‘Game changer’: 5 long COVID treatments researchers are most excited about
Gabe Castro-Root
June 15, 2023
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Here are five they highlighted.
Low-dose naltrexone
Naltrexone, known more commonly by its brand names Vivitrol and Revia, is a drug made to treat abuse of drugs and alcohol by reducing their effects on the brain. At a low dose, it has shown promise as a treatment for the chronic fatigue that so many long COVID patients experience, according to Dr. Carla Kuon, the co-director of UCSF’s post-COVID clinic.
The drug works by reducing inflammation in the nervous system caused by COVID infection, Kuon said. It does so by regulating the activity of glial cells, which help maintain neurons but can cause inflammation when they’re activated.
“Low-dose naltrexone also has general anti-inflammation effects on the body, and we know inflammation is a big driver of the symptoms of long COVID,” Kuon said. “I personally, as a clinician, have used naltrexone in many patients with success.”
Dr. Hector Bonilla, the co-director of Stanford University’s long COVID clinic, said he also has observed positive results from naltrexone treatment among his patients. But he cautioned that because naltrexone is available as a cheap generic drug, there’s less financial incentive for pharmaceutical companies to fund research into its use as a long COVID treatment. Those trials will be needed to establish its benefits more clearly, he said.
Ivabradine and beta blockers
Ivabradine and beta blockers are different drugs that regulate the heartbeat, slowing it to allow more blood to be pumped with each contraction. These medications are being studied as a treatment for long COVID patients who develop postural orthostatic tachycardia syndrome, or POTS, a condition that results in dizziness and a very fast heartbeat when a person stands.
Ivabradine “has been a game changer” for long COVID patients with POTS, Kuon said.
Hannah Davis, co-founder of the Patient-Led Research Collaborative, a group of researchers who are also long COVID patients, said medications like these are helpful but can be a drain on the body’s resources, often leading to exhaustion when they wear off. She described using a beta blocker as taking energy from the future to support activity in the present.
“If I really have to be present for something, I’ll take a beta blocker knowing I’ll crash later,” Davis said.
A spokesman for Amgen, which manufactures ivabradine, said the company was not actively pursuing long COVID studies with the drug.
Metformin
A
recent study from the University of Minnesota found that the anti-diabetic drug metformin
reduced the risk of developing prolonged illness by up to 63% for those who started taking it within three days of contracting COVID.
The study, which included over 1,000 participants between ages 30 and 85, suggests the cheap, generic blood sugar medication may prevent viruses from replicating. Its low cost and wide availability could make it an attractive option for preventing long COVID if future research backs up the findings.
Metformin’s “use as a preventive measure could have significant public health implications,” said Dr. Carolyn Bramante, who led the study, in a statement after the results were published.
But the study examined metformin’s use only in preventing long COVID. More research is needed to determine whether the drug is a viable treatment for those already suffering from long COVID.
Antihistamines
COVID frequently causes activation of mast cells, a type of white blood cell found throughout the body. Mast cells release histamines and can lead to allergy-like symptoms including hives, flushing and dizziness. In long COVID patients, those symptoms can drag on long after the initial infection has run its course.
Histamines are also involved in POTS and neuroinflammation, Kuon said, so treating mast cell activation could help reduce other symptoms, too.
Davis said she wants to see clinical trials of prescription antihistamines, but was hopeful over-the-counter ones like benadryl would also prove useful.
A case report published last year in the
Journal for Nurse Practitioners showed promise for antihistamine treatments in two long COVID patients, and larger clinical trials are underway.
“I’ll be very interested in those trials because treating mast cell activation is a big part of how I treat long COVID,” Kuon said.
Anticoagulants
Small blood clots are a less common symptom of long COVID, but they can cause low blood-oxygen levels. Patient advocates are pushing for more trials of anticoagulants, which slow or prevent clotting.
“You feel woozy all the time,” Davis said of oxygen deprivation from microclots.
Bonilla said the clots could make full recovery more difficult, since decreased oxygen flow to vital organs means the body’s other functions may not operate at full capacity.
A study published last year in the journal
Frontiers in Cardiovascular Medicine found that the drug sulodexide, which treats clotting, significantly improved cardiovascular function and reduced chest pain in long COVID patients. But, as with all potential long COVID treatments, more research is needed to better understand the role of anticoagulants in treating the disease.
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https://www.sfchronicle.com/health/article/long-covid-treatment-18144379.php
