In France, at the end of 2022, 2.06 million people over the age of 18 suffered from long Covid with a prevalence twice as high among women as among men. A recent international systematic review has just compared the effectiveness of different treatments on the regression of long Covid symptoms. Overview of the results obtained.
How to define long Covid?
Public Health France estimates the prevalence of long Covid in adults between 1.2 and 4% depending on the severity of the symptoms. Indeed, long COVID does not primarily concern individuals affected by severe forms of the disease. All infected subjects, even with a moderate form, can develop long COVID.
Nearly four years after the epidemic, the medical profession is still encountering difficulties with the care pathway to be deployed in the event of long COVID. As the causes of long COVID remain unknown (the main hypotheses are based on the role of genetic, psychological, hormonal, inflammatory and immune factors), its diagnosis is difficult to establish, as are the best treatment methods. Today, several symptomatic therapies are being developed to provide relief to patients.
A consensus was reached and the World Health Organization (WHO) offers a description of the symptoms of post-COVID 19 illness. The diagnosis is made beyond 3 months after the initial phase of COVID-19.
Ces symptoms associated with long Covid, multiple and evolving in a fluctuating manner, are:
- Disabling fatigue and muscle pain (myalgia);
- Difficulties with memory and concentration (patients speak of “brain fog);
- Respiratory disorders and tachycardia;
- Poor regulation of blood pressure;
- Digestive, renal, reproductive, vascular and immunological disorders.
The study protocol
To carry out their study, the researchers, supervised by Jason Busse of Canadian McMaster University in Hamilton, selected, from the databases, 24 clinical trials from 2021 to 2024 aimed at evaluating the effectiveness of a drug or non-drug therapy in adults with long Covid.
These 24 trials included, in total, 3695 patients. Four trials (n=708 patients) studied drug interventions, eight (n=985) physical activity or rehabilitation, three (n=314) behavioral interventions, four (n=794) dietary interventions, four (n=794) n=309) medical devices and technologies, and one (n=585) a combination of physical exercise and mental health rehabilitation.
Also, although the trials were of varying quality, the researchers assessed their risk of bias and the certainty of the evidence using statistical tools.
Unexpected results
Cognitive-behavioral therapy (CBT) and a physical and mental rehabilitation program very slightly improve the symptoms of long COVID, in the order of 2% to 8%.
According to the researchers, a CBT program reduces fatigue and improves concentration. A physical and mental rehabilitation program combined and supervised results in improved recovery. It also reduces symptoms of depression.
Intermittent aerobic exercise 3 to 5 times per week for 4 to 6 weeks also improves physical function more than continuous aerobic exercise.
To know! Aerobic exercise works major muscle groups and increases heart rate over a period of time. It is very effective in building endurance and strengthening heart and lung function. Examples of aerobic exercise are walking, running, cycling or swimming. Intermittent exercise can be broken down into two 15-minute sessions, while continuous exercise will consist of a single 30-minute session.
On the other hand, no convincing evidence has been demonstrated on the effectiveness of other drug and dietary interventions. Such as taking the antidepressant vortioxetine, leronlimab antibodies, coenzyme Q10 or a combination of probiotics and prebiotics.
To know! La coenzyme Q10 is found mainly in fish and meat, lamb and beef in particular. It has strong antioxidant properties.
Also, no evidence of effectiveness was not demonstrated for these non-pharmacological interventions. This includes brain rehabilitation and transcranial direct current stimulation. Likewise, inspiratory muscle training and hyperbaric oxygen did not show significant results. An educational mobile application on long COVID has also not proven its effectiveness.
For Janet Scott, infectious disease specialist at the University of Glasgow Virus Research Centre, who spoke at the Science Media Centre:
“While evidence supports cognitive behavioral therapy and rehabilitation programs for long COVID, patients need more than just exercises and counseling: they need a holistic, individualized approach including medical assessment complete. We don't yet have a miracle solution. This review shows that we are still in the early stages of understanding the treatment of long COVID. Remember that 239 other tests are underway”.
Sources
– Long Covid: a systematic review takes stock of the most effective interventions. www.lequotidiendumedecin.fr. Accessed December 19, 2024.
– Interventions for the management of long covid (post-covid condition): living systematic review . pubmed.ncbi.nlm.nih.gov. Consulté le 19 décembre 2024.
