© IE Online Media Services Pvt Ltd
Tags:
Journalism of Courage
Can Metformin, a widely-used clinical drug for controlling Type 2 diabetes, prevent long COVID in patients? According to a recent study published as a pre-print in The Lancet, researchers found that there was a 42 per cent lower chance of being detected with long Covid among people who had taken this oldest and most commonly used anti-diabetes drug. Treatment with Metformin during acute COVID-19 infection prevented over 40 per cent of long Covid cases, says the study.
Although the drug has shown promise as a therapeutic option for cancer and ageing, can it be considered for pandemic protocols? Noted endocrinologist Dr Shashank Joshi says it’s early days yet. “The study looks attractive but this is experimental evidence. Metformin is still not in any standard of care,” he says.
Why Metformin?
Metformin has been shown in earlier studies to prevent the COVID virus from multiplying in a test tube, and this antiviral action is what adds to its protective ability. The drug inhibits a protein called MTOR that the virus uses to assemble itself before becoming a new set of viruses outside the cell.
What do long Covid studies in India indicate?
“Currently, long Covid is an emerging entity. We are systematically conducting studies on long Covid in the country and following patients over one, two and three years, where all three variants of SARS CoV2 have had some impact beyond six months. Most have been reversible except those in patients who had severe or critical Covid, were left with lung disease or pulmonary fibrosis, or developed heart disease, hypertension and diabetes post-infection. In the neuropsychiatric domain, there is a different study group looking at damage to the brain, nerves and muscles. All these are currently being investigated and as time passes, we will have better data and publications,” says Dr Joshi.
Dr Subhash Salunkhe, a national COVID-19 task force member, says there have been complaints about the central nervous system being affected. “However long Covid has not impacted a major section of the population,” he adds.
Metformin may be beneficial but more studies are needed in the Indian context
Dr Sanjay Pujari, an Indian Council of Medical Research (ICMR) COVID-19 task force member, says that this is the first, randomized, trial suggesting that Metformin may have reduced the incidence of long-COVID when used amongst outpatients with acute COVID-19. “However, the diagnosis of long-COVID in this study was based on patients reporting the diagnosis as defined by their medical provider on a survey. This is a major limitation of the study. But, other drugs in the same trial, like Ivermectin and Fluvoxamine, did not show any benefit for long-COVID. Hence, there is a signal that when used for the treatment of acute COVID-19 with mild illness, Metformin may be beneficial in preventing long-COVID,” he adds.
Since short-course Metformin is cheap, safe and easily available, this intervention may be useful if further specifically designed studies confirm this finding. “This is the first trial showing a signal for the efficacy of any pharmacotherapy for preventing long-COVID. However, this cannot be still translated into practice pending further confirmatory studies. Considering the debilitating nature of long COVID, studies confirming the role of Metformin and the mechanism of benefit need to be conducted in India and other developing countries,” he says.
What trial results show so far
COVID-OUT was a Phase 3 multi-site trial to assess the efficacy of Metformin, Ivermectin and/or Fluvoxamine as early outpatient treatments for COVID-19. It followed more than 1,000 participants (who were also overweight) for 10 months to assess whether early treatment prevented the development of long Covid. Treatment with Metformin during acute COVID-19 infection prevented over 40 per cent of long Covid cases, with 6.3 per cent of participants in the Metformin group and 10.6 per cent in the placebo group receiving a diagnosis of long Covid from a medical provider.
Metformin’s prevention of over 40 per cent of severe COVID 19 in the Covid-Out trial is consistent with two other randomised trials that assessed Metformin as prevention of COVID-19, according to researchers. Neither Ivermectin nor Fluvoxamine had any benefit for the prevention of long Covid.
