I quite wish that in studies like this, the projections of the subjects themselves were also evaluated. What their self reported expectation was, as well as their projection of the impact of the treatment, and then one week on whether they thought they were getting the placebo or the actual drug. It would be really interesting to contrast it against the final outcomes.
The reason I mention this is SSRIs. In modern controlled trials, they show a placebo level effect on many things they're still actively used to treat. And that's quite impressive given the dramatic side effects of them, making a double blind study essentially impossible. And so in any domain where psychosomatic issues may play a role, which is arguably most of everything, it would seem that projections contrasted against outcomes would be quite informative.
This is more preventative treatment vs a after the fact treatment? Am I misunderstanding?
"In conclusion, early outpatient COVID-19 treatment with metformin decreased the subsequent risk of long COVID by 41·3% during 10-month follow-up. This finding is consistent with the 42·3% reduction in health-care utilisation for severe COVID-19 with metformin in the first 14 days of the trial. Fluvoxamine and ivermectin did not decrease the risk of long COVID, which was also consistent with the findings for severe COVID-19 outcomes by day 14. As the COVID-19 pandemic continues to evolve, all therapeutics require further prospective, interventional trials to assess long COVID incidence, including among people who have received vaccination and booster vaccination, and people with previous SARS-CoV-2 infection. "
Yes. It’s in the second sentence of the background section at the top.
“We aimed to evaluate whether outpatient COVID-19 treatment with metformin, ivermectin, or fluvoxamine soon after SARS-CoV-2 infection could reduce the risk of long COVID.”
It’s exciting to see a study on Long Covid taken seriously. I know people whose lives have been absolutely wrecked by this and they often have trouble being taken seriously by medical professionals. This is heartening.
> Outpatient treatment with metformin reduced long COVID incidence by about 41%, with an absolute reduction of 4.1%, compared with placebo.
The 4.1% is just decimal, using the middle-dot typographical version of decimal point.
Both figures are applicable and have different meanings. It's just a coincidence that they have the same digits this time.
Rough summary: The 41% is comparing the effect of metformin vs placebo metformin, both administered following protocols. It means nearly half of people (meeting the study criteria - age range, etc.) who would have got long Covid (as reported at 300 days) wouldn't get it if they took metformin following the protocol within 3 days of their positive Covid PCR test.
The 4.1% says how many fewer people got long Covid after getting Covid (and meeting the study criteria - age range, PCR test timing etc), that was attributable to having the real metformin. It doesn't tell you that it moved the needle from 10.4% of people (who had Covid etc) getting long Covid down to 6.3% (both as reported at 300 days). But it does tell you the difference between those figures, which is how many people's lives (4.1% of those people who had Covid etc) would likely be improved by taking it and following the protocol.
They tested Ivermectin, Metaformin and Fluvoxamine, obviously everything's toxic at a high enough dose but are those drugs considered especially bad? It's not chemo, right?
As someone whose only previous knowledge of ivermectin was from being given it to treat a parasite infection acquired in the backwaters of southeast asia a decade ago, I've been confused to see it keep coming up in the context of COVID. I thought it was just some weird Internet fad from the pandemic, but then here's a Lancet article about a trial evaluating the use of it for "long COVID". What is the proposed mechanism of action?
well I mean diabetes patients have to take metformin and it of course prolongs their life but it also subjects them to potential lactic acidosis, because it's toxic.
Medicine is taking the lesser of two poisons because you literally don't have a choice in the matter. It can be way better than it is but we have such awful perverse incentives and lack of responsibility rampant in the field.
The reason I mention this is SSRIs. In modern controlled trials, they show a placebo level effect on many things they're still actively used to treat. And that's quite impressive given the dramatic side effects of them, making a double blind study essentially impossible. And so in any domain where psychosomatic issues may play a role, which is arguably most of everything, it would seem that projections contrasted against outcomes would be quite informative.