Long COVID is notoriously hard to treat: chronic exhaustion, muscle pain, memory problems and shortness of breath accompany many patients for years, with no approved cure. Now a British study offers the first robust evidence that at least the fatigue can be eased somewhat with simple, long-available drugs.
A team led by Amitava Banerjee of University College London and Melissa Heightman of University College London Hospitals studied nearly 800 adults who had suffered severe exhaustion for more than a year on average and had not been treated in hospital. At twelve specialist clinics ranging from Hull and the Scottish Highlands to Leicester and London, participants received, for twelve weeks, either the usual specialist care alone or that care plus one of three drugs: the antihistamine combination famotidine/loratadine, the anti-inflammatory gout drug colchicine, or the blood thinner rivaroxaban. The results appeared in the journal The Lancet Infectious Diseases.
The first striking finding affected every group: on a 40-point scale, fatigue improved by an average of 4.3 points — including among those who received no trial drug. “It is heartening that people had a significant reduction in fatigue across all arms of the trial,” says Heightman. Given the long and severe history of illness, she says, this is more than the mere passage of time could explain — and evidence of the value of integrated care tailored to each individual.
A small but informative signal
Beyond this general improvement, two of the drugs offered an additional benefit: those taking the antihistamine or colchicine recorded a further reduction in fatigue of about 1.5 points after twelve weeks. The effect did not last, however, once participants stopped taking the drugs; by 24 weeks it had disappeared. “These drugs alone are unlikely to be the answer to long COVID fatigue,” Banerjee notes. Both act on the immune system, so they may address the immune dysregulation that has been linked to long COVID — though the precise mechanism, he says, needs further research.
The blood thinner rivaroxaban, by contrast, offered no benefit over specialist care alone. That is itself informative, since clotting disturbances and microthrombi are discussed as a possible cause of long COVID; yet the study provides no argument for using anticoagulants, according to Banerjee.
For the researchers, the real advance is that long COVID can now be tested in large, controlled trials like any other disease. Even small effects from safe, inexpensive and widely available drugs are valuable, stresses Danny McAuley of the NIHR: every signal helps to better understand the immune and inflammatory processes behind the condition and to develop more precisely targeted treatments for future trials.