Evaluation of the efficacy and safety of Melatonin in moderately ill patients with COVID-19: A structured summary of a study protocol for a randomized controlled trial

Abstract

Objectives We will evaluate the efficacy and safety of Melatonin, compared to the standard therapeutic regimen on clinical symptoms and serum inflammatory parameters in patients with confirmed COVID-19, who are moderately ill. Trial design This is a single-center, randomized, double-blind, placebo-controlled clinical trial with a parallel-group design conducted at Shahid Mohammadi Hospital, Bandar Abbas, Iran. Participants All patients admitted to Severe Acute Respiratory Syndrome Departments of Shahid Mohammadi Hospital, Bandar Abbas, Iran will be screened for the following criteria. Inclusion criteria: 1. Age ≥20 years 2. Confirmed SARS-CoV-2 diagnosis (positive polymerase chain reaction). 3. Moderate COVID-19 pneumonia (via computed tomography and or X-ray imaging), requiring hospitalization. 4. Hospitalized ≤48 hours. 5. Signing informed consent and willingness of the participant to accept randomization to any assigned treatment arm. Exclusion criteria: 1. Underlying diseases, including chronic hypertension, diabetes mellitus, seizure, depression, chronic hepatitis, cirrhosis, and cholestatic liver diseases. 2. Severe and critical COVID-19 pneumonia. 3. Use of warfarin, corticosteroids, hormonal drugs, alcohol, other antiviral and investigational medicines, and illegal drugs (during the last 30 days). 4. History of known allergy to Melatonin. 5. Pregnancy and breastfeeding. Intervention and comparator Intervention group: The standard treatment regimen for COVID-19, according to the Iranian Ministry of Health and Medical Education's protocol, along with Melatonin capsules at a dose of 50 mg daily for a period of seven days. Control group: The standard therapeutic regimen for COVID-19 along with Melatonin-like placebo capsules at a dose of one capsule daily for a period of seven days. Both Melatonin and placebo capsules were prepared at the Faculty of Pharmacy and Pharmaceutical Sciences, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. Main outcomes The primary outcomes are the recovery rate of clinical symptoms and oxygen saturation as well as improvement of serum inflammatory parameters, including C-reactive protein, tumor necrosis factor-alpha (TNF-ɑ), interleukin-1β (IL-1β), and IL-6 within seven days of randomization. The secondary outcomes are the time to improve clinical and paraclinical features along with the incidence of serious adverse drug reactions within seven days of randomization. Randomization Included patients will be allocated to one of the study arms using block randomization in a 1:1 ratio (each block consists of 10 patients). This randomization method ensures a balanced allocation between the arms during the study. A web-based system will generate random numbers for the allocation sequence and concealment of participants. Each number relates to one of the study arms. Blinding (masking) All study participants, clinicians, nurses, research coordinators, and those analyzing the data are blinded to the group assignment. Numbers to be randomized (sample size) A total of 60 patients randomized into two groups (30 in each group). Trial Status The trial protocol is Version 1.0, August 14, 2020. Recruitment began August 22, 2020, and is anticipated to be completed by November 30, 2020. Trial registration The trial protocol has been registered in the Iranian Registry of Clinical Trials (IRCT). The registration number is “IRCT20200506047323N5”. The registration date was 14 August 2020. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting the dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.

The influence of selection bias on identifying an association between allergy medication use and SARS-CoV-2 infection

“…Of these, identifying therapeutic candidates that would represent a "repurposing" of an existing drug, whose safety profile is well-established, would be preferred. [3] Although the mechanism is not well understood, some antihistamines have been shown to exhibit direct antiviral activity against SARS-CoV-2 isolates in vitro; thus understanding whether these medications confer in vivo protection has been of particular interest. [3À5] Format: Original report Funding: The University of Florida Children's Miracle Network partially funded this study.…”

Role of Melatonin on Virus-Induced Neuropathogenesis—A Concomitant Therapeutic Strategy to Understand SARS-CoV-2 Infection

“…Intravenous melatonin administration in ICU patients suffering from Covid-19 is currently under trial to better understand the dosage paradigm and efficaciousness of melatonin [ 18 , 22 ]. Another clinical trial is also under investigation, where the capability of melatonin will be explored in the prophylaxis of Covid-19 infection [ 20 ], along with its safety parameters compared to the standard therapeutic regimen [ 19 ]. Interestingly, melatonin treatment has positive outcomes in Covid-19 patients needing mechanical ventilation [ 21 ].…”

“…Regarding PD, as the basal ganglia is an assailable target of HIV, infected subjects have a greater risk of developing this devastating condition [ 16 ]. In this context, apart from neurodegenerative diseases, much information is currently being gathered on investigations into the preventive roles of melatonin in patients affected by viral diseases like Covid-19 [ 17 , 18 , 19 , 20 , 21 , 22 ]. In this review, the therapeutic role of melatonin in virus-induced neuropathogenesis is discussed in detail.…”

The Coronavirus Disease 2019 (COVID-19): Key Emphasis on Melatonin Safety and Therapeutic Efficacy

“…Interestingly, there is only one study on whether intravenous melatonin, administered to patients located in the Intensive Care Unit (ICU), can reduce mortality [81,82]. The other published protocol evaluates the efficacy and safety of 50 mg of melatonin daily administered during seven days, compared to the standard therapeutic regimen [83]. As shown in Table 1, the rest of the trials test oral melatonin efficacy in mild or moderate patients; noteworthily, the administered doses go from 3 to 100 mg. As we previously pointed, selecting the correct doses is absolutely necessary to obtain reliable results [18,84].…”