Post by Nadica (She/Her) on Sept 27, 2024 0:28:22 GMT
Want To Prevent Long Covid? Should You Take Metformin Or Paxlovid? - Published Sept 25, 2024
In this extended drug ad, no covid prevention methods are mentioned. The only sure-fire way to assure someone does not develop long covid is to assure they do not get infected in the first place. In this article, we can clearly see profit being put ahead of common sense public health.
By Judy Stone
Previously, I wrote about Paxlovid being underprescribed for treating acute Covid in patients at high risk for serious illness. The FDA granted an Emergency Use Authorization based on data showing that “Paxlovid significantly reduced the proportion of people with Covid-19 related hospitalization or death” by 88% compared to placebo.
In unvaccinated people, Paxlovid was also associated with a 26% lower risk of long Covid in a study by Ziyad Al-Aly.
The data on Paxlovid for those previously vaccinated is mixed. A smaller study from the University of California at San Francisco found no benefit in people who had been previously vaccinated.
Another study by Pfizer was published in the New England Journal of Medicine in April 2024. Of 1288 patients divided between those vaccinated and those not, there was no reduction of symptom duration and little difference in hospitalization rate.
Paxlovid carries a number of side effects, particularly nausea, diarrhea, and a metallic taste—and especially its cost, up to $1561 for a five-day course, per GoodRx. It also comes with a host of contraindications. Note: If you have Medicare, you should have Paxlovid covered. Same if you are a veteran or are on Medicaid. If you have a copay or uninsured, you may be able to get coverage through Pfizer’s Patient Access Program by visiting paxlovid.iassist.com or call 877-219-7225. This program will end Dec 31, 2024. But this requires filling out forms online and energy you might not have when you are acutely ill. It also will likely result in a delay in getting treatment. Paxlovid is more effective given early in the course of illness.
Metformin
In contrast, metformin is of growing interest in treating COVID-19 and particularly for preventing long Covid.
First, was Carolyn Bramante’s study in The Lancet last year. If metformin was started within the first three days of illness and continued for 14 days, her study showed a 41% reduction in the incidence of long Covid, with an absolute decrease of 4·1%, compared with placebo, when started.
In a May 2024 study (COVID-OUT), Bramante’s group showed the SARS-CoV-2 viral load was cut 3.6-fold with metformin compared to placebo. Viral rebound from Day 5 to Day 10 was also significantly reduced. If started less than four days from symptom onset, metformin reduced the odds of severe COVID-19 by 55% and of long COVID by 65%. This trial was conducted in a standard-risk population—older than 30, overweight, and not needing hospitalization.
The most recent news supporting the use of metformin comes from the NIH-funded Researching COVID to Enhance Recovery (NIH RECOVER) Initiative. Most of the 1300 patients in Bramante’s 2023 Lancet paper were obese or overweight but did not have diabetes. This study specifically looked at patients who already had diabetes, comparing electronic health records from 75,996 adults already taking metformin to 13,336 records from patients who took other types of medicine for their diabetes. They found that patients taking metformin had a 13% to 21% lower incidence of long COVID or death.
Besides lowering blood sugar, metformin reduces viral load and pro-inflammatory molecules that contribute to clotting.
Metformin is not a panacea, but we are steadily learning more of its benefits—most recently, anti-aging and anti-inflammatory effects. Side effects are primarily GI — nausea or diarrhea and the medicine is better-tolerated when titrated up. It is relatively inexpensive, $10-30 for a 60-day, 500 mg dose, and rarely has serious side effects.
At a minimum, I believe all adults with acute COVID-19 should be offered metformin. I’ve been frustrated that in my education to community groups and my free weekly COVID-19 newsletter, I have recommended acutely ill, high-risk people ask their physicians for an antiviral and metformin. Yet my friends tell me their physician or nurse practitioner has refused their specific request to prescribe either medication. Even after being presented with data, some practitioners are refusing the request for a 2-week course of metformin, because “it’s just for diabetes.”
