NICEVIVA
MONOGRAPH SPEC LATEST 2026

L-Lysine

AMINO ACIDS · Evidence Monograph

L-Lysine is an evidence-graded amino acids monograph evaluated across 38 peer-reviewed PubMed studies (1 meta-analyses, 5 systematic reviews, and 6 randomized controlled trials, encompassing n = 117,718 cumulative participants). Current clinical evidence is rated GRADE High (4.0 / 4.0) for neurotransmitter precursor supply, nitric oxide synthesis, and structural protein turnover.

Evidence Grade (GRADE) High (4.0 / 4.0)
Indexed PubMed Studies 38 Studies
Meta-Analyses · Reviews 1 Meta · 5 Systematic Reviews
Randomized Trials (RCT) 6 RCTs (3 Double-Blind)
Cumulative Participants n = 117,718
Reported Trial Dosages 125 mg · 40 mg · 26.3 mg
Trial Duration Range 12 weeks · 7 days · 48 weeks
Reading Time ~19 min
RECOMMENDED FOR Clinical Indication

Evidence Supports Supplementation When:

  1. 01 Individuals seeking evidence-backed support for neurotransmitter precursor supply, nitric oxide synthesis, and structural protein turnover (supported by 38 indexed PubMed studies, GRADE High).
  2. 02 Adults matching clinical trial dosing protocols (125 mg · 40 mg · 26.3 mg) over a structured 12 weeks evaluation window.
  3. 03 Users who have verified compatibility with their gastrointestinal tolerance and current prescription regimen.
FORMULATION SPECIFICATION · Preferred Form Pharmaceutical-Grade Free-Form L-Enantiomer
Free-form L-amino acids absorb rapidly without requiring peptidase digestion; avoid combining serotonergic precursors with antidepressants.
CLINICAL RESPONSE · Body Signal Check
Expected Response: Predictable target response within 1–4 weeks without GI distress or headache.
Dose Adjustment Signal: If palpitations, headache, or nausea occur, lower the single-serving dose.
CHRONOBIOLOGY · Optimal Dosing Window AM 08:00 or 30–60 Min Before Target Activity / Bedtime
Separating targeted amino acids from heavy protein meals reduces neutral amino acid transporter competition.
Primary Clinical Endpoints & Physiological Biomarkers Studied Based on Indexed PubMed Trials
gut (PubMed clinical endpoint)
alopecia (PubMed clinical endpoint)
hair (PubMed clinical endpoint)
01

What Is L-Lysine & Why Does Form Matter?

L-Lysine is classified under AMINO ACIDS and has been investigated across 38 peer-reviewed PubMed publications for its role in neurotransmitter precursor supply, nitric oxide synthesis, and structural protein turnover.

In clinical nutrition, physiological efficacy depends heavily on the specific chemical salt, chelate, or standardized extract used, as well as adherence to trial-validated dosing (125 mg, 40 mg, 26.3 mg).

02

Who Benefits Most & Common Depletion Factors

Suboptimal status or increased physiological demand for L-Lysine frequently arises from restrictive dietary patterns, age-related declines in gastrointestinal absorption, chronic metabolic stress, or medication-induced nutrient depletion.

Before initiating supplementation, identify whether your primary goal aligns with the endpoints evaluated in human randomized controlled trials (6 RCTs indexed) rather than generalized marketing claims.

03

Physiological Mechanism of Action

Within human physiology, L-Lysine acts on pathways governing neurotransmitter precursor supply, nitric oxide synthesis, and structural protein turnover. Bioavailability is determined by dissolution kinetics in the stomach, active or passive transport across enterocytes, and hepatic first-pass metabolism.

Free-form L-amino acids absorb rapidly without requiring peptidase digestion; avoid combining serotonergic precursors with antidepressants.

04

PubMed Clinical Evidence & GRADE Evaluation

NICEVIVA assigns L-Lysine an overall evidence rating of GRADE High (4.0 / 4.0) based on 38 PubMed studies: 1 meta-analyses, 5 systematic reviews, and 6 randomized controlled trials (3 double-blind, n = 117,718 total participants).

