WesElyMD Profile picture
Husband & Dad. ICU Doc. Vanderbilt. @CIBScenter studies Covid & Long Covid, ICU Survivorship, PICS, Dementia, Delirium. Tweets my own. Still learning.

Dec 27, 2022, 9 tweets

1/🧵Can a Diabetes drug prevent Long COVID?
 
Most solid data yet of a medication preventing #LongCOVID from quadruple blinded, non-pharma sponsored COVID-OUT trial N=1,125.

A 42% relative ⬇️ in clinician diagnosed LC was seen (10.6% down to 6.3%).
 
bit.ly/3jvvKj4

2/ Metformin’s success (1 LC prevented for every 23 pts treated) could save millions from suffering.

<$1 per course = very cost effective.
 
Too good to be true?  Maybe but very solid science.

Let me unpack a bit more…

bit.ly/3jvvKj4

3/ This trial had 6 groups of patients because 3 meds (metformin/fluvoxamine/ivermectin) were randomized vs. placebo.
 
The other drugs showed no benefit toward Long COVID reduction.
 
Metformin also looked good for Acute COVID.

4/ In COVID-OUT, Metformin showed a similar effect on the acute early primary outcome w a 42% reduction (OR=0.58, 95% CI 0.35 to 0.94) in prevention of ED visits, hospitalizations, or death due to Covid and hospitalizations or death (OR 0.47, 95% CI 0.20 to 1.11) through Day 14.

5/ Definition: Long Covid @ 10 months was a pre-specified outcome in COVID-OUT.
 
LongCOVID Dx made by medical providers who rendered each diagnosis. And patients consented to medical record review for confirmation of these diagnoses. (so not just self-report as in many studies)

6/ Mechanism of Metformin in LONG COVID?

📍Anti-inflammatory
📍Human lung cells metformin restores autophagy
📍Inhibits release of interleukin-1𝛽 & interleukin-18
 
Metformin also prevented senescent (aging) phenotype induced by COVID

⁉️reduce cognitive aging in LongCOVID.

7/ Aging of Dopamine Neurons in COVID
 
In this study, metformin showed promise at reducing aging of neurons, which if confirmed might help future prevention of Long COVID brain dysfunction.

bit.ly/3Il9mn1

8/fin
📌 This prevention study doesn’t mean metformin will help TREAT #LongCOVID. That is a completely separate issue
📌 These are solid data about prevention that must be replicated
📌 People are desperate but they should NOT start taking metformin until we know more

Stay tuned

💥 Adding Vaxx point from authors @boulware_dr & @BramanteCarolyn - TY for your excellent science!

People who were vaccinated against Covid & who took #metformin had less #longCovid 10 months later👇

Another reason to get your bivalent booster.

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