Therapeutic trials for Long COVID-19: A call to action from the interventions taskforce of the RECOVER Initiative
Bonilla, H; Peluso, MJ; Rodgers, K; et al., Frontiers in Immunology
Published
March 2023
Journal
Frontiers in Immunology
Abstract
Although most individuals recover from acute SARS-CoV-2 infection, a significant number continue to suffer from Post-Acute Sequelae of SARS-CoV-2 (PASC), including the unexplained symptoms that are frequently referred to as long COVID, which could last for weeks, months, or even years after the acute phase of illness. The National Institutes of Health is currently funding large multi-center research programs as part of its Researching COVID to Enhance Recover (RECOVER) initiative to understand why some individuals do not recover fully from COVID-19. Several ongoing pathobiology studies have provided clues to potential mechanisms contributing to this condition. These include persistence of SARS-CoV-2 antigen and/or genetic material, immune dysregulation, reactivation of other latent viral infections, microvascular dysfunction, and gut dysbiosis, among others. Although our understanding of the causes of long COVID remains incomplete, these early pathophysiologic studies suggest biological pathways that could be targeted in therapeutic trials that aim to ameliorate symptoms. Repurposed medicines and novel therapeutics deserve formal testing in clinical trial settings prior to adoption. While we endorse clinical trials, especially those that prioritize inclusion of the diverse populations most affected by COVID-19 and long COVID, we discourage off-label experimentation in uncontrolled and/or unsupervised settings. Here, we review ongoing, planned, and potential future therapeutic interventions for long COVID based on the current understanding of the pathobiological processes underlying this condition. We focus on clinical, pharmacological, and feasibility data, with the goal of informing future interventional research studies.
Authors
Hector Bonilla, Michael J Peluso, Kathleen Rodgers, Judith A Aberg, Thomas F Patterson, Robert Tamburro, Lawrence Baizer, Jason D Goldman, Nadine Rouphael, Amelia Deitchman, Jeffrey Fine, Paul Fontelo, Arthur Y Kim, Gwendolyn Shaw, Jeran Stratford, Patricia Ceger, Maged M Costantine, Liza Fisher, Lisa O'Brien, Christine Maughan, John G Quigley, Vilma Gabbay, Sindhu Mohandas, David Williams, Grace A McComsey
Keywords
SARS- CoV-2; clinical trials; long COVID; long haulers; post-acute sequela of SARS-CoV-2 (PASC); recover; treatment
Short Summary
RECOVER researchers reviewed ongoing, planned, and potential future treatment options for Long COVID, based on our current understanding of the biological causes of Long COVID symptoms and conditions. The purpose of this study is to help guide future research by summarizing the current state of the science as a call for urgent and efficient research to help the millions who continue to suffer from Long COVID around the world.
Researchers identified a number of studies that attempted to treat the various symptoms and conditions of Long COVID that may be useful to consider or incorporate when designing a larger research project aimed at treating the underlying biological cause of those symptoms and conditions.