SARS- CoV-2 is a novel virus with no proven therapeutic options for the management of the illness caused by it.

Several different drugs have been used for the treatment of COVID-19 since the outset of the pandemic. However, the outcomes have been mixed. Early findings from the compassionate use of remdesivir prompted FDA approval for this drug in COVID-19 management. However, later trials did notfind significant clinical benefit.

A recent study involving bromhexine in COVID-19 patients has been able to yield some positive results. The open-label, randomized trial evaluated the efficacy of early oral bromhexine therapy among COVID-19 patients with pneumonia in terms of intensive care unit (ICU) admission, rate of mechanical ventilation, and mortality. Seventy eight patients were randomized 1:1 to either bromhexine therapy or the control group (n=39 in each group). Patients in both the groups received standard therapy. 

Primary outcome measure - Reduction in the rate of ICU admissions, intubation/mechanical ventilation, and 28-day mortality.

Secondary outcomes measures- Clinical improvement of symptoms (fever, dyspnea, and weakness) assessment of C-reactive protein (CRP), lactate dehydrogenase (LDH), neutrophil/lymphocyte ratio (NLR), and duration of hospital stay.

Findings – 

• Bromhexine group had significantly reduced ICU admissions (5.1% vs. 28.2%), intubation (2.6% vs. 23.1%) and 28-day mortality(0% vs. 12.8%), in comparison with the standard treatment group.
• Assessment of improvement of key respiratory symptoms, including cough and dyspnea within two weeks: Dyspnea remained in 3.4% in the treatment group vs. 48.3% in the standard group; cough remained in 6.9% in the treatment group compared to 40.0% in the standard group. Fatigue continued in 6.9% in treatment group vs. 34.5% in standard group.
• Patients receiving bromhexine had improvement in the level of LDH (363.2±83.6 vs. 445.3±115.2) and NLR [1.7 (1.0) vs. 3.0 (6.3)]within two weeks, in comparison with the standard group.
• None of the patients had a positive CRP within two weeks while 81.8% in the standard group had a positive CRP.
• The difference in the duration of hospital stay was not significant between the two groups.
• No major adverse events in the study.
• Oral bromhexine clearly reduced mortality among patients with COVID-19. 

The drug could therefore be repurposed for the treatment of patients with COVID-19.

Source: Ansarin K, Tolouian R, Ardalan M, et al. Effect of bromhexine on clinical outcomes and mortality in COVID-19 patients: A randomized clinical trial. Bioimpacts. 2020; 10(4): 209–215.