Randomized-Controlled Trial to Compare the Efficacy of Andrographis paniculata Powder and Favipiravir for the Treatment of Mild COVID-19
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Abstract
Introduction and objective: This study sought to determine the effectiveness of the Andrographosis paniculata (fa thalai chon in Thai) herb, in ground-powder form, in the treatment of COVID-19 compared to favipiravir, which is the current standard treatment regimen in Thailand.
Methods: The study was a randomized controlled trial in subjects aged 18 to under 60 years, who were diagnosed with COVID-19 by a positive RT-PCR test and were recruited from Muaklek Hospital from October 2021 to April 2022 classified as having mild disease. Patients were block randomized into three treatment groups. The first group was treated with ground powder of the aerial parts of A. paniculata (400 mg per capsule containing 11.35 mg of andrographolide) 180 mg/day for 5 days. The second group was treated with ground A. paniculata leaves (400 mg per capsule containing 24 mg of andrographolide) 180 mg/day for 5 days. The third group was treated with favipiravir at a dose of 3,600 mg on day 1 and 1,600 mg/day on days 2 to 5. Patients were followed up for 10 days, with worsening of clinical severity indicated by change in color category, new pulmonary infiltrations on x-ray, and viral load reduction on days 0, 5 and 10 as the primary outcomes.
Results: All 231 subjects were recruited to the study, with 77 assigned to each group. None of the groups had worsening of clinical severity indicated by change in color category. The difference in new pulmonary infiltrations between the groups was not statistically significant (p=0.07), nor was the elevation in liver enzymes (p=0.7). Viral loaded reduction did not differ significantly between each group. Log reduction on day 10 was 3.943 ± 1.354 in the first group, 3.943 ± 1.414 in the second group, and 3.994 ± 1.284 in the third group, which also showed no significant difference (p=0.996).
Discussion: The efficacy of ground powder of both aerial parts and leaves of A. paniculata was not significantly different from favipiravir in the treatment of COVID-19, whether measured by pulmonary infiltrations on x-ray, change in clinical severity, or viral load reduction, throughout the follow-up period of on days 0, 5 and 10.
Conclusion and recommendation: Comparison of effectiveness between powders of both aerial parts and leaves of A. paniculata shows no significant differences from favipiravir in the treatment of mild COVID-19 apart from the cost, where A. paniculata is more accessible and affordable. The conclusion of the study supports the decision to use A. paniculata powder as first treatment for mild COVID-19.
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