Effect of papaya leaf extract on platelet count in dengue fever: a randomized controlled trial (PLEAD Trial)

Abstract

Background: Thrombocytopenia is a prominent feature of dengue fever and dengue hemorrhagic fever. Papaya leaves have been used by many patients due to their perceived beneficial effect on platelet count. However, scientific data on this beneficial effect is lacking.Methods: A single centre, single blinded, randomized placebo controlled trial was conducted at the Department of Medicine, Jinnah Hospital Lahore. Adult patients admitted with diagnosis of dengue fever (DF) or dengue hemorrhagic fever (DHF) and platelet counts ≤50 × 109/L were eligible for the study. After obtaining written informed consent participants were randomly assigned to either treatment or control group. 5ml of papaya leaf extract in syrup form was given twice daily for four days to treatment group and placebo solution was given to control group. Platelet counts were checked on daily basis. Outcome was measured in terms of platelet increments from baseline.Results: Thirty-nine (39) patients were enrolled and 28 (72%) were male. 19 (48.7%) patients received papaya leaf extract. Mean baseline platelet counts of treatment and control group were comparable, 36.2 × 109/L and 34.1 × 109/L respectively. Mean platelet counts at the end of treatment were 142.3 × 109/L and 116.5 × 109/L in treatment and control group respectively (p = 0.182). Platelet count normalized (i.e. ≥150 × 109/L) in 9 (47.4%) patients in treatment group and 5 (25%) patients in control group (p = 0.191). Similarly, no significant differences in mean platelet count increments from baseline were found between treatment and control group on day 2 (23.7 × 109/L vs 15.9 × 109/L, p = 0.242), day 3 (42.6 × 109/L vs 35.1 × 109/L, p = 0.424), day 4 (71.6 × 109/L vs 58.4 × 109/L, p = 0.309) and day 5 (106 × 109/L vs 82.3 × 109/L, p = 0.189). No significant adverse event occurred in either group.Conclusion: Papaya leaf extract, in this study, did not show any effect on platelet count in dengue fever.

Efficacy and safety of Carica papaya leaf extract in the dengue: A systematic review and meta-analysis

“…[13171819] Step by step method of inclusion and exclusion of studies is depicted in Figure 1. All studies were single-center randomized trials, except one which was multicentric.…”

“…[13171819] C. papaya compared with control was associated with a statistically significant increase in platelet count (MD = 20.27 [95% CI 6.21–34.73; P = 0.005]). There was significant heterogeneity ( I 2 = 50%).…”

“…[18] There was no significant difference between C. papaya and control for the subjects whose platelet count reached to the normal level (RR = 0.53, 95% CI 0.22–1.29; P = 0.16).…”

“…[13171819] There was no significant difference in rise in platelet count between C. papaya and control (MD = 13.38 [95% CI − 7.71–34.51; P = 0.21]). There was significant heterogeneity between subgroups ( I 2 = 85%).…”

“…[171819] C. papaya administration was significantly associated with increase in platelet count as compared to the control (MD = 28.25 [95% CI 14.14–42.37; P < 0.0001]). There was no heterogeneity observed ( I 2 = 0%), and similar results were obtained for the (SMD = 0.58 [95% CI 0.25–0.91; P < 0.0006], I 2 = 31%).…”