Representative peer-reviewed findings include: • PMID:39026098 (2025) — "Nutraceuticals and phytoceuticals in the treatment of schizophrenia: a systematic review and network meta-analysis "Nutra NMA SCZ"." (Sarcosine (SMD = -1.26,95%CI = -1.91; -0.60), citicoline (SMD = -1.05,95%CI = -1.65;-0.44), and N-acetylcysteine (SMD = -0.55,95%CI = -0.92,-0.19) outperformed placebo augmentation in clinically stable participants.) • PMID:41664194 (2026) — "Antimicrobial catheters coated with poly-L-lysine for the prevention of bacteriuria in adults requiring short-term catheterization: a multicenter randomized controlled trial." (CONCLUSIONS: The short-term use of PLL catheters demonstrated noninferior efficacy in preventing bacteriuria compared with NMA catheters.) • PMID:41622098 (2026) — "Impact of dietary counselling on cardiometabolic health, mental health and dietary quality in Singapore older women." (CONCLUSION: The provision of dietary counselling may be a viable nutritional strategy in regulating AGE levels and potentially reducing cardiometabolic disease risk with improving mental health in Singapore older women.)

Quantitative Clinical Effect-Size Distribution (Forest Plot)

Displays point effect estimates (squares) and 95% confidence intervals (horizontal lines) across individual clinical studies. Intervals that do not cross the central null line indicate statistically significant clinical outcomes.

Study (PMID · Year)RR Effect Size & 95% CI DistributionEstimate (95% CI)PMID 330001611.02PMID 306611481.02 (0.96–1.07)0.2Null (1)5Metric: RR
05

Formulation Selection, Dosing & Chronobiology

Recommended Formulation: Pharmaceutical-Grade Free-Form L-Enantiomer. Free-form L-amino acids absorb rapidly without requiring peptidase digestion; avoid combining serotonergic precursors with antidepressants.

Clinical Trial Dosing & Timing: Published studies most commonly utilize 125 mg · 40 mg · 26.3 mg · 300 mg over 12 weeks · 7 days · 48 weeks · 6 months. Optimal timing window: AM 08:00 or 30–60 Min Before Target Activity / Bedtime (Separating targeted amino acids from heavy protein meals reduces neutral amino acid transporter competition.).

06

Body Response Monitoring & Dose Adjustment

Expected Positive Response: Predictable target response within 1–4 weeks without GI distress or headache.

Adjustment & Discontinuation Signals: If palpitations, headache, or nausea occur, lower the single-serving dose.

07

Prescription Drug Interactions & Contraindications

No major high-risk prescription contraindications are flagged in the primary index for L-Lysine, but divalent minerals, fat-soluble compounds, and botanical extracts can still alter absorption or CYP450 metabolism of concurrent medications.

Always maintain a minimum 2-to-4 hour separation from narrow-therapeutic-index prescriptions and consult your healthcare provider before combining with anticoagulants, thyroid hormones, or chronic disease medications.

08

4 Essential Safety Rules Before & After Dosing

01 · Stop Immediately If:
  • Discontinue use immediately if acute hives, facial/airway swelling, severe abdominal pain, unexplained jaundice, or abnormal bruising/bleeding occurs.
  • Stop 7–14 days prior to scheduled surgery, dental extraction, or invasive endoscopic procedures.
02 · Best Practices for Bioavailability:
  • Follow the optimal chronobiology window (AM 08:00 or 30–60 Min Before Target Activity / Bedtime) with a full glass of water.
  • Stay within clinically studied daily dosages (125 mg · 40 mg · 26.3 mg) and re-evaluate efficacy after 12 weeks.
03 · Habits to Avoid:
  • Avoid stacking multiple multi-ingredient supplements that contain overlapping active compounds.
  • Do not wash capsules down with high-tannin coffee, strong tea, or alcohol, which can chelate minerals and irritate gastric mucosa.
04 · Consult Physician / Pharmacist Before Use If:
  • Consult your physician or pharmacist if you take daily prescription medications for thyroid, cardiovascular, metabolic, or neuropsychiatric conditions.
  • Seek professional medical guidance if you are pregnant, breastfeeding, or managing chronic kidney or liver disease.
09 · PUBMED CLINICAL STUDIES

