Could metformin prevent long Covid? In the previously published COVID-OUT study, over 1400 patients with a new diagnosis of Covid-19 (symptoms + PCR) were randomized to receive metformin, fluvoxamine, ivermectin, placebo, or any combination thereof (six arms). No drug or combination improved the primary outcome (a composite outcome of hypoxemia, visit to the emergency department, hospitalization, or death). That was in NEJM Aug 18 2022.
But for a secondary outcome — long Covid, defined by patient report of having received that diagnosis from a physician or other provider — metformin reduced the risk by over 40% (6% for metformin vs. 10% receiving placebo). No other drug or combination appeared to have an effect on long Covid incidence. The Kaplan-Meier curves begin separation at around day 60-90, and their separation widens and stays wide throughout study follow-up.
Why might metformin prevent long Covid? In-vitro, ex-vivo tissue assays suggest that metformin inhibits viral replicatio…
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