Abstract
Background Indomethacin, a well-known non-steroidal anti-inflammatory
drug (NSAID), with effective broad spectrum anti-viral activity, was
evaluated for efficacy and safety of indomethacin in treating RT-PCR
positive covid-19 patients Materials and Methods Patients with RT-PCR
positive covid-19 who were admitted to hospital were offered the option
to receive indomethacin 50 to 75mg daily in addition to the Indian
council of medical research (ICMR) standard covid-19 treatment. Patients
who declined the indomethacin option were offered paracetamol for pain
and fever. The endpoint was the development of hypoxia. Secondary
endpoints were time to become afebrile and time to resolution of cough
and myalgia. Propensity Score Matching was used to compare indomethacin
and paracetamol treatments. A separate group of severely ill patients
who were admitted with hypoxia were treated with indomethacin 75mg; the
endpoint was the requirement for mechanical ventilation or admission to
the intensive care unit (ICU). Blood chemistry was collected before and
after the treatment. The patients were monitored every day for clinical
parameters. . Results A total of 104 patients received indomethacin, 82
with mild-moderate disease and 22 with severe disease. Matching reduced
the number of patients to 72. In the indomethacin mild-moderate disease
group, one patient out of 72 in the matched group developed hypoxia and
required oxygen compared with 28 out of 72 patients in the matched group
who received paracetamol. Patients who received indomethacin also
experienced more rapid symptomatic relief compared to paracetamol arm.
In the indomethacin severe disease group no patient deteriorated enough
to require mechanical ventilation. There were no adverse reactions to
indomethacin or deterioration of renal or liver function. Conclusion The
use of indomethacin compared with paracetamol, in addition to the
standard ICMR treatment in hospitalised covid-19 patients was associated
with marked reductions in the severity and duration of illness, without
any adverse effects.