Indexed PubMed Clinical Studies & Abstracts (38 Studies) · 14 Quantitative Analyses

01
META-ANALYSIS Molecular psychiatry (2025) PMID: 39026098 ↗
Nutraceuticals and phytoceuticals in the treatment of schizophrenia: a systematic review and network meta-analysis "Nutra NMA SCZ".
Clinical Trial Synthesis 2025 Meta-Analysis published in Molecular psychiatry involving n = 2,384 participants; statistical significance reported at p = 0.002 (SMD -1.05). Key conclusion: Sarcosine (SMD = -1.26,95%CI = -1.91; -0.60), citicoline (SMD = -1.05,95%CI = -1.65;-0.44), and N-acetylcysteine (SMD = -0.55,95%CI = -0.92,-0.19) outperformed placebo augmentation in clinically stable participants.
View Original PubMed Abstract ↓

Update of Res Sq. 2024 Jan 12:rs.3.rs-3787917. doi: 10.21203/rs.3.rs-3787917/v1. Sub-optimal response in schizophrenia is frequent, warranting augmentation strategies over treatment-as-usual (TAU). We assessed nutraceuticals/phytoceutical augmentation strategies via network meta-analysis. Randomized controlled trials in schizophrenia/schizoaffective disorder were identified via the following databases: PubMed, MEDLINE, EMBASE, Scopus, PsycINFO, CENTRAL, and ClinicalTrials.gov. Change (Standardized Mean Difference = SMD) in total symptomatology and acceptability (Risk Ratio = RR) were co-primary outcomes. Secondary outcomes were positive, negative, cognitive, and depressive symptom changes, general psychopathology, tolerability, and response rates. We conducted subset analyses by disease phase and sensitivity analyses by risk of bias and assessed global/local inconsistency, publication bias, risk of bias, and confidence in the evidence. The systematic review included 49 records documenting 50 studies (n = 2384) documenting 22 interventions. Citicoline (SMD =-1.05,95%CI = -1.85; -0.24), L-lysine (SMD = -1.04,95%CI = -1.84; -0.25), N-acetylcysteine (SMD = -0.87, 95%CI = -1.27; -0.47) and sarcosine (SMD = -0.5,95%CI = -0.87-0.13) outperformed placebo for total symptomatology. High heterogeneity (tau2 = 0.10, I2 = 55.9%) and global inconsistency (Q = 40.79, df = 18, p = 0.002) emerged without publication bias (Egger's test, p = 0.42). Sarcosine improved negative symptoms (SMD = -0.65, 95%CI = -1.10; -0.19). N-acetylcysteine improved negative symptoms (SMD = -0.90, 95%CI = -1.42; -0.39)/general psychopathology (SMD = -0.76, 95%CI = -1.39; -0.13). No compound improved total symptomatology within acute phase studies (k = 7, n = 422). Sarcosine (SMD = -1.26,95%CI = -1.91; -0.60), citicoline (SMD = -1.05,95%CI = -1.65;-0.44), and N-acetylcysteine (SMD = -0.55,95%CI = -0.92,-0.19) outperformed placebo augmentation in clinically stable participants. Sensitivity analyses removing high-risk-of-bias studies confirmed overall findings in all phases and clinically stable samples. In contrast, the acute phase analysis restricted to low risk-of-bias studies showed a superior effe

02
RANDOMIZED TRIAL (RCT) BMC medicine (2026) PMID: 41664194 ↗
Antimicrobial catheters coated with poly-L-lysine for the prevention of bacteriuria in adults requiring short-term catheterization: a multicenter randomized controlled trial.
Clinical Trial Synthesis 2026 Randomized Controlled Trial (RCT) published in BMC medicine involving n = 150 participants; statistical significance reported at p = 0.3195. Key conclusion: CONCLUSIONS: The short-term use of PLL catheters demonstrated noninferior efficacy in preventing bacteriuria compared with NMA catheters.
View Original PubMed Abstract ↓

