The Potential of Glycyrrhizinate in the Management of COVID-19: A Systematic Review of the Efficacy and Safety of Glycyrrhizin Preparations in the Treatment of SARS and MERS

Am J Chin Med. 2020;48(7):1539-1552. doi: 10.1142/S0192415X20500767. Epub 2020 Nov 13.

Abstract

The SARS-CoV-2 outbreak in 2019 highlighted the fact that no specific medications providing effective treatment have been identified and approved. We explored the possibilities for COVID-19 by systematically reviewing evidence on the efficacy and safety of glycyrrhizin preparations for SARS and MERS. Electronic databases were systematically searched from inception to February 2020 for eligible studies that evaluated the efficacy and safety of glycyrrhizin preparations for SARS and MERS. A quantitative analysis or descriptive analysis was applied. Five retrospective cohort studies were included, and NOS scores ranged from 5-7 points. The clinical symptoms of dry cough, chest distress and dyspnoea improved quickly, and elevated serum levels of aminotransferase decreased after compound glycyrrhizin treatment. The SARS-CoV antibody appeared earlier in the treated group than in the control group ([Formula: see text][Formula: see text]d). Compared to that with conventional medications, the average period from peak to 50% improvement of lesions, in terms of X-ray manifestations, was shorter with compound glycyrrhizin treatment ([Formula: see text]2.1[Formula: see text]d), and treatment reduced the dosage ([Formula: see text][Formula: see text]mg/d) and duration of the corticosteroids used, without other serious adverse reactions. Based on the available evidence regarding glycyrrhizin preparations for treating SARS and MERS, we infer that compound glycyrrhizin could be an optional therapeutic strategy for SARS-CoV-2 infections, especially those complicated with liver damage. Further research using well-designed randomized clinical trials (RCTs) is warranted to determine the dosage and duration of use of compound glycyrrhizin and to monitor its specific adverse effects.

Keywords: Antiviral; COVID-19; Glycyrrhizin; Hepatic Protectant; SARS-CoV-2; Systematic Review.

Publication types

  • Systematic Review

MeSH terms

  • Anti-Inflammatory Agents / therapeutic use
  • COVID-19 / drug therapy*
  • COVID-19 / epidemiology
  • COVID-19 / virology
  • Coronavirus Infections / drug therapy*
  • Coronavirus Infections / virology
  • Glycyrrhizic Acid / therapeutic use*
  • Humans
  • Middle East Respiratory Syndrome Coronavirus / drug effects*
  • Middle East Respiratory Syndrome Coronavirus / physiology
  • Pandemics
  • SARS Virus / drug effects*
  • SARS Virus / physiology
  • SARS-CoV-2 / drug effects*
  • SARS-CoV-2 / physiology
  • Severe Acute Respiratory Syndrome / drug therapy*
  • Severe Acute Respiratory Syndrome / virology
  • Treatment Outcome

Substances

  • Anti-Inflammatory Agents
  • Glycyrrhizic Acid