TCM shows potential for mild COVID-19 caused by Omicron

Longyizhengqi (LYZQ) granule, a traditional Chinese medicine (TCM), might be a promising drug for the treatment of mild COVID-19 caused by the Omicron variant, a prospective study from China suggests.

“On April 6, 2022, the WHO clearly affirmed the efficacy and safety of TCM in the treatment of COVID-19 and encouraged WHO Member States to consider the possibility of using TCM in the treatment of COVID-19 within their healthcare systems and regulatory frameworks,” said the researchers.

The LYZQ granule, a classic TCM that has been used to treat mild influenza, was hypothesized to be effective against COVID-19. “Hence, it was recommended in the treatment of mild COVID-19 cases during the Omicron outbreak in China. However, clinical evidence on its efficacy and safety is lacking,” they pointed out.

As such, the team conducted this study in four Mobile Cabin Hospitals in Jinshan District, Shanghai, China (n=3,243; mean age 43 years, 72 percent male). Participants received conventional treatment with (n=667) or without LYZQ granule 5 g BID (n=2,576). Conventional treatment comprised bed rest, intensified supportive treatment, vital signs monitoring, and specified effective oxygenation measures. At the attending physician’s discretion, Lianhuaqingwen capsule or acetaminophen were permitted for high-grade fever. [Infect Drug Resist 2023;16:1611-1618]

Compared with those who were on conventional treatment only, those in the LYZQ arm had significant reductions in time for nucleic acid to turn negative (10.7 vs 14.2 days; p<0.01) and hospital stay (9.9 vs 12.5 days; p<0.01).

“[Cutting] the negative transition time for nucleic acid can accelerate utilization rate of beds in mobile cabin hospitals, avoid crowding out of medical resources, and reduce medical pressure. This was important in the Omicron outbreak in Shanghai,” the researchers noted.

LYZQ treatment also led to greater changes in cycle threshold (Ct) value (ie, day 8 minus day 2 Ct value) for the N gene (10.33 vs 8.44; p<0.01) and Orf gene (8.44 vs 7.31; p<0.01) compared with those receiving conventional treatment alone.

Viral load is at its peak during the early stages of COVID-19, rendering patients more infectious and more likely to develop antiviral resistance. [J Infect 2020;81:357-371; Lancet Infect Dis 2020;20:411-412; N Engl J Med 2020;382:1177-1179; Lancet Infect Dis 2020;20:515-516] “Ct value is an indicator of viral load … If the viral load in patients can be effectively reduced in a shorter time, the high transmissibility of COVID-19 can be successfully controlled, and further immune escape of the virus can be prevented,” the researchers explained.

Therefore, the changes in Ct value signal the potential of the LYZQ granule to effectively reduce viral load in COVID-19 patients, thus weakening infectivity and curbing transmission of the disease.

Only 17 patients reported experiencing diarrhoea symptoms following use of the LYZQ granule, but these were mitigated with probiotics or berberine. Although the mechanism is unclear, the researchers postulated that the diarrhoea events may have been driven by the Patchouli and Atractylodes content of the LYZQ granule, as these promote gastrointestinal motility. [Front Pharmacol 2021;12:727154; J Ethnopharmacol 2018;226:143-167]

There were no serious adverse events reported.

“[Taken together, our study demonstrated the potential of the LYZQ granule to] effectively shorten the negative transition time of nucleic acid and total hospitalization days, and increase the changes of Ct values,” they said, calling for longer studies to validate the results.