New Delhi, India
| | | | - Ankit Jaiswal
- Central Council for Research in Ayurvedic Sciences, New Delhi, India
| | - Rajesh Kotecha
- Ministry of Ayush, Government of India, New Delhi, India
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Singh H, Srivastava S, Yadav B, Rai AK, Jameela S, Muralidharan S, Mohan R, Chaudhary S, Singhal R, Rana R, Khanduri S, Sharma BS, Chandrasekhararao B, Srikanth N, Chaturvedi S. AYUSH-64 as an adjunct to standard care in mild to moderate COVID-19: An open-label randomized controlled trial in Chandigarh, India. Complement Ther Med 2022; 66:102814. [PMID: 35149205 PMCID: PMC8824368 DOI: 10.1016/j.ctim.2022.102814] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/15/2022] [Accepted: 02/04/2022] [Indexed: 12/15/2022] Open
Abstract
Objective To determine the therapeutic efficacy and safety of AYUSH-64 as an add-on to standard care in mild to moderate COVID-19. Design setting, and interventions This open-label randomized controlled parallel-group trial was conducted at a designated COVID care centre in India in 80 patients diagnosed with mild to moderate COVID-19 and randomized into two groups. Participants in the AYUSH-64 add-on group (AG) received AYUSH-64 two tablets (500 mg each) three times a day for 30 days along with standard conventional care. The control group (CG) received standard care alone. Main outcome measures Proportion of participants who attained clinical recovery on day 7, 15, 23 and 30, proportion of participants with negative RT-PCR assay for COVID-19 at each weekly time point, change in pro-inflammatory markers, metabolic functions, HRCT chest (CO-RADS category) and incidence of Adverse Drug Reaction (ADR)/Adverse Event (AE). Results Out of 80 participants, 74 (37 in each group) contributed to the final analysis. Significant difference was observed in clinical recovery in the AG (p < 0.001 ) compared to CG. Mean duration for clinical recovery in AG (5.8 ± 2.67 days) was significantly less compared to CG (10.0 ± 4.06 days). Significant improvement in HRCT chest was observed in AG (p = 0.031) unlike in CG (p = 0.210). No ADR/SAE was observed or reported in AG. Conclusions AYUSH-64 as adjunct to standard care is safe and effective in hastening clinical recovery in mild to moderate COVID-19. The efficacy may be further validated by larger multi-center double-blind trials.
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Affiliation(s)
- Harbans Singh
- Department of Ayurveda, Central Ayurveda Research Institute, Patiala, Punjab, India.
| | - Sumit Srivastava
- Department of Ayurveda, Shri Dhanwantry Ayurvedic College and Hospital, Chandigarh, India.
| | - Babita Yadav
- Department of Ayurveda, Central Council for Research in Ayurvedic Sciences, Ministry of Ayush, Govt. of India, India.
| | - Amit K Rai
- Department of Ayurveda, Central Council for Research in Ayurvedic Sciences, Ministry of Ayush, Govt. of India, India.
| | - Sophia Jameela
- Department of Ayurveda, Central Council for Research in Ayurvedic Sciences, Ministry of Ayush, Govt. of India, India.
| | - Sanuj Muralidharan
- Department of Ayurveda, Shri Dhanwantry Ayurvedic College and Hospital, Chandigarh, India.
| | - Rijin Mohan
- Department of Ayurveda, Shri Dhanwantry Ayurvedic College and Hospital, Chandigarh, India.
| | - Shikha Chaudhary
- Department of Ayurveda, Shri Dhanwantry Ayurvedic College and Hospital, Chandigarh, India.
| | - Richa Singhal
- Biostatistical Unit, Central Council for Research in Ayurvedic Sciences, Ministry of Ayush, Govt. of India, India.
| | - Rakesh Rana
- Biostatistical Unit, Central Council for Research in Ayurvedic Sciences, Ministry of Ayush, Govt. of India, India.
| | - Shruti Khanduri
- Department of Ayurveda, Central Council for Research in Ayurvedic Sciences, Ministry of Ayush, Govt. of India, India.
