The rapid diffusion and great contagion of SARS-Coronavirus-2 have made difficult to design and execute randomized controlled trials of outpatient therapy. It is now well known that Covid-19 disease (Covid-19) is not only just an upper respiratory tract disease. Indeed in many cases, particularly if a prompt treatment is not undertaken, the infection may evolve towards a more severe disease and the occurrence of a cytokine storm with vasculitis, thromboembolism, and multi-organ damage. Therefore it is mandatory promptly to start a therapy at the onset of symptoms, even before Polymerase Chain Reaction (PCR test) response, to mitigate or even to stop the progression of the disease.
For this purpose many care committees have arisen all over the world. In particular, in Italy there is the committee for the right to an early at home treatment of Covid-19. Recently the task force of this Committee has published a detailed therapeutic scheme, based on the experience of Covid-19 treatment from more than two hundred physicians. The therapy usually begins with a Non-Steroidal Anti-inflammatory Drug (NSAID) or with hydroxychloroquine and, when appropriate, Azithromycin or Doxycycline, cough suppressants, corticosteroids, enoxaparin, and home oxygen therapy are added.
Among NSAIDs, indomethacin could be the best choice. It is a well-known potent anti-inflammatory agent that non selectively inhibits cyclooxygenase -1 and -2, and has also shown a potent antiviral activity. Indomethacin also reduces the levels of interleukin-6 and tumour necrosis factor. Both cytokines are responsible for some of the detrimental effects of Covid-19.
Our limited experience with Indomethacin is based on 45 home patients (from 31 to 68 years old) with mild or moderate Covid-19. The doses prescribed ranged from 25 to 50 mg per os tid. Only in the case of clinical worsening, other drugs, according to the therapeutic scheme of the Italian Committee, were added. All these patients recovered with negative PCR test on an average of 12 days, with negligible side effects.
Conclusions: While waiting for the positive effects of mass vaccinations and/or EBM indications, a prompt treatment of Covid-19 patients should be started at home, even before the PCR test result, choosing among those drugs that, for their potential effects on pathophysiological mechanisms of the disease, may have a medical rationale.
Keywords: COVID-19, Early home treatment, Indomethacin.