The King of Bitters is under serious consideration as a candidate to fight COVID, but it will take a few months to see if he realizes his potential
News that detainees in Thailand are receiving capsules of a herbal medicine called green chiretta (Andrographis paniculata) to treat asymptomatic and mild COVID is unlikely to come as a surprise to the average Thai citizen.
In Thailand, health professionals and the general public alike are familiar with the green chiretta – nicknamed the “king of bitters” – which is as popular as paracetamol for treating colds and flu.
In 1991, researchers at Mahidol University in Bangkok, Thailand, concluded after a clinical trial that chiretta (6 g per day) was as effective as paracetamol (4 g per day) in relieving fever and aches and pains. sore throat in patients with inflammation of the pharynx and tonsils (pharyngotonsillitis). Since then, several reviews have shown that chiretta may be more effective than a placebo in treating uncomplicated upper respiratory infections. Reported side effects tend to be mild and short-lived.
In line with the global trend of using cold and flu medications to relieve symptoms of mild COVID, and in the face of an emergency, the Thai Correctional Service has given the herbal remedy to 11,800 inmates with mild symptoms of upper respiratory tract infections and now claims that 99% of them have recovered, prompting the Thai Ministry of Higher Education, Science, Research and Innovation to recommend that asymptomatic patients take 180 mg of chiretta per day, divided into three doses with meals.
As far as we know, complete data for this intervention has not been disclosed to the international scientific community and details of the study are scarce. For example, we do not know if there was a control group (a group that received a placebo or a different treatment for comparison) and, if so, whether inmates were randomly assigned to a group or to the other.
This type of “randomized controlled trial” is the gold standard for clinical research. Especially if it is a “double blind”, meaning that neither the participants nor the researchers know who received the new drug and who received the placebo. This removes the conscious and unconscious bias from the study.
Additionally, COVID recovery rates are extremely difficult to calculate and only make sense if subjects are first diagnosed with a validated SARS-CoV-2 test. For comparison, recovery rates announced by Thai authorities are somewhat higher than overall COVID recovery rates in India (32% to 83%) or Australia (96% recovered after 120 days).
In a review of herbal drugs that could be beneficial for treating COVID, chiretta was seen as “promising” when assessing the risks and benefits. It contains an active compound called andrographolide. Purified Andrographolide has been hailed as moderately effective in inhibiting SARS-CoV-2 replication according to a laboratory test. And a recent computer simulation showed that it can bind (attach) well to the coronavirus spike protein (the spike protein is the part of the coronavirus that clings to human cells to enter it). But if these experiences translate into real benefits, it can only be proven with a well-designed clinical trial.
More evidence soon
Fortunately, such studies are underway. In Thailand, a randomized controlled trial with just over 3,000 participants compared chiretta extract (containing 20 mg of andrographolide per capsule, for a total of 180 mg per day, dosed in three capsules taken before each meal for five days) with “standard care” in people with asymptomatic COVID. The main outcome the researchers are looking at is the number of people in each group who end up in the hospital within 28 days of having a positive coronavirus test. The trial is expected to end in May 2022.
A small trial at Tbilisi State Medical University in Georgia is testing a combination of chiretta extract and Siberian ginseng to treat mild symptoms of COVID. The results are also expected in early 2022.
The King of Bitters is being seriously considered as a candidate to fight COVID, but it will take a few months to see if he realizes his potential.
Jose Prieto Garcia, Associate Professor of Natural Products and Phytochemistry, Liverpool John Moores University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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