METFORMIN, LONG COVID and ME/CFS

new hopes?

Since the beginning of the pandemic, METFORMIN has received a greater and grater attention and interest from infectious disease doctors and, in general, millions of researchers and patients worldwide.

Everything started after a trial published in the Lancet Infectious Diseases found that a two week course of metformin given within three days of testing positive for SARS-CoV-2 led to 40% fewer long covid diagnoses over the following 10 months compared with people who had taken placebo. As summarized here, participants were randomly allocated to receive placebo or metformin which was titrated over six days from 500 mg to 1000 mg. They were asked whether a medical provider had given them a diagnosis of long covid in follow-up surveys on days 180, 210, 240, 270, and 300. This method of ascertaining long covid was chosen as the definition of long covid rapidly changed over the study period. The cumulative incidence of long covid by day 300 was 6.3% (35 of 564) in participants given metformin compared with 10.4% (58 of 562) in those receiving placebo (hazard ratio 0.59, 95% confidence interval 0.39-0.89; P=0.012). When metformin was started within three days of symptom onset, its effect was potentially greater (hazard ratio 0.37 (95% CI 0.15-0.95) than in those who started metformin four days or longer after symptom onset (HR 0.64, 0.40-1.03).

This study opens interesting scenarios and some questions I’ll try to answer below:

1- Why metformin can prevent development of Long Covid in patients with acute COVID-19?

2- If some patients develop Long Covid following re-infections, should we consider metformin during acute Covid-19 in patients at risk of developing it?

3- Since most patients WITH LONG COVID experience worsening of their symptoms when become re-infected, should we consider treating them with Metformin when get a new SARS-CoV-2 infection?

4- Last, but not least… Can Metformin improve Long Covid symptoms in patients that have already developed Long Covid?

5- can this be tried in adolescents as well?