High dose melatonin as an adjuvant therapy in intubated patients with COVID-19: A randomized clinical trial

Abstract

Objective: In the COVID-19 pandemic, the SARS-CoV-2 virus has infected millions of people worldwide. Mortality primarily results from the inflammation state and its complications. High-dose melatonin has been established as an anti-inflammatory agent. This study evaluated high dose melatonin as an adjuvant therapy in critically ill patients with SARS-CoV-2 infection.Methods: We conducted a double-blinded, randomized clinical trial of 21 mg of melatonin per day compared with a placebo in 67 patients with COVID-19. We enrolled patients older than 18 years of age with docu-mented SARS-CoV-2 infection, who were admitted to the intensive care unit and underwent invasive mechanical ventilation. Administration of melatonin and placebo through a nasogastric tube continued for 5 days. The main outcomes were mortality rate, duration of me-chanical ventilation, changes in oxygenation indices, and C-reactive protein (CRP) levels.Results: No significant differences were observed in mortality and duration of mechanical ventilation between the control and intervention groups. After 5 days of the intervention, the mean (+/- standard deviation) CRP and platelet count were 47.28 (+/- 38.86) mg/L and 195.73 (+/- 87.13) x 1000/mL, respectively, in the intervention group and 75.52 (+/- 48.02) mg/L and 149.62 (+/- 68.03) x 1000/mL, respectively, in the control group (P < 0.05).Conclusion: High-dose melatonin in intubated patients with COVID-19 was associated with a decrease in CRP levels. However, this treatment did not apparently affect patient outcomes.