Long COVID may be chronic and require anti-inflammatory drugs: study

News image: Long COVID may be chronic and require anti-inflammatory drugs: studyBy Dennis Thompson Health Day Reporter

THURSDAY, May 12, 2022 (HealthDay News)

Emerging evidence suggests that long-term COVID patients suffer from endemic inflammation that ravages the whole body – and that mitigating that inflammation could be the key to saving their lives.

Severe systemic inflammation during hospitalization for COVID increases the risk of dying within a year of the patient’s apparent recovery, University of Florida researchers have found.

The greater a person’s inflammation while hospitalized with COVID, the greater the likelihood of dying within a year of recovering from the initial infection, researchers report in the journal Frontiers in Medicine.

Additionally, patients who were prescribed anti-inflammatory steroids had a lower risk of death after discharge than those who did not receive the drugs, the researchers said, although this remains a controversial idea.

“COVID affects multiple organ systems with inflammation“said lead researcher Arch Mainous, vice chair for research in the Department of Community Health and Family Medicine at the University of Florida. “Our data definitely suggests that it may be worth treating people with some kind of anti-inflammatory” after they left the hospital.

This new research follows a UF study from late last year, which found that people who recovered from severe COVID were more than twice as likely to die within the next year from any cause compared to people with mild COVID to moderate who have not been hospitalized or to people who have never been infected, Mainous said.

“So the question that arose was, why is this?” Mainous said. “Why would that be? »

To find an answer, Mainous and his colleagues followed more than 1,200 COVID patients treated at UF for COVID-19 between January 2020 and December 2021, to see how they fared in the year following their recovery.

The research team specifically looked at each patient’s levels of C-reactive protein (CRP), an enzyme secreted by the liver as part of the immune response. CRP is a common measure of systemic inflammation.

They also checked whether a patient had been prescribed oral steroids when discharged from hospital.

Hospitalized COVID-19 patients with the highest levels of inflammation during their infection were about 60% more likely to die within a year of discharge, compared to COVID patients with the least inflammation, found. Researchers.

Additionally, the risk of death for COVID-19 patients with severe inflammation dropped by about 50% if they received anti-inflammatory steroids after hospitalization.

Mainous said this systemic inflammation explains why the long COVID is producing so many different health issues in people.

“That’s why some people have cognitive problems, while others can’t smell, and others have kidney problems or strokes,” Mainous said. “Severe general systemic inflammation hits different people in different ways. COVID seems to hit a lot of things at once. That’s one of the reasons that when we start looking at COVID, a lot of things seem completely unrelated.”

However, Mainous said it was too early to say whether recovered COVID patients should be put on long-term anti-inflammatories. This was only an observational study, not a clinical trial specifically testing the effectiveness of anti-inflammatory drugs.

“I’m not suggesting people get put on steroids or go home and down a bottle of Advil,” Mainous said. “I say that leads us to trials of these things as a potential treatment.”

The long COVID should be considered a chronic diseasesince most of these patients continue to suffer from symptoms for months, said Dr. Ravindra Ganesh, medical director of the post-COVID-19 care clinic at Mayo Clinic in Rochester, Minnesota.

“Most of our patients have symptoms within the last six months, and some then develop ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome), which can last a lifetime,” Ganesh said.

However, Ganesh added that “from what we see in our patients, in the majority, the symptoms eventually go away.”

While he agrees that inflammation remains elevated in long-term COVID patients, Ganesh isn’t sure that prescribing long-term anti-inflammatories is the right way to go.

“It’s an idea we’ve explored, but anti-inflammatories have their own risks, including that of secondary infections,” Ganesh said.

“In a recently published meta-analysis, which included seven studies involving a total of 2,214 patients, patients who did not require oxygen but received steroids had an increased risk of progressing to severe disease and death. They also had a prolonged duration of fever, longer duration to viral clearance and increased length of hospital stay,” he said.

“It’s unclear how long this will last COVID, but it would be a pretty tough risk/benefit conversation,” Ganesh concluded.

More information

The United States Centers for Disease Control and Prevention know more about long COVID.

SOURCES: Arch Mainous, PhD, vice chair, research, University of Florida Department of Community Health and Family Medicine; Ravindra Ganesh, MBBS, MD, medical director, Mayo Clinic COVID-19 Care Clinic; Frontiers in MedicineMay 12, 2022

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