| | - Bhagwan S Sharma
- Department of Ayurveda, Central Council for Research in Ayurvedic Sciences, Ministry of Ayush, Govt. of India, India.
| | - Bhogavalli Chandrasekhararao
- Department of Ayurveda, Central Council for Research in Ayurvedic Sciences, Ministry of Ayush, Govt. of India, India.
| | - Narayanam Srikanth
- Department of Ayurveda, Central Council for Research in Ayurvedic Sciences, Ministry of Ayush, Govt. of India, India.
| | - Sarika Chaturvedi
- Department of Research Directorate, Dr. D Y Patil Vidyapeeth, Pune, Maharashtra, India.
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Kumar A, Rai A, Khan MS, Kumar A, Haque ZU, Fazil M, Rabbani G. Role of herbal medicines in the management of patients with COVID-19: A systematic review and meta-analysis of randomized controlled trials. J Tradit Complement Med 2022; 12:100-113. [PMID: 35036347 PMCID: PMC8747767 DOI: 10.1016/j.jtcme.2022.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 12/23/2022] Open
Abstract
Background and aim The management of the worldwide spreading COVID-19 consists of amelioration of its symptoms but no cure is yet available. Herbal medicines supplemented with the Western medicine have been applied for COVID-19 treatment in India, China, Iran, and other countries. This systematic review and meta-analysis of RCTs evaluates the effect and safety of herbal intervention in the management of COVID-19. Experimental procedure RCTs from databases like PubMed, Cochrane Library, ScienceDirect, Google Scholar, Science Direct, CTRI, AYUSH Research Portal, India, were reviewed and the data were extracted for study sample demographics, intervention details, clinical effect, inflammatory markers and safety monitoring. Outcomes were expressed as Risk-ratio (RR) with 95% CI for dichotomous data, and Mean-Difference (MD) with 95% CI for continuous data. Result and conclusion From the 32 eligible studies, a total of 3177 COVID-19 patients were included in the review. Herbal intervention as an adjuvant to Western medicine causes significantly higher improvement compared to Western medicine alone [Fever (RR = 1.09 CI 1.03, 1.15), Cough (Risk-Ratio = 1.22 CI 1.08, 1.37), Fatigue (Risk-Ratio = 1.27 CI 1.11, 1.44), Chest CT Improvement (Risk-Ratio = 1.15 CI 1.08, 1.23)]. The laboratory parameters were also better in the herbal medicine group compared to standard care group only WBC (MD = 0.36 CI 0.16, 0.55), Lymphocyte percentage (MD = 5.48 CI 3.05, 7.92), Absolute lymphocyte count (MD = 0.23 CI 0.07, 0.39), CRP (MD = −5.66 CI -7.96, −3.37). However, duration of hospital stays (MD = −1.82 CI -3.84, 0.21); IL-6 (MD = −3.67 CI -8.76, 1.43), ESR Level (MD = −10.38 CI -25.96, 5.21) were statistically insignificant. No significant adverse events for herbal medications were noted in the included RCTs, during the time of the studies. (n = 665, RR 0.93; 95% CI 0.76, 1.14). Herbal intervention along with Western medicine has better recovery for fever, cough, fatigue, chest CT Improvement, RT-PCR Negativity, sore-throat, and duration of hospital stay. The laboratory parameters (e.g., WBC, Lymphocyte percentage, Absolute Lymphocyte count, CRP, IL-6, ESR levels) were also better in the herbal medicine group compared to standard care group only. No significant adverse events for herbal medications were noted in the included RCTs.
