To determine the effect of Pycnogenol® versus placebo on patient-reported health status in people with post COVID-19 condition.
The primary aim of this 12-week quadruple blind, single-center randomized controlled trial is to determine the effect of Pycnogenol® (200mg daily) versus placebo on patient-reported health status (EQ-Visual Analogue Scale) in people with post COVID-19 condition. Secondary outcomes include symptoms, fatigue, cognitive function, health-related quality of life, functional exercise capacity and blood biomarkers of inflammation, endothelial function and oxidative stress. Pycnogenol® is a licensed pine tree bark extract (Pinus pinaster ssp. atlantica) and primarly used for the treatment of venous disorders. Various studies reported beneficial effects in other conditions such as diabetes, metabolic syndrome and cardiovascular disorders. Pycnogenol® exerts antioxidative, anti-inflammatory and antiproliferative effects and has been shown to improve vascular endothelial function. Pycnogenol® may have potential to improve the health status of people suffering from post COVID-19 condition. This trial lasts for 12 weeks. Participants are invited to visit the study center four times: screening visit, baseline visit, follow-up 1 visit (6 weeks after baseline visit), follow-up 2 visit (12 weeks after baseline visit). In a substudy using baseline data, the investigators plan to study associations between objectively measured physical activity, severity of post COVID-19 condition, symptom burden and severity (e.g., fatigue, dyspnoea), functional exercise capacity, and health-related quality of life.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
153
Single center, quadruple blind randomized controlled trial comparing Pycnogenol® versus Placebo.
Single center, quadruple blind randomized controlled trial comparing Pycnogenol® versus Placebo.
University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Department of Public & Global Health
Zurich, Switzerland
Health status (EQ-VAS)
EQ-Visual Analogue Scale (EQ-VAS also known as "Feeling thermometer") assessed daily over 7 consecutive days prior to the baseline and at the end of the follow-up 2 visit (i.e., study end after 12 weeks). The scale ranges from 0-100 with 0 representing worst health status and 100 representing best health status.
Time frame: Change from baseline to 12 weeks
Post COVID-19 symptoms
Symptoms (present/not present) and symptom severity (5- point Likert scale: 1=not bad at all, 2=mild, 3=moderate, 4=severe, 5=very severe) will be assessed using a self-administered online questionnaire. Symptoms will also be recorded in a paper diary and completed on a weekly basis.
Time frame: Change from baseline to 12 weeks
Fatigue
Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-F). 13-item questionnaire with a 7-day recall period assessed at baseline and after 12 weeks. The level of fatigue is measured on a 5-point Likert scale (4 = not at all fatigued to 0 = very much fatigued). Individual item scores are summed, with lower scores indicating more severe fatigue.
Time frame: Change from baseline to 12 weeks
Dyspnea
Symptom domain of the Chronic Respiratory Questionnaire (CRQ) assessed at baseline and after 12 weeks. The questionnaire contains 5 questions; 7-point Likert-type scale ranging from 1 (most severe dyspnea) to 7 (no dyspnea).
Time frame: Change from baseline to 12 weeks
Cognitive function
Montreal Cognitive Assessment (MoCA) assessed at baseline and after 12 weeks. The cut-off score \< 26 for cognitive impairment will be used in this study.
Time frame: Change from baseline to 12 weeks
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Anxiety and depression
Hospital, Anxiety and Depression Scale (HADS) assessed at baseline and after 12 weeks. Symptoms of depression and anxiety (14 questions, 4-point Likert-type scale).
Time frame: Change from baseline to 12 weeks
Health-related quality of life (EQ-5D-5L)
The EQ-5D-5L assesses the 5 dimensions mobility, self-care, usual activities, pain/discomfort, anxiety/depression. The EQ-5D-5L scores each dimension on five levels of severity ranging from 1 = "no problems" to 5 = "extreme problems. The instrument will be used at baseline and after 12 weeks.
Time frame: Change from baseline to 12 weeks
Functional exercise capacity
A 30 second Sit-to-Stand (STS) will be performed at baseline and after 12 weeks. The number of repetitions that the participant completes the full sit-to-stand movement on a chair during 30 seconds. A familiarisation test will be done at the screening visit to rule out potential learning effects.
