Source: Science Direct

René Lima-Morales, Pablo Méndez-Hernández, Yvonne N. Flores, Patricia Osorno-Romero, Elizabeth Cuecuecha-Rugerio, Adrián Nava-Zamora, Diego Rolando Hernández-Galdamez, Daniela Karola Romo-Dueñas, Jorge Salmerón


•TNR4 is a multidrug therapy (Ivermectin, Azithromycin, Montelukast and ASA) for COVID-19 cases.

•TNR4 increased the likelihood of recovery 3.4 times in ambulatory COVID-19 cases.

•The multidrug therapy TNR4 reduced the risk of hospitalization by 75%.

•The multidrug therapy TNR4 reduced the risk of death by 81%.



There is an urgent need for effective treatments to prevent or attenuate lung and systemic inflammation, endotheliitis, and thrombosis related to COVID-19. The aim of this study was to assess the effectiveness of a multidrug-therapy consisting of Ivermectin, Azithromycin, Montelukast and Acetylsalicylic Acid (“TNR4” therapy) to prevent hospitalization and death among ambulatory COVID-19 cases in Tlaxcala, Mexico.

Design and Methods

A comparative effectiveness study was performed among 768 confirmed SARS-CoV-2 cases aged 18 to 80 years, who received ambulatory care at the Ministry of Health of Tlaxcala. A total of 481 cases received the TNR4 therapy, while 287 received another treatment (comparison group). All participants received home visits and/or phone calls for clinical evaluation during the 14 days after enrollment.


Nearly 85% of cases who received the TNR4 recovered within 14 days compared to 59% in the comparison group. Likelihood of recovery within 14 days was 3.4 times greater among the TNR4 group than in the comparison group. Patients treated with TNR4 had a 75% and 81% lower risk of being hospitalized or death, respectively, than the comparison group.


TNR4 therapy improved recovery and prevented risk of hospitalization and death among ambulatory COVID-19 cases.

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