Andrographis paniculata or favipiravir in Mild COVID-19: A randomized control trial

Abstract

Background: The COVID-19 pandemic led to an urgent search for effective treatments. Andrographis paniculata (AP), a traditional herbal medicine, has shown potential due to its antiviral and anti-inflammatory properties. This study aimed to compare the efficacy and safety of AP capsules with favipiravir (FV) in treating mild COVID-19 patients. Methods: This randomized, double-blind trial was conducted at Siriraj Hospital, Thailand. This study was in the Thai Clinical Trials Registry register, which number is TCTR20240802007. The study included patients aged 18–59 who were diagnosed with mild COVID-19. Participants were randomly assigned to receive either AP capsules (180 mg/day) or FV for five days, with a 10-day follow-up period. Primary outcomes included changes in viral load, pneumonia incidence, and symptom improvement. Secondary outcomes focused on viral clearance and adverse events. Results: A total of 190 participants (95 per group) were enrolled. By day 10, none had developed pneumonia. Both AP and FV effectively reduced viral load, with the Mann-Whitney U-test showing statistical significance (p < 0.05). The AP group showed greater improvement in specific symptoms, particularly in phlegm (1.15 ± 1.58 vs. 1.9 ± 2.04, p = 0.004) and headache (0.15 ± 0.51 vs. 0.47 ± 1.25, p = 0.033), compared to the FV group. Adverse events were minimal and similar between the two groups. Conclusion: Both AP and FV effectively reduced symptoms and viral load with minimal side effects. However, AP showed superior improvements in phlegm and headaches. Consequently, physicians may regard AP as an appropriate option for COVID-19 patients to alleviate symptoms.