Antioxidants and pentoxifylline as coadjuvant measures to standard therapy to improve prognosis of patients with pneumonia by COVID-19

Chavarria, Adrián Palacios; Vázquez, Rafael Ricardo Valdez; Cherit, José Guillermo Domínguez; Bello, Héctor Herrera; Suastegui, Humberto Castillejos; Moreno-Castañeda, Lidia; Alanís Estrada, Gabriela; Hernández, Fabián; González-Marcos, Omar; Saucedo-Orozco, Huitzilihuitl; Pech, Linaloe Manzano; Márquez, Ricardo; Guarner-Lans, Verónica; Torres, Israel Pérez; Soto, Maria Elena

The type 2 coronavirus causes severe acute respiratory syndrome (SARS-CoV-2) and produces pneumonia with pulmonary alveolar collapse. In some cases it also causes sepsis and septic shock. There is no specific treatment for coronavirus disease 2019 (COVID-19). Vitamin C (Vit C), Vitamin E (Vit E), N-acetylcysteine (NAC) and Melatonin (MT) increase the intracellular content of GSH, kidnap free radicals and protect DNA, proteins in the cytosol and lipids in cell membranes. Pentoxifylline (Px) has anti-inflammatory activities. Here we evaluate the effect of Vit C, Vit E, NAC, and MT plus Px in COVID-19 patients with moderate and severe pneumonia. 110 patients of either sex were included. They were divided into five groups with 22 patients each. Group 1 received Vit C+Px, group 2 Vit E+Px, group 3 NAC+Px, group 4 MT+Px, and group 5 only Px. Oxidative stress (OS) markers such as lipid peroxidation (LPO) levels, total antioxidant capacity (TAC) and nitrites (NO(2)(-)) were evaluated in plasma. The antioxidant therapy improved the survival scores including the Sequential Organ Failure Assessment (SOFA), the Acute Physiology and chronic Health Evaluation II (Apache II), the Simplified Acute Physiology Score II (SAPS II), the Critical Illness Risk Score, Launched during COVID-19 crisis (COVIDGRAM) and the Glasgow Coma Scale (GCS). We found that LPO was elevated (p≤0.04) and TAC (p≤0.03), NO(2)(-) (p≤0.04) and inflammation markers such as interleukin-6 (IL-6, p≤0.01) C reactive protein (CRP, p≤0.01) and procalcitonin (PCT, p≤0.05) were diminished in COVID-19 patients upon admission to the hospital. The different antioxidants reversed this alteration at the end of the treatment. The treatment with antioxidant supplements such as Vit C, E, NAC, and MT plus Px could decelerate the aggressive and lethal development of COVID-19. Antioxidant therapy can be effective in this pandemia since it improves the survival scores including SOFA, Apache II, SAPS II, COVIDGRAM, GCS by lowering the LPO, IL-6, CRP, PCT and increasing systemic TAC and NO(2)(-).