Commonly-used drugs show small benefit for long-Covid fatigue
Over-the-counter antihistamines and a prescription anti-inflammatory drug have been shown to have a small benefit in reducing long-Covid fatigue in patients accessing specialist care.
A UK study of 800 adults in England and Scotland – being treated at specialist long-Covid clinics and randomly assigned usual care or famotidine plus loratadine, colchicine, or rivaroxaban – found that all groups showed some meaningful improvement.
But those taking antihistamines and colchicine saw an additional benefit in fatigue reduction after 12 weeks, researchers reported in The Lancet Infectious Diseases.
The participants, who had not been hospitalised with Covid, stopped taking the medicines at this 12-week point and the same reduction was not sustained at 24 weeks, the team reported.
With all groups seeing an average improvement in fatigue of 4.3 points on a 40-point scale, the results highlight the importance of specialist care for long Covid, the study concluded.
The study found that there was no difference to usual care in patients taking rivaroxaban, but those taking antihistamines or colchicine saw an additional 1.5-point improvement on the scale and it may be the medicines are having an impact on immune system dysregulation.
Study author Professor Amitava Banerjee from University College London Institute of Health Informatics explained the medicines were chosen based on the most promising theories of how to improve long Covid when the research began in 2021.
While the study found a small benefit with antihistamines and colchicine ‘these drugs alone are unlikely to be the answer to long Covid fatigue’.
Professor Banerjee added: ‘Both antihistamines and colchicine affect the immune system and it may be that they address the immune dysregulation that long Covid has been linked to, but further research is needed to understand the possible mechanism.’
Dr Melissa Heightman, clinical lead for the post-Covid service at University College Hospital London, said: ‘It is heartening that people had a significant reduction in fatigue across all arms of the trial.
‘This is more than you would expect based on time alone, given that participants had severe fatigue at recruitment and been ill for more than a year on average. This level of improvement shows the importance of specialist long Covid care.’
Co-author Professor Emma Wall, professor of infectious diseases at Queen Mary University of London, said: ‘The value of these results is not only that they suggest a potential treatment approach, but that they help us understand the biology of long Covid itself.
‘Every signal we see in the trial helps us refine our understanding of the immune and inflammatory mechanisms that may be driving the disease, to develop new, better targeted treatments for future trials.’
Professor Daniel Altmann, professor of immunology at Imperial College London, said the current treatment landscape, for those few able to access care, is a rather patchy one of symptom-based approaches.
He noted that the latest study was large-scale and taking a gold-standard approach. He said: ‘Using the best candidate drugs from earlier in the appraisal of this disease, the study shows rather modest, short-term benefit, simply showing what an exceptionally challenging condition this is.’
The results come shortly after disappointing findings from trials based on another key approach, using antivirals to eliminate any presumed long-term reservoir of the virus, he added.
Professor Altmann added: ‘As many of the most severe patients are now five to six years into this disabling condition, they do need hope from large clinical trials. A number of further ones are in progress or planned.’
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