MedicalResearch.com Interview with:
Jamie I Forrest PhD, MPH
Scientific Director, Health Equity & Resilience Observatory (HERO)
Faculty of Applied Science
University of British Columbia
MedicalResearch.com: What is the background for this study?
Response: We’ve known since early in the pandemic that many people don’t fully recover after COVID-19. Fatigue is one of the most persistent and disabling symptoms, and it significantly reduces quality of life — affecting people’s ability to work, care for their families, and participate in daily life.
Until now, there have been very few treatment options backed by solid evidence. Doctors have largely focused on supportive care — helping patients manage their symptoms through rest, pacing, and multidisciplinary teams — because no medication had been shown to work in a well-designed clinical trial. Several smaller or uncontrolled studies had suggested certain drugs might help, but robust randomized controlled trial evidence was scarce.
Interestingly, metformin had previously been shown to reduce the risk of developing Long COVID when taken during the acute phase of infection. Our study asked a different question: can these drugs help people who already have established Long COVID?
Long COVID — also called post-acute sequelae of SARS-CoV-2, or PASC — is a condition where people continue to feel sick for months or even years after recovering from a COVID-19 infection. The most common and debilitating complaint is fatigue: a profound, persistent exhaustion that doesn’t get better with rest and can make even simple daily activities feel impossible. Despite affecting an estimated tens of millions of people worldwide, there are almost no proven treatments.
We wanted to test whether two existing, widely available, and affordable medications could help. The first was fluvoxamine — an antidepressant that also has potent anti-inflammatory effects and acts on brain pathways involved in fatigue. The second was metformin — a common diabetes medication that reduces inflammation and may support cellular energy production. Both had biological reasons to think they might work against Long COVID fatigue, but neither had been rigorously tested for this purpose in a proper clinical trial.
Dr. Chan[/caption]
Edmond S. Chan MD, FRCPC, FCSACI, FAAAAI
Head | Division of Allergy & Immunology | Department of Pediatrics, Faculty of Medicine
Clinical Professor, The University of British Columbia
Clinical Investigator, BC Children's Hospital Research Institute
BC Children's Hospital, Allergy Clinic
Vancouver, BC Canada
Treasurer, CSACI (Canadian Society of Allergy & Clinical Immunology)
MedicalResearch.com: What prompted you to look at the safety of peanut oral immunotherapy specifically in this patient population?
Response: Our previous research has investigated the overall safety of peanut oral immunotherapy (OIT) in preschool populations. However, we have not investigated the relationship between specific patient characteristics and the safety of OIT. Previous literature has shown that patient factors, such as age, gender, baseline sIgE levels, and atopic comorbidities have been shown to impact the safety of OIT for other food allergies and in older patients. However, no data exist on which factors predict safety of peanut OIT in preschool populations.
Dr. Blundon[/caption]
Elizabeth Blundon PhD
Department of Psychology
University of British Columbia – Vancouver
MedicalResearch.com: What is the background for this study?
Response: Many healthcare workers have noticed that dying patients appear to be comforted by the words of their loved ones, even when patients appear to be unconscious and are no longer able to communicate. There is a persistent belief, therefore, that hearing may persist into the last hours of someone's life. Our study attempts to detect evidence of hearing among a small group of unresponsive hospice patients at the end of life.
To do this, we compared the brain activity of young, healthy control participants, with the brain activity of hospice patients, both when the patients were awake and responsive, and again when they became unresponsive. The brain activity we measured was in response to a complex series of tone-patterns, where participants were asked to identify by pressing a button (control participants) or by counting (hospice patients) every time they heard a tone-pattern that was different from the rest of the series. 