Andrographis for COVID-19: Key Study Insights

observational-study PMID: 37625206

Andrographis for COVID-19: Key Study Insights

Quick Summary: This study tested if adding Andrographis paniculata extract to favipiravir helps mild to moderate COVID-19 patients in Thailand. It didn't prevent disease worsening or speed up recovery compared to favipiravir alone, but it lowered inflammation markers that could fight severe cases. No serious side effects were seen, making it a safe option to explore further.

What The Research Found

Researchers wanted to see if Andrographis paniculata extract (a plant-based supplement known for fighting viruses and calming the immune system) could boost the effects of favipiravir, a common COVID-19 drug. Here's what they discovered in simple terms:

No big improvements in symptoms or recovery: On day 4, almost all patients (98.6% with Andrographis vs. 97.3% without) stayed stable and didn't get worse. There was no difference in needing oxygen, hospital stays, or deaths—only about 4% in the placebo group needed extra oxygen.
Lower inflammation levels: The Andrographis group had significantly less IL-1β, a protein that fuels dangerous immune overreactions (called cytokine storms) in severe COVID-19. This happened throughout the 14-day study.
Virus clearance stayed the same: Both groups cleared the virus at similar rates, with no edge for Andrographis.
Safe to use: No major side effects or safety issues popped up in either group.

These results suggest Andrographis might not change the game for mild cases but could help prevent the worst outcomes in sicker patients.

Study Details

This was a high-quality trial called the APFaVi trial, done in Thailand from June to September 2021 when the Delta variant was common.

Who was studied: 146 adults with mild to moderate COVID-19—none were severely ill. They split evenly into two groups of 73 people each.
How long: Patients were followed for 14 days, with key checks on day 4 using a simple scoring system for symptoms and breathing issues.
What they took: One group got 180 mg of Andrographis paniculata extract daily (60 mg three times a day) plus standard favipiravir doses. The other got fake pills (placebo) plus favipiravir. Everyone took it by mouth.

Doctors used tools like the WHO's progression scale (a way to rate how bad symptoms are) and a symptom pain scale to track progress.

What This Means For You

If you're dealing with mild COVID-19 and your doctor prescribes favipiravir, adding Andrographis paniculata probably won't make you feel better faster or stop things from getting worse—stick to proven treatments. But the drop in IL-1β is promising: it hints this herb might help calm raging immune responses in bad cases, potentially avoiding hospital trips.

For everyday users: It's safe based on this study, so if you're into natural supplements for immune support, talk to your doctor—don't self-medicate for COVID-19.
Bigger picture: More research is needed for severe COVID or other variants like Omicron. If inflammation worries you (e.g., in long COVID), this could be worth watching, but it's not a cure-all.
Action step: Always check with a healthcare pro before trying Andrographis, especially if you're on meds—it might interact.

Study Limitations

No study is perfect, and this one has some caveats to keep in mind:

Small group size: Only 146 people, so it might miss rare benefits or risks that show up in bigger crowds.
Short timeline and location-specific: Lasted just 14 days during Thailand's Delta wave—results might differ for longer illnesses, other countries, or new virus strains.
Early check-in focus: Main results looked at day 4, so any slower benefits from Andrographis could have been overlooked.
Unproven benefits: The IL-1β drop is cool, but we don't know yet if it really prevents cytokine storms in real severe cases—needs more testing.

Overall, this builds hope for Andrographis in immune health but reminds us it's not a standalone fix for COVID-19.

Key Findings

The study found that adding 180 mg/day of Andrographis paniculata extract (APE) to favipiravir (FPV) did not improve clinical outcomes (e.g., disease progression, oxygen use, hospitalization, or mortality) in non-severe COVID-19 patients compared to FPV alone. However, APE significantly reduced interleukin (IL)-1β levels, suggesting potential immunomodulatory effects that may mitigate cytokine storms in severe cases. No major adverse events were reported.

Study Design

This was a double-blind, randomized, placebo-controlled clinical trial conducted in Thailand from June–September 2021. The sample included 146 patients (73 per group) with mild to moderate COVID-19. Participants were followed for 14 days, with primary efficacy assessed on day 4 using the WHO Clinical Progression Scale (WHOCPS) and symptom scores.

Dosage & Administration

The APE-FPV group received 180 mg/day of Andrographis paniculata extract (60 mg three times daily) orally alongside favipiravir. The placebo-FPV group received identical capsules without APE. Both groups received favipiravir per standard Thai protocols.

Results & Efficacy

Clinical progression: Non-deterioration of WHOCPS scores on day 4 occurred in 98.63% (APE-FPV) vs. 97.26% (placebo-FPV) (p = 1.000, no significant difference).
Oxygen supplementation: 4.11% of placebo-FPV patients required oxygen; no data specified for APE-FPV.
IL-1β levels: The APE-FPV group showed significantly lower IL-1β levels throughout the study (exact p-value not reported).
Virological outcomes: No differences in viral clearance or SARS-CoV-2 RNA levels between groups.
Safety: No substantial adverse events in either group.

Limitations

Sample size: 146 patients may be insufficient to detect small but meaningful differences in rare outcomes (e.g., mortality).
Population specificity: Conducted in Thailand during Delta variant dominance; results may not generalize to other variants or demographics.
Short duration: Follow-up ended at 14 days, potentially missing longer-term effects.
Primary endpoint timing: WHOCPS assessed on day 4, which may not capture delayed benefits of APE.
Lack of mechanistic data: IL-1β reduction’s clinical relevance in severe disease remains unproven.

Clinical Relevance

For mild to moderate COVID-19 patients treated with favipiravir, APE does not provide additional clinical or virological benefits. However, its observed IL-1β suppression suggests potential utility in severe cases where cytokine storms drive pathology. Supplement users should not expect APE to improve outcomes in early-stage disease but may consider its safety profile in combination therapies. Further research in severe patients and larger trials is warranted.

Note: The study’s design