randomized controlled trial
some concerns about risk of bias
Pyridostigmine
Oral pyridostigmine at a dose of 60 mg/day until the occurrence of any of the prespecified outcomes, hospital discharge, or 14 in-hospital days.
Placebo
Matching placebo (pharmaceutical-grade starch). One tablet P.O. once per day for 14 days.
All patients received best standard of care available for severe COVID-19 in participating centers.
COVID-19 severe or critically
Adults (≥18 years old), with confirmed SARS-CoV-2 infection based on a positive RT-PCR test, requiring in-hospital care, Imaging study compatible with pneumonia, At least one of the following criteria: a). Dyspnea b). Lung infiltrates occupying > 50% of lung fields by CT scan c) PaO2/FiO2 ratio < 300 mmHg d). Peripheral oxygen saturation (SpO2) < 90% while breathing room air, a ≥ 3% drop in baseline SpO2, or the need of increased flow rates of supplemental oxygen in the case of chronic hypoxia; and the need for supplemental oxygen therapy according to the treating medical team’s judgment. e). Alteration of one or more of the following laboratory parameters: D-dimer > 1 μg/mL, Ferritin level > 300 ng/mL, C-reactive protein (CRP) > 3 mg/L, Lactate dehydrogenase (LDH) > 245 U/L, Lymphopenia, defined as < 800 lymphocytes/uL, Creatine kinase (CK) level > 800 IU/L