Thread by @ToshiAkima

More caveats about the COVID-OUT of Metformin for #longСОVΙD. The benefits of Metformin were diminished by vaccination but it was only taken for 14 days (“500 mg on day one, 500 mg twice daily on days 2–5, then 500 mg in the morning and 1000 mg in the evening up to day 14”).🧵

https://twitter.com/white_bite/status/1667227218207199232

There are plenty of studies of viral persistence, showing the ongoing presence of replication-competent virus for many months after the acute illness. In chronic hepatitis C, we treat with antivirals not for 2 weeks but for 12 to 24 weeks!

https://twitter.com/LancetRespirMed/status/1656588712468271104?s=20

The BMJ editorial also states, “Other arms of the trial looked at…fluvoxamine and found that [it did not decrease] the risk of long СОVΙD.” That should say, “looked at a subclinical dose of Fluvoxamine” and found it didn’t work. A half-dose of Metformin probably wouldn’t either.

By comparison to the homeopathic dose of Fluvoxamine, 1500 mg/day of Metformin is quite a decent dose of the drug and they uptitrate to this target dose much faster than is typical when treating diabetes with this drug.

The Lancet study clearly states this: “For fluvoxamine, placebo-controlled trials showed no clinical effect with 50 mg twice daily (ACTIV-6) and clinical benefit with 100 mg twice daily (TOGETHER trial).” Meta-analyses agree with this.

https://twitter.com/HoertelN/status/1618284741337415682?s=20

Unsurprisingly, the Lancet COVID-OUT authors also state: “The fluvoxamine group was closed on Jan 7, 2022, by the independent data and safety monitoring board.” It was not ethical to continue trialling a proven homeopathic drug dose. Whoops. thelancet.com/journals/lanin…

I'm old enough to recall the controversy around AZT in HIV and whether it did anything. There was much debate, but then a meta-analysis showed a small survival benefit. It was tiny, but it was still a triumph because it was the first time an antiretroviral had been proven to work

Metformin monotherapy reminds me of AZT. On its own, the antiviral effect is minor but the magic only happened in antiretroviral therapy when they started to combine drugs with different mechanisms.