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Affiliation(s)
- Ansul Kumar
- Rajendra Institute of Medical Sciences (RIMS), CTVS Department, Bariatu, Ranchi, 834009, India
| | - Arpita Rai
- Oral Medicine and Radiology, Dental Institute. Rajendra Institute of Medical Sciences (RIMS), Bariatu, Ranchi, 834009, India
| | - Mohd Saif Khan
- Critical Care Medicine, New Trauma Centre & Central Emergency, Rajendra Institute of Medical Sciences (RIMS), Bariatu, Ranchi, 834009, India
| | - Amit Kumar
- Rajendra Institute of Medical Sciences (RIMS) Dept of Lab Medicine, Bariatu, Ranchi, 834009, India
| | - Zeya Ul Haque
- Rajendra Institute of Medical Sciences (RIMS), CTVS Department, Bariatu, Ranchi, 834009, India
| | - Mohammad Fazil
- Hakim Ajmal Khan Institute of Literary and Historical Research in Unani Medicine, CCRUM, Jamia Millia Islamia Campus, New Delhi, 110025, India
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11
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Panda AK, Kar S, Rai AK, Rao BCS, Srikanth N. AYUSH- 64: A Potential Therapeutic Agent in COVID-19. J Ayurveda Integr Med 2022; 13:100538. [PMID: 35002178 PMCID: PMC8723836 DOI: 10.1016/j.jaim.2021.100538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/23/2021] [Accepted: 12/10/2021] [Indexed: 10/27/2022] Open
Abstract
Corona Virus disease (COVID-19) has become a global pandemic resulting in large scale morbidity and mortality worldwide. The causative agent SARS-CoV-2 is easily subject to repeated mutation with swift spread of infection. The management of COVID-19 has been a big challenge on account of non-availability of specific therapeutic agents. The complex and multifactorial pathophysiology of COVID-19 requires therapeutic agents with anti-viral properties against SARS-CoV-2 as well as immunomodulatory properties that have a broad-spectrum effectiveness covering the disease in totality. AYUSH-64, a poly-herbal formulation developed by CCRAS, Ministry of AYUSH, Govt. of India through extensive pharmacological, toxicological and clinical studies has proven efficacy in infective febrile conditions such as malaria, micro filaremia, chikungunya and influenza with no safety issues observed in published clinical studies. Based on the empirical evidence, it has been repurposed as an adjuvant to standard care or standalone therapy for asymptomatic and mild to moderate cases of COVID- 19 by the Ministry of AYUSH at a time when India is experiencing wave after wave of COVID-19 variants causing mass distress to the healthcare delivery systems. AYUSH- 64 has four ingredients having immune-modulator, anti-inflammatory, antipyretic, antioxidant and anti-viral activities. These effects could arrest the extreme inflammatory responses in COVID-19 that causes progression to significant morbidity. Several clinical studies on AYUSH-64 in asymptomatic and mild to moderate cases of COVID-19 have been undertaken at reputed medical institutions across the country. The evidence generated through these studies is promising. AYUSH-64 has also been incorporated in the National COVID management protocol based on Ayurveda and Yoga by Government of India for asymptomatic and mild cases of COVID-19. Further, on the basis of tangible evidence generated through robust clinical and experimental studies on AYUSH-64, the Ministry of AYUSH has launched nation-wide campaign for mass distribution of AYUSH-64 to asymptomatic, mild to moderate COVID-19 patients in home isolation to reduce the burden on the hospital-based health care delivery system. This review will highlight about the specifications of AYUSH-64, its probable mechanism of action, its repurposing for COVID-19, various clinical and experimental studies undertaken during the COVID-19 pandemic and the initiatives taken to translate the outcomes of these studies on AYUSH-64.
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Affiliation(s)
- Ashok Kumar Panda
- Central Ayurveda Research Institute for Hepatobiliary Disorders, Bhubaneswar, Central Council of Research in Ayurveda Sciences, Ministry of AYUSH, Govt. of India
| | - Sarbeswar Kar
- JSS Ayurveda Medical College &Hospital, Mysore, Karnataka
| | - Amit Kumar Rai
- Central Council of Research in Ayurveda Sciences, Ministry of AYUSH, Govt. of India
| | - B C S Rao
- Central Council of Research in Ayurveda Sciences, Ministry of AYUSH, Govt. of India
| | - N Srikanth
- Central Council of Research in Ayurveda Sciences, Ministry of AYUSH, Govt. of India
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