Latest research looks at prolonged symptoms, drug treatments in COVID-19

Two recent studies looked at prolonged symptoms after COVID-19 infection. The first, published by Annals of Internal Medicine on July 6, included 410 Swedish outpatients surveyed seven to nine months after COVID-19 diagnosis; 39.0% reported residual symptoms, most commonly fatigue (20.7%), then loss of taste or smell (16.8%), dyspnea (11.7%), and headache (10.0%). Limitations include missing data for 34.8% of participants initially included in the study. The results indicate that “physicians should continue to monitor patients with COVID-19 over the long term,” the authors said A German study, published by Clinical Infectious Diseases on July 5, looked at 96 patients a year after COVID-19 symptom onset (32.3% hospitalized). Only 22.9% were completely free of symptoms, with the most common symptoms being reduced exercise capacity (56.3%), fatigue (53.1%), dyspnea (37.5%), concentration problems (39.6%), problems finding words (32.3%), and sleeping problems (26.0%). Neurocognitive symptoms were more common in women and in patients with an antinuclear antibody titer of 1:160 or greater, suggesting that autoimmunity may be a factor in “long COVID,” the authors said. Study limitations include that 50 patients dropped out before the one-year follow-up, meaning that “increasing willingness of symptomatic patients to take part in a follow up study is a potential confounding factor.”

The NIH's COVID-19 treatment guidelines panel made several updates to its recommendations on July 8, including addition of a figure to guide therapeutic management of outpatients with COVID-19. A few recent studies also looked at treatments for COVID-19. A meta-analysis of trials of interleukin-6 (IL-6) antagonists, published by JAMA on July 6, found that they were beneficial for at least some COVID-19 patients. It included 27 trials with 10,930 hospitalized patients. At 28 days, there were 1,407 deaths among 6,449 patients randomized to IL-6 antagonists and 1,158 deaths among 4,481 patients randomized to usual care or placebo (summary odds ratio, 0.86; 95% CI, 0.79 to 0.95). The reduction in mortality was only significant in patients on tocilizumab (versus sarilumab) and in patients also receiving corticosteroids. The study authors concluded that administration of IL-6 antagonists was associated with lower 28-day all-cause mortality among patients hospitalized for COVID-19. An accompanying editorial noted some limitations of the research and refined that conclusion, saying that the drugs “hold promise for patients hospitalized for COVID-19 with progressive disease and substantial oxygen requirements but are not yet merited for widespread use among patients with mild disease nor with prolonged invasive mechanical ventilation.”

Another meta-analysis, published by Clinical Infectious Diseases on June 28, found that ivermectin doesn't work for COVID-19. It included 10 randomized trials with 1,173 patients (most with mild disease) and found no reduction in all-cause mortality, length of stay, or viral clearance with the drug. Other negative findings, this time on remdesivir and hydroxychloroquine, came from an add-on to the WHO Solidarity trial, published July 13 by Annals of Internal Medicine. COVID-19 patients at 23 hospitals in Norway were randomized to remdesivir (n=42), hydroxychloroquine (n=52), or standard of care (n=87). The treatment groups showed no significant differences in inpatient mortality or viral clearance, which was consistent with the main findings of the Solidarity trial, the authors said.