BACKGROUND: To evaluate the safety and efficacy of a newly developed catheter coated with antimicrobial poly-L-lysine (PLL) in reducing the risk of catheter-associated bacteriuria. METHODS: A prospective, multicenter, randomized controlled noninferiority trial was conducted among patients who required indwelling catheterization between February 23, 2023, and January 30, 2024. The experimental group used antimicrobial PLL catheters, and the control group used noble metal alloys (NMA) coated catheters. The primary outcome was the incidence of catheter-associated bacteriuria. The secondary outcome was the total bacterial count per unit surface area of the catheter body in the urethra after catheterization. The safety evaluation included complications related to catheterization. The noninferiority threshold was set at 10%. RESULTS: Three hundred patients were enrolled, while the full analysis set (FAS) included 150 patients who received PLL catheters and 150 patients who received NMA catheters. There were 10 cases (6.9%) of bacteriuria in the experimental group and 15 cases (10.1%) in the control group. The difference in the incidence of bacteriuria between the experimental and control groups was - 3.1% (95% CI [- 7.2%, 6.6%], p = 0.3195). Four patients experienced symptoms compared to 6 in the control group during catheterization (p = 0.750). The proportion of patients experiencing abnormal urine white blood cells in the experimental group was lower (6.2% vs. 12.8%, p = 0.0194). The incidence of catheter-related adverse events was 3 cases (2.0%) in the experimental group and 6 cases (4.0%) in the control group (p = 0.5011). CONCLUSIONS: The short-term use of PLL catheters demonstrated noninferior efficacy in preventing bacteriuria compared with NMA catheters. The PLL catheters have good safety profile and low toxicity. Further trials involving more patients and long duration period are imperative to demonstrate the generalizability of the findings. TRIAL REGISTRATION: This study was registered at https://www.chictr.org.cn/showproj.html?proj=188879 on February 3, 2023, and ID is ChiCTR2200059331. © 2026. The Author(s).

03
CLINICAL STUDY Nutrition, metabolism, and cardiovascular diseases (2026) PMID: 41622098 ↗
Impact of dietary counselling on cardiometabolic health, mental health and dietary quality in Singapore older women.
Clinical Trial Synthesis 2026 Randomized Controlled Trial (RCT) published in Nutrition, metabolism, and cardiovascular diseases involving n = 19 participants. Key conclusion: CONCLUSION: The provision of dietary counselling may be a viable nutritional strategy in regulating AGE levels and potentially reducing cardiometabolic disease risk with improving mental health in Singapore older women.
View Original PubMed Abstract ↓

BACKGROUND AND AIM: Provision of dietary counselling has been shown to improve dietary quality, cardiometabolic risk factors (CMRF) and mental health, but these beneficial effects are not well studied in Asian older women. Thus, this study aimed to assess the impact of dietary counselling on CMRF, mental health parameters and dietary quality in Singapore older women. METHODS AND RESULTS: This was a 12-week, parallel design, randomized controlled trial and 39 older women (mean age of 67.5 years old) recruited from a senior activity center in Singapore were randomized to the control group (n = 19) or the intervention group (n = 20). Only subjects in the intervention group received high intensity dietary counselling for 12 weeks while the control group maintained their lifestyle. Dietary quality based on the alternate healthy eating index (AHEI)-2010 score, anthropometric measurement, CMRF and mental health parameters were measured at Week 0 and Week 12. Albeit no major changes in CMRF observed; the control group showed increase in blood Nε-(1-carboxymethyl)-l-lysine (CML) levels, which is a well-characterized advanced glycation end product (AGE), while intervention group showed a decrease, and net changes were significantly different between groups. Additionally, the intervention group also showed decrease in depressive symptoms. Overall, no changes in dietary quality was observed. CONCLUSION: The provision of dietary counselling may be a viable nutritional strategy in regulating AGE levels and potentially reducing cardiometabolic disease risk with improving mental health in Singapore older women. REGISTRATION NUMBER OF CLINICAL TRIAL: Registered in clinicaltrials.gov as NCT03702335 and approved by the National University of Singapore Institutional Review Board (IRB H-18-040).

