Effect of Andrographis paniculata Treatment for Nonimmune Patients with Early-Stage COVID-19 on the Prevention of Pneumonia: A Retrospective Cohort Study

Author(s): Amporn Benjaponpitak, Thiti Sawaengtham, Tewan Thaneerat, Kulthanit Wanaratna, Palang Chotsiri, Chalermquan Rungsawang, Sakkarin Bhubhanil, Sataporn Charoensuk, Suwat Benjaponpitak, Sarawut Lapmanee, Sayomporn Sirinavin

Background:

Andrographis paniculata (AP) is an herbal plant that has been used to treat upper respiratory tract infections. Andrographolide is the major active component of AP that inhibits intracellular SARS-CoV-2 replication and has anti-inflammatory action.

Objective:

To investigate the therapeutic and adverse effects of treatment with oral AP-products in patients with early-stage COVID-19.

Methods:

We performed a retrospective cohort study in COVID-19 patients with asymptomatic or mild COVID-19, admitted for isolation and treatment in seven hospitals in three adjacent provinces in central region of Thailand, during December 2020 – March 2021 epidemic when COVID-19 vaccine was not yet available and none were previously infected with SARS-CoV-2. Patient data was prospectively recorded in the structured medical record forms and retrospectively reviewed. This study included patients 15 to 60 years of age with laboratory-confirmed SARS-CoV-2 infection, but without comorbidities or pregnancy. Study AP products were capsules containing a standardised ethanol extract of AP or crude AP powder. Patients were treated for five days with either AP-extract (60 mg andrographolide, 3 times daily) or crude-AP (48 mg andrographolide, 3 times daily), only when available. All eligible patients who received AP treatment were included and control patients who did not receive AP treatment were blindly and randomly selected using a ratio of approximately 1:1. The risk of pneumonia diagnosed by chest radiography was the primary study outcome.

Results:

About 90% of the treatment group received the AP-extract regimen within 7 days after onset of symptoms. Pneumonia occurred in 1/243 AP treatment patients and 69/285 control patients. The risks of pneumonia after adjusting for confounding effects were 0.3% (95%CI, 0%-0.9%) and 24.3% (95%CI, 19.0%-29.7%) in the AP treatment and control groups, respectively. The number needed to treat to avoid pneumonia development in one patient was four (95% CI, 3-5). Mild abnormal symptoms suggesting adverse event of AP treatment were detected in eight patients.

Conclusion:

The oral AP-extract treatment regimen is acceptably safe and associated with highly reduced rates of pneumonia in nonimmune patients with early-stage COVID-19.