Application of nasal spray containing dimethyl sulfoxide (DMSO) and ethanol during the COVID-19 pandemic may protect healthcare workers: A randomized controlled trials

ImportanceRandomized clinical trials (RCTs) on COVID-19 are increasingly being posted as preprints before publication in a scientific, peer-reviewed journal.ObjectiveTo assess time to journal publication for COVID-19 RCT preprints and to compare differences between pairs of preprints and corresponding journal articles.Evidence ReviewThis systematic review used a meta-epidemiologic approach to conduct a literature search using the World Health Organization COVID-19 database and Embase to identify preprints published between January 1 and December 31, 2021. This review included RCTs with human participants and research questions regarding the treatment or prevention of COVID-19. For each preprint, a literature search was done to locate the corresponding journal article. Two independent reviewers read the full text, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2 tool. Time to publication was analyzed using a Cox proportional hazards regression model. Differences between preprint and journal article pairs in terms of outcomes, analyses, results, or conclusions were described. Statistical analysis was performed on October 17, 2022.FindingsThis study included 152 preprints. As of October 1, 2022, 119 of 152 preprints (78.3%) had been published in journals. The median time to publication was 186 days (range, 17-407 days). In a multivariable model, larger sample size and low risk of bias were associated with journal publication. With a sample size of less than 200 as the reference, sample sizes of 201 to 1000 and greater than 1000 had hazard ratios (HRs) of 1.23 (95% CI, 0.80-1.91) and 2.19 (95% CI, 1.36-3.53) for publication, respectively. With high risk of bias as the reference, medium-risk articles with some concerns for bias had an HR of 1.77 (95% CI, 1.02-3.09); those with a low risk of bias had an HR of 3.01 (95% CI, 1.71-5.30). Of the 119 published preprints, there were differences in terms of outcomes, analyses, results, or conclusions in 65 studies (54.6%). The main conclusion in the preprint contradicted the conclusion in the journal article for 2 studies (1.7%).Conclusions and RelevanceThese findings suggest that there is a substantial time lag from preprint posting to journal publication. Preprints with smaller sample sizes and high risk of bias were less likely to be published. Finally, although differences in terms of outcomes, analyses, results, or conclusions were observed for preprint and journal article pairs in most studies, the main conclusion remained consistent for the majority of studies.

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“…After abstract screening and full-text reading, 152 RCTs were included in the analysis. All 152 RCTs were posted on the medRxiv server …”

Section: Resultsmentioning

confidence: 99%

Comparison of Preprint Postings of Randomized Clinical Trials on COVID-19 and Corresponding Published Journal Articles

et al. 2023

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“…There are solid proofs that ethanol has strong virucidal effect against SARS-CoV-2 [5,9]. There are also some attempt to prevent [10] or treat [11] Covid-19 using alcohol. But there are many other explanations as well.…”

Section: Analysis and Discussionmentioning

confidence: 99%

Positive Correlation between Heavy Alcoholic Drinking and SARS-Cov-2 Not-infection Rate

Tong¹

2023

Preprint

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An investigation on the correlation between the strong alcoholic drinking and SARS-Cov-2 uninfection rate is carried out. The investigation is done through a simple survey in China based on the social media software Weixin and the survey mini program Wenjuanxin, during 15:00 Jan.1, 2023 to 12:35 Jan.3, 2023. From the 211 survey questionnaires collected, we find a significant correlation between the frequent (no less than three times a week) strong liquor (higher than 40% alcoholic content in volume) drinking and the higher SARS-Cov-2 uninfection rate (38.6% compared to the value 25.1% for general population). The p-value of this statistical result is 0.018, showing that the correlation is significant.

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“…Both the control group (CG) and intervention group (IG) were enrolled in the standard treatments based on the national clinical guidelines of Iran [ 21 ]. The national standard treatment included intramuscular dexamethasone 8 mg/day for five days, and 200 mg of remdesivir intravenously on day one, followed by 100 mg of remdesivir once daily for four days, infused over 30-60 minutes.…”

Section: Methodsmentioning

confidence: 99%

“…Later, a study dealing with the rationale for ethanol use in this field was presented [ 20 ]. A randomized clinical trial (RCT) evaluating the combined administration of dimethyl sulfoxide and ethanol recently showed considerable COVID-19 prevention in healthcare providers [ 21 ]. To try to find the answer, we conducted a randomized clinical trial aimed at evaluating the effectiveness of ethanol therapy on the clinical status and prognosis of a defined set of patients.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Inhalation of Nebulized Ethanol in COVID-19 Treatment: A Randomized Clinical Trial

Amoushahi¹,

Moazam²,

Tabatabaei³

et al. 2022

Cureus

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Background: Coronavirus disease 2019 (COVID-19) is a pandemic caused by the SARS-CoV-2 virus. Many efforts have been made and are currently being made to prevent and treat this global disease. Objectives: This study was designed to evaluate the efficacy and safety of nebulized ethanol (EtOH) in treating COVID-19. Methods: A randomized clinical trial (RCT) of 99 symptomatic and real-time polymerase chain reaction (RT-PCR)-positive patients admitted to a hospital receiving remdesivir-dexamethasone was conducted. They were randomly assigned to receive distilled water spray (control group (CG)) or 35% EtOH spray (intervention group (IG)). Both groups inhaled three puffs of spray (nebulizer) every six hours for a week. The primary outcome included Global Symptomatic Score (GSS) between the two groups at the first visit and on days three, seven, and 14. Secondary outcomes included the Clinical Status Scale (CSS; a seven-point ordinal scale ranging from death to complete recovery) and readmission rate. Results: A total of 44 and 55 patients were enrolled in the IG and CG, respectively. Although there was no difference at admission, the GSS and CSS improved significantly in the IG (p = 0.016 and p = 0.001, respectively). The IG readmission rate was considerably lower (0% vs. 10.9%; p = 0.02). Conclusions: Inhaled-nebulized EtOH is effective in rapidly improving the clinical status and reducing further treatment. Due to its low cost, availability, and absent/tolerable adverse events, it could be recommended as an adjunctive treatment for moderate COVID-19. Further research on curative effects in more serious cases and in prevention is advisable.

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Application of nasal spray containing dimethyl sulfoxide (DMSO) and ethanol during the COVID-19 pandemic may protect healthcare workers: A randomized controlled trials

Cited by 9 publications

References 37 publications

Comparison of Preprint Postings of Randomized Clinical Trials on COVID-19 and Corresponding Published Journal Articles

Comparison of Preprint Postings of Randomized Clinical Trials on COVID-19 and Corresponding Published Journal Articles

Positive Correlation between Heavy Alcoholic Drinking and SARS-Cov-2 Not-infection Rate

Efficacy and Safety of Inhalation of Nebulized Ethanol in COVID-19 Treatment: A Randomized Clinical Trial

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