The topic of treating Covid-19 and preventing long-term effects such as long Covid has been a major focus in the medical community. In a previous article, the discussion centered around the underprescription of Paxlovid for acute Covid cases in high-risk patients. Paxlovid, an oral antiviral treatment, was found to significantly reduce the risk of hospitalization or death by 88% compared to a placebo in unvaccinated individuals. Additionally, a study by Ziyad Al-Aly revealed that Paxlovid was associated with a 26% lower risk of long Covid in unvaccinated patients.
However, the effectiveness of Paxlovid in previously vaccinated individuals remains unclear. A smaller study from the University of California at San Francisco found no benefit in this group. Similarly, a study by Pfizer published in the New England Journal of Medicine showed no significant reduction in symptom duration or hospitalization rate in patients who had been vaccinated.
On the other hand, the use of metformin in treating Covid-19 and preventing long Covid has gained traction. Research conducted by Carolyn Bramante and her team showed promising results. Starting metformin within the first three days of illness and continuing for 14 days resulted in a 41% reduction in the incidence of long Covid. Another study, COVID-OUT, demonstrated that metformin significantly reduced viral load compared to a placebo and lowered the odds of severe Covid-19 and long Covid if started early in the course of illness.
Recent findings from the NIH-funded Researching COVID to Enhance Recovery (NIH RECOVER) Initiative further support the use of metformin. Patients with diabetes who were already taking metformin had a lower incidence of long Covid or death compared to those taking other diabetes medications. Metformin not only helps lower blood sugar but also reduces viral load and pro-inflammatory molecules that contribute to clotting.
Metformin is relatively inexpensive and has primarily gastrointestinal side effects. It is better-tolerated when titrated up and rarely has serious side effects. Despite the growing evidence of its benefits, some healthcare providers are hesitant to prescribe metformin for Covid-19 treatment due to its association with diabetes.
In conclusion, the use of metformin in treating Covid-19 and preventing long-term complications like long Covid shows promise. With the mounting evidence of its benefits, it is hoped that healthcare providers will consider broader uptake of metformin in the treatment of acute Covid-19 cases.
