Thailand Approves Andrographis to Treat COVID-19
In late December 2020, the government of Thailand approved a pilot study of the use of the southern Asian herb andrographis (Andrographispaniculata, Acanthaceae) to treat early symptoms and reduce the severity of COVID-19. Initially, the treatment will be available at five state-owned hospitals in Thailand, on a voluntary basis for people 18-60 years old with minor symptoms. It reportedly will be given to patients within 72 hours of symptom onset.
Called fah talai jone in Thai and “the king of bitters,” among other names, andrographis is a small annual plant. In India’s traditional medical system of Ayurveda, the plant’s dried leaves and shoots are used for bronchitis, cough, diarrhea, dyspepsia (indigestion), fever, inflammation, and skin diseases. In traditional Chinese medicine, the plant has been used to treat colitis (inflammatory disease of the colon), cough, dysentery, fever, influenza, and sore throat. Modern studies have focused on andrographis’ potential benefits for respiratory and digestive conditions.
In late June 2020, The Nation Thailand reported that phase 1 of the Thai research initiative on andrographis for COVID-19 had begun at two hospitals in Thailand. In this preliminary trial, patients received andrographis extract capsules* if they were confirmed to be infected with COVID-19 and had mild to moderate symptoms, including fever and coughing, lasting no more than 72 hours.
In this first phase, six subjects reportedly received 60 mg, or three times the normal dose, of andrographis extract capsules three times per day, while another six subjects received 100 mg, or five times the normal dose, three times per day. This phase focused on safety, disinfecting activity, and reducing virus-cell division.
In late August 2020, The Nation Thailand reported that the lower dose of andrographis showed benefits in the preliminary trial, especially for coughing. Within three days, both cough volume and overall symptom severity reportedly decreased significantly. After five days, other symptoms improved, and real-time polymerase chain reaction (PCR) tests were negative for the COVID-19 virus in two patients. After three weeks, real-time PCR tests were negative in all six subjects, but additional studies are needed to confirm the results.
Phase 2 was scheduled to begin in September 2020 and reportedly included 60 volunteers who were divided into two groups: one that received andrographis and one that received placebo. Details about the results of this phase are unclear, but in December, when the andrographis extract was approved for the pilot study, the Thai government reportedly claimed that the plant could be used as a safe, effective, less costly treatment alternative and can reduce inflammation. The plants used in the Thai COVID-19 research initiative are being sourced from Thailand.
In a study published in November 2020, researchers screened 122 Thai natural products (114 medicinal plant extracts and eight purified compounds) for activity against SARS-CoV-2, the virus that causes COVID-19. Among six selected candidates, andrographis extract had moderate inhibitory activity against the virus in cell cultures, while its purified compound andrographolide exhibited 99.9% inhibitory activity against the virus in cell cultures. Another in vitro study from Thailand published in December 2020 showed that a 95% ethanol extract of andrographis leaves significantly inhibited the production of SARS-CoV-2 in a human lung cell model. The andrographis leaf material met the criteria of the Thai Herbal Pharmacopoeia, and its powder was made into an extract using 95% ethanol at a 4:1 ratio. It is unclear if these two studies played a part in the government’s approval of andrographis for COVID-19.
In an email notice sent by the American Herbal Pharmacopoeia (AHP) on January 4, 2021, about the Thai government’s approval of andrographis, Roy Upton, RH (AHG), DipAyu, president of AHP, was quoted as saying: “Mobilizing immune defenses as soon as symptoms arise is critically important for management of any upper respiratory infection.
“It is a strategy employed by Chinese herbal practitioners for centuries and is a formal part of [COVID-19] treatment protocols in China, where more than 90% of COVID patients are treated with herbs,” whereas for many COVID-19 patients in the United States, the disease progresses while waiting for the test results.