Time frame: Change from baseline to 12 weeks
Physical activity
Physical activity measured with an accelerometer (ActiGraph wGT3X-BT, Pensacola, FL, USA), which is worn at the right hip over 8 consecutive days prior to the baseline and 12 week study visit. Number of daily steps and time spent in different intensity domains (min per day) will be analysed.
Time frame: Change from baseline to 12 weeks
Soluble Thrombomodulin (sTM)
Blood biomarker of endothelial health measured with Enzyme-linked Immunosorbent Assay (ELISA) or Luminex (bead-based immunoassay) at baseline and after 12 weeks.
Time frame: Change from baseline to 12 weeks
von Willebrand Factor antigen (VWF:Ag)
Blood biomarker of endothelial health measured with Enzyme-linked Immunosorbent Assay (ELISA) or Luminex (bead-based immunoassay) at baseline and after 12 weeks.
Time frame: Change from baseline to 12 weeks
Syndecan-1
Blood biomarker of endothelial health measured with Enzyme-linked Immunosorbent Assay (ELISA) or Luminex (bead-based immunoassay) at baseline and after 12 weeks.
Time frame: Change from baseline to 12 weeks
Circulating Cascular Cell Adhesion Molecule-1 (sVCAM 1)
Blood biomarker of endothelial health measured with Enzyme-linked Immunosorbent Assay (ELISA) or Luminex (bead-based immunoassay) at baseline and after 12 weeks.
Time frame: Change from baseline to 12 weeks
C-reative protein (CRP)
Marker of inflammation (serum) measured at baseline and after 12 weeks by a certified laboratory (Analytica, Zurich, Switzerland).
Time frame: Change from baseline to 12 weeks
Interleukine 6 (IL 6)
Marker of inflammation measured with Enzyme-linked Immunosorbent Assay (ELISA) or Luminex (bead-based immunoassay) at baseline and after 12 weeks.
Time frame: Change from baseline to 12 weeks
sCD40L
Marker of coagulation and platelet function measured with Enzyme-linked Immunosorbent Assay (ELISA) or Luminex (bead-based immunoassay) at baseline and after 12 weeks.
Time frame: Change from baseline to 12 weeks
sP selectin
Adhesion molecule measured with Enzyme-linked Immunosorbent Assay (ELISA) or Luminex (bead-based immunoassay) at baseline and after 12 weeks.
Time frame: Change from baseline to 12 weeks
D-Dimer
Marker of coagulation and platelet function measured in citrate blood at baseline and after 12 weeks by certified laboratory (Analytica, Zurich, Switzerland).
Time frame: Change from baseline to 12 weeks
Activated partial thromboplastin time (aPTT)
Marker of coagulation and platelet function measured in citrate blood at baseline and after 12 weeks by certified laboratory (Analytica, Zurich, Switzerland).
Time frame: Change from baseline to 12 weeks
International normalized ratio (INR) blood test
Marker of coagulation and platelet function measured in citrate blood at baseline and after 12 weeks by certified laboratory (Analytica, Zurich, Switzerland).
Time frame: Change from baseline to 12 weeks
Total antioxidant capacity (TAC)
Marker of oxidative stress measured in blood plasma at baseline and after 12 weeks. TAC will be measured using the well-established Ferric Reduction Capability of Plasma (FRAP) method using a commercially available kit.
Time frame: Change from baseline to 12 weeks
Aspartate aminotransferase (ASAT)
Marker of liver function measured in blood serum at baseline and after 12 weeks by a certified laboratory (Analytica, Zurich, Switzerland).
Time frame: Change from baseline to 12 weeks
Alanine aminotransferase (ALAT)
Livery enzyme measured in blood serum at baseline and after 12 weeks by a certified laboratory (Analytica, Zurich, Switzerland).
Time frame: Change from baseline to 12 weeks
Gamma glutamyltransferase (γ-GT)
Livery enzyme measured in blood serum at baseline and after 12 weeks by a certified laboratory (Analytica, Zurich, Switzerland).
Time frame: Change from baseline to 12 weeks
Creatinine
Creatinine including clearance measured in blood serum at baseline and after 12 weeks by a certified laboratory (Analytica, Zurich, Switzerland).
Time frame: Change from baseline to 12 weeks