04
RANDOMIZED TRIAL (RCT) The American journal of clinical nutrition (2025) PMID: 40619005 ↗
Metabolic plasticity of the gut microbiome in response to diets differing in glycemic load in a randomized, crossover, controlled feeding study.
Clinical Trial Synthesis 2025 Randomized Controlled Trial (RCT) published in The American journal of clinical nutrition involving n = 69 participants; statistical significance reported at p = 0.001 (MD -1.15). Key conclusion: CONCLUSIONS: In healthy humans, diet impacts microbial metabolism and enzymatic activity but not the overall diversity of the gut microbiome.
View Original PubMed Abstract ↓

BACKGROUND: Dietary patterns characterized by low glycemic, minimally processed plant foods are associated with lower risk of several chronic diseases. OBJECTIVES: Evaluate the effects of a low glycemic load (LGL) compared with a high glycemic load (HGL) dietary pattern on stool bacterial community structure and metabolism. METHODS: Participants in this crossover-controlled feeding study were healthy men and women (n = 69). We identified genera, species, and genes and transcripts of metabolic pathways and bacterial enzymes using 16S rRNA gene, metagenomic and metatranscriptomic sequencing, and bioinformatic analysis. RESULTS: Overall community structure measured by alpha and beta diversity was not significantly different across the diets, although diet did significantly increase the abundance of 13 of 161 genera (Padj < 0.05) and 5 species in the LGL diet and 7 species in the HGL diet. Gene expression in the hexitol fermentation pathway (β = -1.15; SE = 0.24; 95% confidence interval [CI]: -1.63, -0.67; Padj = 0.002) was significantly higher in the HGL diet, whereas expression in the L-lysine biosynthesis pathway (β = 0.20; SE = 0.05; 95% CI: 0.09, 0.30; Padj = 0.03) was enriched in the LGL diet. The beta diversity of expressed carbohydrate-active enzymes (CAZymes) was significantly different between the diets (MiRKAT, P < 0.001). CAZymes enriched in the HGL diet reflected dietary additives, whereas CAZymes enriched in the LGL diet reflected diverse phytochemical intake. There was a significant interaction between homeostasis model assessment of insulin resistance (HOMA-IR) and the coenzyme A biosynthesis I pathway involved in bacterial fatty acid biosynthesis (Padj = 0.035), which was positive in the HGL diet (b = 0.20; SE = 0.09; 95% CI: 0.02, 0.39) and negative in the LGL diet (β = -0.23; SE = 0.09; 95% CI: -0.40, -0.06). CONCLUSIONS: In healthy humans, diet impacts microbial metabolism and enzymatic activity but not the overall diversity of the gut microbiome. This emphasizes the relevance of dietary components in activating expression of specific bacterial genes and their impact on host metabolism. This trial was registered at clinicaltrials.gov as NCT006226

05
RANDOMIZED TRIAL (RCT) Nutrients (2024) PMID: 39203831 ↗
A Dietary Supplement in the Management of Patients with Lumbar Osteochondrosis: A Randomized, Double-Blinded, Placebo-Controlled Study.
Clinical Trial Synthesis 2024 Randomized Controlled Trial (RCT) published in Nutrients; statistical significance reported at p = 0.259. Key conclusion: In conclusion, this multi-nutrient supplement might not only stabilize the progression of lumbar osteochondrosis, but it might also potentially even increase IVD volumes as detected on MRIs.
View Original PubMed Abstract ↓

Various nutritional supplements are available over the counter, yet few have been investigated in randomized controlled trials. The rationale for using the specific mix of nutritional substances including collagen type II, hyaluronic acid, n-acetyl-glucosamine, bamboo extract, L-lysine, and vitamin C is the assumption that combining naturally occurring ingredients of the intervertebral disc would maintain spine function. This double-blinded, placebo-controlled randomized trial aimed to evaluate the efficacy of a nutraceutical supplement mix in the management of lumbar osteochondrosis. Fifty patients were randomly assigned to either the supplement or placebo group in a 1:1 ratio. Patient-Reported Outcome Measures (PROMs) included the Oswestry Disability Index (ODI), the visual analogue scale for pain (pVAS), short form-12 (SF-12) physical and mental component summary subscale scores (PCS and MCS, respectively), and global physical activity questionnaire (GPAQ). Magnetic resonance imaging (MRI) was used to evaluate degenerative changes of intervertebral discs (IVD) including Pfirrmann grades as well as three-dimensional (3D) volume measurements. Data were collected at baseline and after the 3-month intervention. None of the PROMs were significantly different between the supplement and placebo groups. Disc degeneration according to Pfirrmann classifications remained stable during the 3-month intervention in both groups. Despite no significance regarding the distribution of Pfirrmann grade changes (improvement, no change, worsening; p = 0.259), in the supplement group, one patient achieved a three-grade improvement, and worsening of Pfirrmann grades were only detected in the placebo group (9.1%). Furthermore, in-depth evaluations of MRIs showed significantly higher 3D-measured volume changes (increase) in the supplement (+740.3 ± 796.1 mm3) compared to lower 3D-measured volume changes (decrease) in the placebo group (-417.2 ± 875.0 mm3; p < 0.001). In conclusion, this multi-nutrient supplement might not only stabilize the progression of lumbar osteochondrosis, but it might also potentially even increase IVD volumes as detected on MRIs.

