Background: Many clinical trials have been ongoing for a safe and effective treatment in COVID 19 targeting viral proteins, viral entry pathways, or immune regulatory pathways.  Zinc plays a pivotal role in developing and maturing both the innate and acquired anti-viral immune response, and its deficiency is linked with immune dysregulation. Zinc also plays a direct inhibition of SARS-CoV-2 replication. Supplemented with nitazoxanide (immunomodulatory effect), ribavirin (broad-spectrum anti-viral effect against RNA viruses), and ivermectin (broad anti-viral and anti-inflammatory activity) may prove to be beneficial in the treatment of SARS-CoV-2 infection. 

Methods: A non-randomized trial that included 62 patients on the triple combination treatment of nitazoxanide, ribavirin, and ivermectin plus zinc versus 51 age-and sex-matched patients on routine supportive treatment. 

Results: The trial results showed that the clearance rates were 05 and 58.1% on the 7th day and 13.7% and 73.1% on the 15th day in the supportive treatment and combined anti-viral groups, respectively. The cumulative clearance rates on the 15th day were reported to be 13.7% and 88.75 in the supportive treatment and combined anti-viral groups, respectively. 

Study inference: The study results concluded that the combined use of nitazoxanide, ribavirin and ivermectin plus zinc supplement effectively cleared the SARS-CoV-2 from the nasopharynx in a shorter time than symptomatic therapy. 

Reference: Elalfy H, Besheer T, El-Mesery A, et al. effect of a combination of nitazoxanide, ribavirin, and ivermectin plus zinc supplement (MANS.NRIZ study) on the clearance of mild COVID-19. J Med Virol. 2021; 93: 3176-3183.