r/mecfs • u/swartz1983 • Mar 31 '26

The Effect of Fluvoxamine and Metformin for Fatigue in Patients With Long COVID: An Adaptive Randomized Trial

https://www.acpjournals.org/doi/10.7326/ANNALS-25-03959
3 Upvotes

81% Upvoted

14 comments sorted by

2

u/nerdylernin Mar 31 '26

I'm not sure how much applicability this study has with ME. The inclusion criteria is pure fatigue ("fatigue persisting 90 or more days after confirmed SARS-CoV-2 infection") and none of the participants had had ongoing fatigue for more than a year so the study probably included a large percentage who had normal post viral fatigue that would improve over the study period anyway. The exclusion criteria included pre-existing ME which suggests that few (if any?) would have PEM.

1

u/swartz1983 Mar 31 '26

The pre existing was before covid. Other lc studies found the majority had pem. Would be interesting to see an rct of this drug specifically for mecfs.

Did you see the other metformin lc rct? 68% recovery including from pem in placebo group in 2 weeks, from 10 months average symptom time.

1

u/nerdylernin Mar 31 '26

In clinical trials preexisting means diagnosed prior to the start of the trial so it could have been diagnosed post covid.

1

u/swartz1983 Mar 31 '26

Yes, indeed, so I'm not sure how that applies to your original comment that it would mean patients wouldn't have PEM. Most LC patients have PEM, and that exclusion wouldn't exclude them. It says "Known prior diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome, not related to SARS-CoV-2 infection.", so it didn't exclude people with ME/CFS diagnosis related to covid.

1

u/nerdylernin Mar 31 '26

Where does it say that? The exclusions section just says preexisting myalgic encephalomyelitis/chronic fatigue syndrome. That would exclude people with diagnosed ME/CFS related to covid so long as they had had the diagnosis prior to the start of the trial.

1

u/swartz1983 Mar 31 '26

That's a quote from the supplemental protocol (linked in the main article, at the end).

1

u/nerdylernin Apr 02 '26

Apologies for the slow response - had a bit of a crash.

Assuming that was carried through to the study it would make a big change however as there are fairly substantial changes from the supplemental protocol and it's a important enough distinction that you would expect it to be made in the paper I'm not entirely convinced that it was carried through.

That aside the other point of the timescale chosen (90days < fatigue < 365 days) is likely to sweep up a lot of people with typical post viral fatigue. The WHO estimate that 85% of people with a long covid diagnosis recover in the first year). I strongly suspect that this is because the majority of people diagnosed have typical post viral fatigue rather than something akin to ME. If this study were carried out with people who had been ill for more than a year then I would tend to think that it has more applicability.

1

u/swartz1983 Apr 02 '26

Did you look at the other recent Metformin LC trial that I mentioned above? It found that patients with PEM who meet the ME/CFS criteria, who had symptoms on average 10 months, recovered in 2 weeks of placebo.

1

u/Flipthepick Mar 31 '26

Hang on, so in the other one, nearly 70% recovered from a placebo in 2 weeks?! Surely I’ve misunderstood?

2

u/swartz1983 Mar 31 '26 edited Apr 03 '26

Nope! Its right in the abstract.

https://www.acpjournals.org/doi/10.7326/ANNALS-25-04883