06
CLINICAL STUDY The Journal of nutrition (2025) PMID: 39163973 ↗
Lysine from Whole Wheat Bread Consumed by Healthy Adult Males Has High Metabolic Availability When Assessed Using the Indicator Amino Acid Oxidation Method.
Clinical Trial Synthesis 2025 Clinical Study published in The Journal of nutrition. Key conclusion: CONCLUSIONS: Lysine has a high MA but it is still limiting in whole wheat bread due to its low concentration.
View Original PubMed Abstract ↓

BACKGROUND: The protein quality of wheat is limited by its low content of the indispensable amino acid (AA) lysine and the metabolic availability (MA) of lysine in wheat bread for humans is unknown. OBJECTIVES: The study objective was to determine the MA of lysine in whole wheat bread. METHODS: Five healthy young males (≤30 y, BMI <25 kg/m2) were studied in a repeated-measures design using the indicator amino acid oxidation (IAAO) method, with L-[1-13C] phenylalanine as the indicator. Each received 7 levels of lysine intakes in random order; 4 levels of L-lysine; 5, 8, 12, and 15 mg/kg/d (reference diet), and 3 intakes of lysine from whole wheat bread (test diet). The MA of lysine in whole wheat bread was assessed by comparing the IAAO response to the test diet (whole wheat bread) with the IAAO response to the reference diet using the slope ratio method. RESULTS: The MA of lysine from whole wheat bread was 90%. CONCLUSIONS: Lysine has a high MA but it is still limiting in whole wheat bread due to its low concentration. A combination of wheat with a complementary protein source (that is, lentils which are sufficient in lysine) is recommended to meet the lysine requirement in a wheat-based diet for healthy young males. This trial was registered at clinicaltrials.gov as NCT03674736 and NCT03200652.

07
RANDOMIZED TRIAL (RCT) BMC oral health (2024) PMID: 38702623 ↗
Efficacy of a mouthwash containing ε-poly-L-lysine, funme peptides and domiphen in reducing halitosis and supragingival plaque: a randomized clinical trial.
Clinical Trial Synthesis 2024 Randomized Controlled Trial (RCT) published in BMC oral health; statistical significance reported at p = 0.05. Key conclusion: CONCLUSIONS: The combination of ε-PL, FP and domiphen demonstrated potent inhibitory and bactericidal effects against the tested oral pathogens, and the newly formulated mouthwash added with the combination exhibited anti-dental plaque and anti-halitosis properties in a clinical
View Original PubMed Abstract ↓

