Over-the-counter antihistamines and a prescription anti-inflammatory drug both have a small benefit in reducing long Covid fatigue among people receiving care from specialist long Covid clinics, according to new findings from a large clinical trial led by University College London and University College London Hospitals on July 8.
The study, published in The Lancet Infectious Diseases journal and funded by the National Institute for Health and Care Research, involved nearly 800 adults in England with long Covid who were randomly assigned either usual care or one of three types of drugs: a combination of antihistamines (allergy medicines), an anti-inflammatory drug called colchicine (used to treat gout), or a blood thinner called rivaroxaban (typically used to prevent blood clots and strokes).
The research team found that all groups experienced a meaningful reduction in their self-reported fatigue over 12 weeks (improving an average of 4.3 points on a 40-point scale), supporting the idea that specialist long Covid care can lead to important improvements in symptoms. Those taking antihistamines and colchicine, but not the blood thinner rivaroxaban, saw a small additional benefit in fatigue reduction at 12 weeks (an extra 1.5 point improvement on the scale). However, this benefit was not sustained at 24 weeks (12 weeks after the participants stopped taking the drugs).
Professor Amitava Banerjee said, "We tested potential medicines based on the most promising theories of how to improve long Covid when we started out in 2021. Our findings suggest these drugs alone are unlikely to be the answer to long Covid fatigue. Antihistamines and the anti-inflammatory drug, colchicine, did provide a small benefit, but this did not last once participants stopped taking them and so they are unlikely to improve symptoms over the long term on their own." Banerjee added, "Both antihistamines and colchicine affect the immune system and it may be that they address the immune dysregulation that long Covid has been linked to, but further research is needed to understand the possible mechanism." He also said, "The blood thinner, rivaroxaban, had no benefit and so our results do not support the use of anti-coagulation medicine for long Covid."
Dr. Melissa Heightman said, "It is heartening that people had a significant reduction in fatigue across all arms of the trial. This is more than you would expect based on time alone, given that participants had severe fatigue at recruitment and been ill for more than a year on average." She continued, "This level of improvement shows the importance of specialist long Covid care. These services in England offer integrated care from a range of specialties with community-based rehabilitation to develop a plan for a person based on their symptoms and all of the ways the condition affects them."
Professor Danny McAuley said, "The NIHR is proud to have funded this vital trial, which highlights the value of specialist care in delivering meaningful relief for long Covid patients. Finding even modest benefits for these inexpensive drugs, which are safe and commonly used for other conditions, is incredibly important to improve evidence-based treatment... By providing high-quality data needed to refine clinical approaches...this research ensures that NIHR is helping build clearer...patient care which can be provided in community." Professor Emma Wall added, "Because long Covid is such a new...condition...we started by listening to what patients were telling us about their symptoms...then looking at biological signals that might explain them and treatments that might help....Every signal we see helps us refine our understanding of immune inflammatory mechanisms that may be driving disease...develop new better targeted treatments for future trials."
