The solely assured technique to forestall Lengthy COVID is to keep away from getting contaminated by SARS-CoV-2, the virus that causes COVID-19. Lately, nonetheless, researchers have discovered promising indicators that sure medication could cut back the chance of growing Lengthy COVID in the event that they’re taken shortly after an infection.
These research are preliminary, however they increase an intriguing query: Ought to everybody who will get COVID-19 take treatment in hopes of avoiding Lengthy COVID?
Right here’s what consultants say.
Which medication may forestall Lengthy COVID?
Research have lately highlighted two promising medication: Paxlovid and metformin.
Paxlovid is an antiviral licensed to deal with COVID-19 amongst individuals at excessive threat of extreme illness, together with aged adults and folks with underlying well being circumstances. Final 12 months, researchers discovered that high-risk individuals who took Paxlovid inside 5 days of testing optimistic for COVID-19 had been 26% much less more likely to have Lengthy COVID signs after 90 days, in comparison with individuals who weren’t handled. On Mar. 23, the identical researchers revealed up to date information in JAMA Inner Drugs. Amongst a bigger group of high-risk individuals who had been tracked for six months—greater than 35,000 of whom took Paxlovid—the drug confirmed the identical discount in threat.
Metformin, in the meantime, is just not a basic antiviral; it’s lengthy been accredited as a Sort 2 diabetes therapy. However research recommend that it could have antiviral properties, probably limiting SARS-CoV-2’s means to repeat itself. In a single latest research (which has not but been peer-reviewed), metformin lower the chance of Lengthy COVID by greater than 40% amongst obese or overweight adults who took it once they had COVID-19, in comparison with those that didn’t take the drug.
I’ve COVID-19. Ought to I take an antiviral to forestall Lengthy COVID?
It’s too quickly to advocate that for the overall inhabitants. Dr. Harlan Krumholz, a professor on the Yale Faculty of Drugs who’s learning Paxlovid as a possible therapy for Lengthy COVID, says even essentially the most promising research outcomes should be confirmed earlier than they affect medical selections.
“We zig and we zag on proof on a regular basis. To easily begin telling all people to start out taking a drugs” earlier than there’s stable information is overzealous, he says.
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There’s nonetheless debate about what causes Lengthy COVID, provides Stefan Sarafianos, a professor at Emory College who research antivirals. Some consultants suppose remnants of the virus linger within the physique and trigger long-lasting signs. If that’s true, it’s “intuitive” that an antiviral drug may assist forestall that end result—however, Sarafianos says, it’s not clear if that speculation is the appropriate one. “Lengthy COVID is an enormous thriller,” he says.
Regardless of the unknowns, sure sufferers could wish to pursue Paxlovid prescriptions, says Dr. Ziyad Al-Aly, an assistant professor on the Washington College Faculty of Drugs in St. Louis and co-author of the JAMA research on Paxlovid. For individuals at excessive threat of extreme COVID-19, who already stand to profit from Paxlovid, the potential of stopping Lengthy COVID is an added bonus, Al-Aly says.
However “in individuals who don’t have threat components,” Al-Aly says, it’s principally “an evidence-free zone.”
Research have proven that Paxlovid has minimal impact amongst lower-risk individuals as much as 28 days after their diseases started. Krumholz says it’s value monitoring the drug’s results over an extended time frame, however as of now, there’s no robust information to recommend youthful, wholesome individuals needs to be taking it.
Metformin could also be helpful for a bigger group of individuals, argues Dr. David Boulware, a professor on the College of Minnesota Medical Faculty and co-author of the research on the drug’s potential means to forestall Lengthy COVID. Boulware and his colleagues studied adults ages 30 to 85 who had been both obese or overweight. Greater than 70% of U.S. adults are both obese or overweight, so that features a massive swath of the inhabitants.
Boulware personally determined to take metformin when he caught the virus final summer time. However, he says, it’s one factor for a doctor to make a private alternative, or to advocate a drug for a selected affected person based mostly on their well being profile, and one other to make a sweeping advice for the entire inhabitants.
Dr. Anand Viswanathan, a medical assistant professor on the NYU Grossman Faculty of Drugs, agrees that it’s too quickly to advocate metformin to most people. The analysis “represents a very good early sign,” he says. However “we want extra research to corroborate that information earlier than I’d vouch for mass use.”
That’s very true, Krumholz says, as a result of metformin isn’t a basic antiviral. He’d like extra data on the way it may fit towards SARS-CoV-2 earlier than recommending it to sufferers for the prevention of Lengthy COVID.
Is it dangerous to take Paxlovid or metformin to forestall Lengthy COVID?
Each Paxlovid and metformin are secure, however they arrive with attainable unwanted side effects together with gastrointestinal points, muscle ache, and unsightly aftertastes, in addition to rarer however extra severe points.
Plus, Paxlovid interacts with various widespread medicines, Viswanathan says, which means sufferers could need to pause their different therapies whereas they take it. Which may be worthwhile for somebody who may get significantly in poor health from untreated COVID-19, nevertheless it’s a tougher promote for somebody who could not even profit from taking Paxlovid.
Widespread Paxlovid use may additionally theoretically increase the chance of antiviral resistance, Sarafianos says. Drug resistance occurs when pathogens mutate sufficient to cease responding to the medicines meant to tame them. Overuse or misuse of medication (corresponding to by lacking doses or stopping therapy early) will increase the possibilities of that taking place.
Though resistance to Paxlovid is just not at present a significant concern, Sarafianos says it’s attainable—probably extra so if the drug is extensively used, since some sufferers may not take Paxlovid correctly due to its disagreeable aftertaste and unwanted side effects.
It’s “a numbers sport,” Sarafianos says. “As extra individuals take [a drug], the extra potentialities there are to give you a resistant pressure.”
Viswanathan provides that there might be shortages if everybody with COVID-19 begins clamoring for these medication, no matter whether or not they actually work. “These medicines are a restricted useful resource, they’ve unwanted side effects, and we needs to be prioritizing their use for the supposed affected person populations that may truly get the [proven] profit,” Viswanathan says.
The state of affairs could change sooner or later, as extra analysis comes collectively. However for now, consultants say, it’s finest to make use of Paxlovid and metformin within the methods regulators have licensed them.
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