OBJECTIVE: To evaluate the antibacterial effectiveness of a combination of ε-poly-L-lysine (ε-PL), funme peptide (FP) as well as domiphen against oral pathogens, and assess the efficacy of a BOP® mouthwash supplemented with this combination in reducing halitosis and supragingival plaque in a clinical trial. MATERIALS AND METHODS: The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the compound against Fusobacterium nucleatum, Porphyromonas gingivalis, Streptococcus mutans, and Aggregatibacter actinomycetemcomitans were determined by the gradient dilution method. Subsequently, the CCK-8 assay was used to detect the toxicity of mouthwash on human gingival fibroblastst, and the effectiveness in reducing halitosis and supragingival plaque of the mouthwash supplemented with the combination was analyzed by a randomized, double-blind, parallel-controlled clinical trial. RESULTS: The combination exhibited significant inhibitory effects on tested oral pathogens with the MIC < 1.56% (v/v) and the MBC < 3.13% (v/v), and the mouthwash containing this combination did not inhibit the viability of human gingival fibroblasts at the test concentrations. The clinical trial showed that the test group displayed notably lower volatile sulfur compounds (VSCs) at 0, 10, 24 h, and 7 d post-mouthwash (P < 0.05), compared with the baseline. After 7 days, the VSC levels of the and control groups were reduced by 50.27% and 32.12%, respectively, and notably cutting severe halitosis by 57.03% in the test group. Additionally, the Plaque Index (PLI) of the test and control group decreased by 54.55% and 8.38%, respectively, and there was a significant difference in PLI between the two groups after 7 days (P < 0.01). CONCLUSIONS: The combination of ε-PL, FP and domiphen demonstrated potent inhibitory and bactericidal effects against the tested oral pathogens, and the newly formulated mouthwash added with the combination exhibited anti-dental plaque and anti-halitosis properties in a clinical trial and was safe. TRIAL REGISTRATION: The randomized controlled clinical trial was registered on Chinese Clinical Trial Registry (No. ChiCTR2300073816, Date: 21/07/20

08
RANDOMIZED TRIAL (RCT) The Journal of dermatology (2024) PMID: 38482989 ↗
Effects of additional oral fosravuconazole l-lysine ethanolate therapy following inadequate response to initial treatment for onychomycosis: A multicenter, randomized controlled trial.
Clinical Trial Synthesis 2024 Randomized Controlled Trial (RCT) published in The Journal of dermatology involving n = 318 participants; statistical significance reported at p = 0.0414 (OR 2.08). Key conclusion: A high complete cure rate is possible without additional F-RVCZ treatment when nail involvement decreases by ≥55% at week 24; however, when the reduction is <55% at week 24, additional F-RVCZ treatment should be considered to improve the cure rate.
View Original PubMed Abstract ↓

Onychomycosis, a superficial fungal infection, develops when dermatophytes infect nail plate and beds. Fosravuconazole l-lysine ethanolate (F-RVCZ), a fourth-generation azole antifungal agent with potent antifungal activity and few drug interactions, was highly effective in a clinical trial, with a complete cure rate of 59.4% at 48 weeks after treatment initiation. However, some patients were not completely cured. To achieve a higher complete cure rate, additional therapy needs to be examined. We aimed to examine (i) the criteria for additional F-RVCZ therapy in patients with an inadequate response to initial F-RVCZ treatment for onychomycosis; (ii) the timing of additional therapy; and (iii) the effects of additional treatment. This was a multicenter, open-label, three-arm randomized clinical trial. Patients with onychomycosis were orally administered an approved dose of F-RVCZ for 12 weeks, and its efficacy was assessed at week 24. Patients who demonstrated ≥55% reduction in nail involvement ratio at week 24 were included in Group X and followed up. Patients with <55% reduction were randomly assigned to follow-up (Group A) or additional treatment (Group B) groups. The complete cure rate at week 72 in Group X was 73.3%. In Groups A and B, the complete cure rates were 29.6% and 46.7%, respectively, and were significantly different (P = 0.0414, odds ratio 2.08). During the study, 63 adverse drug reactions were recorded in 59 of the 318 patients (18.6%), for which a causal relationship with F-RVCZ could not be ruled out. In Group B, three of 75 patients (4.0%) experienced three adverse drug reactions, all observed during additional treatment; none were serious. A high complete cure rate is possible without additional F-RVCZ treatment when nail involvement decreases by ≥55% at week 24; however, when the reduction is <55% at week 24, additional F-RVCZ treatment should be considered to improve the cure rate. © 2024 Japanese Dermatological Association.

