Preventing Long COVID for People with Obesity

Rear View Mirror of an ExcavatorIn many ways, COVID seems to be in the rear view mirror. Travel, meetings, and busyness have cranked up to a level that makes it seem like the pause we took for the pandemic is a distant memory. But not for folks who develop long COVID – which is about ten percent of people who have a bout with this virus. That risk goes up for people with obesity. So a new study finding that an inexpensive diabetes drug – metformin – can be effective for preventing long COVID in people with overweight or obesity is good news indeed.

RCT: A 41% Reduction of Risk

This new study in Lancet Infectious Diseases by Carolyn Bramante and colleagues is impressive. It is a randomized, quadruple blinded, phase 3 trial of 1,431 persons with overweight or obesity who had COVID with symptoms for less than seven days when they enrolled in the study.

The acronym for this study was COVID-OUT. With six different arms, it tested two other drugs beside metformin: fluvoxamine and ivermectin. Neither of those drugs had any effect on either short-term or long term outcomes. The short term outcomes (severe COVID events in the first two weeks of infection) were reported in August last year with a paper in the New England Journal of Medicine. In that report, there was an insignificant reduction (16%) in the acute risk of severe COVID events with metformin.

In this report of long-term outcomes, fluvoxamine and ivermectin once again had no effect. But the persons who received metformin had a 41 percent reduction in risk of long COVID symptoms after ten months. For those who got it within three days of their first symptoms, the reduction in risk appeared to be even greater – 63 percent.

Landmark Findings

In a commentary alongside this study, Harvard’s Jeremy Samuel Faust was effusive:

“If confirmed, the findings from the study by Bramante and colleagues are profound and potentially landmark on two distinct counts. First, to our knowledge, this is the first high-quality evidence from a randomised controlled trial to show that the incidence of long COVID can be reduced by a medical intervention, metformin—an inexpensive treatment with which clinicians have ample experience.

“Second, the authors have, perhaps inadvertently, made an important contribution to medical epistemology. If a new disease has been sufficiently well characterised by clinicians so that it can be successfully modified by a therapy compared with placebo, then the entity must, from a practical standpoint, truly exist. Put differently, a treatment can only be effective if there is something to treat.”

In sum, long COVID is a real risk, especially for people living with obesity, and timely care can help with preventing it. This is good news.

Click here for Bramante study and here for the Faust commentary. For further new insights on long COVID, click here and here.

Rear View Mirror of an Excavator, photograph by Reinhold Möller, licensed under CC BY-SA 4.0

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June 12, 2023