Effect of Bromhexine among COVID-19 Patients - A Meta-Anaylsis

Abstract

Background and Aims: Bromhexine is an affordable and easily available mucolytic that appears to be beneficial among patients with COVID-19. It acts as a potent inhibitor of transmembrane serine protease 2, which is essential for the viral entry and propagation of SARS-CoV-2. Several trials have been conducted to determine its efficacy, however, its usefulness remains controversial.

Methods: Trials that utilized bromhexine among COVID-19 patients were investigated. The treatment arm received bromhexine hydrochloride tablets for 14 days plus standard of care while the control arm received standard of care only. The primary outcomes were mortality within 28 days of hospitalization, rate of intubation, and clinical improvement. The secondary outcomes were rate of intensive care unit (ICU) admission, discharge from hospital, and requirement of oxygen support.

Results and Conclusions: 3 studies with a total of 196 patients were analyzed in this meta-analysis. The number of mortality, intubated patients, and patients who required oxygen support were lower in the bromhexine group however it was not statistically significant (p=0.14, p=0.08, p=062). Clinical improvement was also better with the bromhexine group but did not achieved statistical significance (p=0.14). The rate of ICU admission and discharge from hospital favored bromhexine and is also statistically significant (p=0.04, p=0.01). Despite numerous available treatment, COVID-19 continuous to be a major worldwide health concern. The use of bromhexine as an alternative treatment would be of great importance given its affordability and accessibility to patients however, additional studies are still needed to prove its benefits.