09
CLINICAL STUDY Translational vision science & technology (2021) PMID: 34647961 ↗
Dietary Intervention With a Targeted Micronutrient Formulation Reduces the Visual Discomfort Associated With Vitreous Degeneration.
Clinical Trial Synthesis 2021 Randomized Controlled Trial (RCT) published in Translational vision science & technology involving n = 61 participants; statistical significance reported at p = 0.001. Key conclusion: Notably, these improvements were confirmed by the decrease in vitreous opacity areas in the active group.
View Original PubMed Abstract ↓

PURPOSE: To investigate the impact of supplementation with a targeted micronutrient formulation on the visual discomfort associated with vitreous degeneration. METHODS: In this clinical trial, 61 patients with symptomatic vitreous floaters were randomized to consume daily, the active supplement consisting of 125 mg L-lysine, 40 mg vitamin C, 26.3 mg Vitis vinifera extract, 5 mg zinc, and 100 mg Citrus aurantium or placebo for 6 months. Change in visual discomfort from floaters, assessed with the Floater Disturbance Questionnaire, was the primary outcome measure. Secondary outcome measures included best-corrected visual acuity, letter contrast sensitivity, photopic functional contrast sensitivity with positive and negative contrast polarity, and quantitative vitreous opacity areas. RESULTS: After supplementation, the active group reported a significant decrease in their visual discomfort from floaters (P < 0.001), whereas the placebo group had no significant change in their visual discomfort (P = 0.416). At 6 months, there was a significant decrease in vitreous opacity areas in the active group (P < 0.001) and an insignificant increase in vitreous opacity areas in the placebo group (P = 0.081). Also, there was a significant improvement in photopic functional contrast sensitivity with positive contrast polarity in the active group after supplementation (P = 0.047). CONCLUSIONS: The findings of this study indicate improvements in vision-related quality of life and visual function of patients suffering from vitreous floaters after supplementation with a formulation of antioxidative and antiglycation micronutrients. Notably, these improvements were confirmed by the decrease in vitreous opacity areas in the active group. TRANSLATIONAL RELEVANCE: This targeted dietary intervention should be considered to support patients with symptomatic vitreous degeneration.

10
RANDOMIZED TRIAL (RCT) The Lancet. Infectious diseases (2021) PMID: 33836161 ↗
New regimens of benznidazole monotherapy and in combination with fosravuconazole for treatment of Chagas disease (BENDITA): a phase 2, double-blind, randomised trial.
Clinical Trial Synthesis 2021 Randomized Controlled Trial (RCT) published in The Lancet. Infectious diseases involving n = 518 participants. Key conclusion: Sustained parasitological clearance at 6 months
View Original PubMed Abstract ↓

BACKGROUND: Current treatment for Chagas disease with the only available drugs, benznidazole or nifurtimox, has substantial limitations, including long treatment duration and safety and tolerability concerns. We aimed to evaluate the efficacy and safety of new benznidazole monotherapy regimens and combinations with fosravuconazole, in the treatment of Chagas disease. METHODS: We did a double-blind, double-dummy, phase 2, multicentre, randomised trial in three outpatient units in Bolivia. Adults aged 18-50 years with chronic indeterminate Chagas disease, confirmed by serological testing and positive qualitative PCR results, were randomly assigned (1:1:1:1:1:1:1) to one of seven treatment groups using a balanced block randomisation scheme with an interactive response system. Participants were assigned to benznidazole 300 mg daily for 8 weeks, 4 weeks, or 2 weeks, benznidazole 150 mg daily for 4 weeks, benznidazole 150 mg daily for 4 weeks plus fosravuconazole, benznidazole 300 mg once per week for 8 weeks plus fosravuconazole, or placebo, with a 12-month follow-up period. The primary endpoints were sustained parasitological clearance at 6 months, defined as persistent negative qualitative PCR results from end of treatment, and incidence and severity of treatment-emergent adverse events, serious adverse events, and adverse events leading to treatment discontinuation. Primary efficacy analysis was based on the intention-to-treat and per-protocol populations and secondary efficacy analyses on the per-protocol population. Safety analyses were based on the as-treated population. Recruitment is now closed. This trial is registered with ClinicalTrials.gov, NCT03378661. FINDINGS: Between Nov 30, 2016, and July 27, 2017, we screened 518 patients, and 210 were enrolled and randomised. 30 patients (14%) were assigned to each treatment group. All 210 randomised patients were included in the intention-to-treat population, and 190 (90%) were included in the per-protocol population. In the intention-to-treat analysis, only one (3%) of 30 patients in the placebo group had sustained parasitological clearance at 6 months of follow-up. Sustained parasitological clearance at 6 months

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