A clinical trial found that fluvoxamine significantly improved fatigue and quality of life for Long COVID patients with persistent symptoms.
RT’s Three Key Takeaways:
Fluvoxamine Efficacy: A clinical trial found that the low-cost antidepressant fluvoxamine significantly reduced fatigue and improved quality of life in adults with long COVID symptoms.
Comparative Results: While fluvoxamine showed a 99 percent probability of outperforming a placebo, the study found that metformin offered no meaningful benefit for treating established fatigue.
Clinical Evidence: Researchers noted that these findings provide clinicians with the first strong evidence for a medication that helps manage the most common and debilitating symptom of the condition.
A global research team co-led by McMaster University identified fluvoxamine as one of the first medications shown to meaningfully reduce fatigue in patients living with long COVID, according to a news release.
The randomized, placebo-controlled trial found that the low-cost antidepressant significantly improved quality of life among adults. The findings were published in the Annals of Internal Medicine.
Fatigue is the most common symptom of long COVID, affecting an estimated 65 million people worldwide. Despite the impact, few proven treatments exist for those unable to work, care for their families, and resume their normal lives years after the pandemic began.
“This is an important step forward for patients who have been desperate for evidence-based options,” said Edward Mills, senior author, professor in McMaster’s department of health research methods, evidence, and impact, and co-principal investigator of the trial, in a news release. “Fluvoxamine showed consistent and meaningful benefits, and because it’s already widely used and well understood, it has clear potential for clinical use.”
The REVIVE-TOGETHER trial enrolled 399 adults in Brazil who experienced fatigue for at least 90 days after a confirmed Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. Participants were randomly assigned to receive fluvoxamine, metformin, or a placebo for 60 days. Researchers noted that both fluvoxamine and metformin had biological reasons to suggest they might work, but neither had been tested for this purpose in a clinical trial.
The study found fluvoxamine reduced fatigue more than the placebo, with a 99 percent probability the drug outperformed the control group. While previous research showed metformin reduces the risk of developing long COVID when taken during an acute infection, this study showed it offered no benefit for treating established fatigue symptoms, according to the news release.
The trial utilized a Bayesian adaptive design, which allowed researchers to stop treatment arms early once results were clear.
“The trial used a sophisticated adaptive design that allowed it to reach conclusions more efficiently than traditional trials, stopping early when the evidence was clear enough – a design innovation as important as the findings themselves,” said Gilmar Reis, lead author, researcher with Cardresearch, and part-time associate professor at McMaster, in a news release.
Long COVID remains a major public healthcare challenge, affecting an estimated 65 million people worldwide, according to the research team. Yet most medical guidelines still offer only supportive care, such as pacing and symptom management. Researchers emphasized that while fluvoxamine is a promising option, long COVID is a complex condition with multiple biological pathways.
“This trial gives clinicians their first strong evidence for a medication that helps reduce long COVID fatigue. Patients want something they can try today – and this finding brings us closer to that reality,” said Jamie Forrest, corresponding author and postdoctoral research fellow at the University of British Columbia, in a news release.