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

Fluvoxamine significantly reduces fatigue and improves quality of life in long COVID patients, with a 99% probability of superiority at 90 days.

• Why it matters: Long COVID-related fatigue is a common and debilitating symptom lacking effective treatments, creating a critical need for therapeutic options to improve patient outcomes.
• What they did: An adaptive, randomized, placebo-controlled trial in Brazil assessed 399 adults with long COVID fatigue, comparing fluvoxamine (100 mg BID), metformin (750 mg BID then 500 mg BID), and placebo over 60 days with follow-up to day 90, measuring changes in Fatigue Severity Scale scores.
• The result: Fluvoxamine demonstrated a mean difference of -0.43 at day 60 and -0.58 at day 90 in FSS scores, with high probabilities of superiority, whereas metformin results were inconclusive due to dose changes and early termination; adverse events were lower with fluvoxamine.