With the mounting evidence of metformin’s benefit and the massive toll of long Covid, hopefully we’ll see broader metformin uptake.
In this extended drug ad, no covid prevention methods are mentioned. The only sure-fire way to assure someone does not develop long covid is to assure they do not get infected in the first place. In this article, we can clearly see profit being put ahead of common sense public health.
By Judy Stone
Previously, I wrote about Paxlovid being underprescribed for treating acute Covid in patients at high risk for serious illness. The FDA granted an Emergency Use Authorization based on data showing that “Paxlovid significantly reduced the proportion of people with Covid-19 related hospitalization or death” by 88% compared to placebo.
In unvaccinated people, Paxlovid was also associated with a 26% lower risk of long Covid in a study by Ziyad Al-Aly.
The data on Paxlovid for those previously vaccinated is mixed. A smaller study from the University of California at San Francisco found no benefit in people who had been previously vaccinated.
Another study by Pfizer was published in the New England Journal of Medicine in April 2024. Of 1288 patients divided between those vaccinated and those not, there was no reduction of symptom duration and little difference in hospitalization rate.
Paxlovid carries a number of side effects, particularly nausea, diarrhea, and a metallic taste—and especially its cost, up to $1561 for a five-day course, per GoodRx. It also comes with a host of contraindications. Note: If you have Medicare, you should have Paxlovid covered. Same if you are a veteran or are on Medicaid. If you have a copay or uninsured, you may be able to get coverage through Pfizer’s Patient Access Program by visiting paxlovid.iassist.com or call 877-219-7225. This program will end Dec 31, 2024. But this requires filling out forms online and energy you might not have when you are acutely ill. It also will likely result in a delay in getting treatment. Paxlovid is more effective given early in the course of illness.
Metformin
In contrast, metformin is of growing interest in treating COVID-19 and particularly for preventing long Covid.
First, was Carolyn Bramante’s study in The Lancet last year. If metformin was started within the first three days of illness and continued for 14 days, her study showed a 41% reduction in the incidence of long Covid, with an absolute decrease of 4·1%, compared with placebo, when started.
In a May 2024 study (COVID-OUT), Bramante’s group showed the SARS-CoV-2 viral load was cut 3.6-fold with metformin compared to placebo. Viral rebound from Day 5 to Day 10 was also significantly reduced. If started less than four days from symptom onset, metformin reduced the odds of severe COVID-19 by 55% and of long COVID by 65%. This trial was conducted in a standard-risk population—older than 30, overweight, and not needing hospitalization.
The most recent news supporting the use of metformin comes from the NIH-funded Researching COVID to Enhance Recovery (NIH RECOVER) Initiative. Most of the 1300 patients in Bramante’s 2023 Lancet paper were obese or overweight but did not have diabetes. This study specifically looked at patients who already had diabetes, comparing electronic health records from 75,996 adults already taking metformin to 13,336 records from patients who took other types of medicine for their diabetes. They found that patients taking metformin had a 13% to 21% lower incidence of long COVID or death.
Besides lowering blood sugar, metformin reduces viral load and pro-inflammatory molecules that contribute to clotting.
Metformin is not a panacea, but we are steadily learning more of its benefits—most recently, anti-aging and anti-inflammatory effects. Side effects are primarily GI — nausea or diarrhea and the medicine is better-tolerated when titrated up. It is relatively inexpensive, $10-30 for a 60-day, 500 mg dose, and rarely has serious side effects.
At a minimum, I believe all adults with acute COVID-19 should be offered metformin. I’ve been frustrated that in my education to community groups and my free weekly COVID-19 newsletter, I have recommended acutely ill, high-risk people ask their physicians for an antiviral and metformin. Yet my friends tell me their physician or nurse practitioner has refused their specific request to prescribe either medication. Even after being presented with data, some practitioners are refusing the request for a 2-week course of metformin, because “it’s just for diabetes.”
With the mounting evidence of metformin’s benefit and the massive toll of long Covid, hopefully we’ll see broader metformin uptake.