Safety and Efficacy of Popular Iranian Herbal Cold Remedy for COVID-19: A Randomized Clinical Trial in Mild to Moderate COVID-19 Cases

Background: In traditional Persian medicine, an herbal cold remedy containing Sugarcane, Black Myrobalan, and mastic is mentioned and it was being widely provided by grocery stores. With the advent of the COVID-19 pandemic, the increased desire for this traditional remedy has led to a debate in society. Huge parts of the Iranian population have started using this remedy for the treatment of COVID-19; while no study has evaluated its efficiency and possible side effects. Thus, we aimed to evaluate the effects of Sugarcane, Black Myrobalan, and Mastic‏ ‏herbal medications for COVID-19 patients. Methods: This was a double-blinded randomized clinical trial study conducted over three months from May 2020 to July 2020 in SARS-COV2 PCR positive patients admitted in the COVID-19 ward of Peymaniyeh Hospital in Jahrom, Iran. Patients with severe COVID-19 infection were not recruited. The intervention group received the routine COVID-19 treatment protocol and the herbal supplement received the combination of black myrobalan and mastic and sugarcane, twice a day (3 g of herbal supplement). Study groups were compared in terms of demographic variables, vital signs, and clinical and laboratory variables for safety and efficiency assessment. Results: Seventy-two patients with COVID-19, divided into intervention (n=37) and control (n = 35) groups were studied. Intervention and control groups had not any significant difference in terms of baseline characteristics. The time-to-event analysis revealed a statistically significant difference in 4 symptoms of cough, fever, dyspnea, and myalgia (P< 0.05). There was no significant difference in averaged O2 vital signs between the two groups (P> 0.05). The Control group in comparison to the intervention group had a significantly lower decrease in C-reactive protein during 7 days (P< 0.05). Patients in the herbal supplement group were hospitalized for 4.12 days and patients in the control group were hospitalized for 8.37 days (P=0.001). ICU admission and death only happened in 3 (8.6%) patients of the control group. Conclusion: This study showed that the proposed herbal remedy could be applied as supplementation to conventional management of COVID-19 patients with mild disease, while more research is needed for clinical application of this remedy.