en Epidemiology Original Article <div style="text-align: justify;"><span style="font-size:10pt"><span style="line-height:200%"><span courier="" new="" style="font-family:"><span style="color:black"><b><span style="font-size:11.0pt"><span style="line-height:200%"><span arial="" style="font-family:">Background: </span></span></span></b><span style="font-size:11.0pt"><span style="line-height:200%"><span arial="" style="font-family:">Remdesivir is a nucleoside inhibitor of RNA polymerase with the antiviral activity used in the treatment of COVID-19 pneumonia. One of the remdesivir side effects is hepatotoxicity. Given the growing body of data supporting silymarin&#39;s antiviral and hepatoprotective properties, the present research sought to explore the impact of silymarin on laboratory parameters, frequency of symptoms, and liver enzymes in COVID-19 patients. </span></span></span></span></span></span></span><br> <span style="font-size:10pt"><span style="line-height:200%"><span courier="" new="" style="font-family:"><span style="color:black"><b><span style="font-size:11.0pt"><span style="line-height:200%"><span arial="" style="font-family:">Materials and Methods:</span></span></span></b><span style="font-size:11.0pt"><span style="line-height:200%"><span arial="" style="font-family:"> In this double-blind randomized clinical trial 70 patients were divided into two groups of 35. Intervention group received remdesivir + 140 mg Silymarin, 3 times, daily for 1 week, and the control group received remdesivir + placebo. Patients&#39; symptoms and laboratory findings were assessed at baseline and 5,7,10, and 14 days&rsquo; post enrollment.</span></span></span></span></span></span></span><br> <span style="font-size:10pt"><span style="line-height:200%"><span courier="" new="" style="font-family:"><span style="color:black"><b><span style="font-size:11.0pt"><span style="line-height:200%"><span arial="" style="font-family:">Results:</span></span></span></b><span style="font-size:11.0pt"><span style="line-height:200%"><span arial="" style="font-family:"> Liver enzymes level (aspartate aminotransferase, and alkaline phosphatase), and lactate dehydrogenase were significantly decreased in the intervention group (p < 0.05). Among the clinical symptoms, cough (p=0.03), shortness of breath (p= 0.006), headache (p=0.01), and muscle pain (p=0.03) were significantly lower in the treatment group comparing to the control group. Moreover, the severity of disease in the intervention group was substantially lower than that among the control group.</span></span></span></span></span></span></span><br> <span style="font-size:10pt"><span style="line-height:200%"><span courier="" new="" style="font-family:"><span style="color:black"><b><span style="font-size:11.0pt"><span style="line-height:200%"><span arial="" style="font-family:">Conclusion:</span></span></span></b><span style="font-size:11.0pt"><span style="line-height:200%"><span arial="" style="font-family:"> Concomitant use of remdesivir with silymarin might reduce hepatotoxicity and ultimately improve the patients&#39; condition. More clinical trials with different dosages and larger sample sizes are recommended.</span></span></span></span></span></span></span><br> &nbsp;</div> COVID-19,Liver Enzymes,Silymarin,Remdesivir, 132 138 http://johe.rums.ac.ir/browse.php?a_code=A-10-632-1&slc_lang=en&sid=1 Saeed Badiei saeedbadiei@yahoo.com 22400319475328460010702 22400319475328460010702 No Resident in Internal Medicine, Clinical Research Development Unit, Hajar Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran. Shahrekord University of Medical Sciences Shima Rahmati shimarahmati1987@gmail.com 22400319475328460010703 22400319475328460010703 No Ph.D. in Molecular Medicine, Cancer Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran. Shahrekord University of Medical Sciences Hadi Raeisi Shahraki Biostat91@gmail.com 22400319475328460010704 22400319475328460010704 No Assistant Prof., Dept. of Epidemiology and Biostatistics, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran. Shahrekord University of Medical Sciences Zahra Habibi Dr_z_habibi@yahoo.com 22400319475328460010705 22400319475328460010705 Yes Assistant Prof., Clinical Research Development Unit, Hajar Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran. Shahrekord University of Medical Sciences