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. 2023 Nov;124(Pt B):110966.
doi: 10.1016/j.intimp.2023.110966. Epub 2023 Oct 5.

Low-dose naltrexone use for the management of post-acute sequelae of COVID-19

Hector Bonilla  1 , Lu Tian  2 , Vincent C Marconi  3 , Robert Shafer  4 , Grace A McComsey  5 , Mitchel Miglis  6 , Philip Yang  7 , Andres Bonilla  8 , Lauren Eggert  9 , Linda N Geng  10
Affiliations

Low-dose naltrexone use for the management of post-acute sequelae of COVID-19

Hector Bonilla et al. Int Immunopharmacol. 2023 Nov.

Abstract

The global prevalence of Post-Acute Sequelae of SARS-CoV-2 Infection (PASC) stands at approximately 43 % among individuals who have previously had acute COVID-19. In contrast, in the United States, the National Center for Health Statistics (NCHS) estimates that around 11 % of individuals who have been infected with SARS-CoV-2 go on to experience long COVID. The underlying causes of PASC remains under investigation, and there are no currently established FDA-approved therapies. One of the leading hypotheses for the cause of PASC is the persistent activation of innate immune cells with increase systemic inflammation. Naltrexone is a medication with anti-inflammatory and immunomodulatory properties that has been used in other conditions that overlap with PASC. We performed a retrospective review of a clinical cohort of 59 patients at a single academic center who received low-dose naltrexone (LDN) off-label as a potential therapeutic intervention for PASC. The use of LDN was associated with a fewer number of symptoms, improved clinical symptoms (fatigue, post-exertional malaise, unrefreshing sleep, and abnormal sleep pattern), and a better functional status. This observation warrants testing in rigorous, randomized, placebo-controlled clinical trials.

Keywords: LDN; Long COVID; Long haulers; Naltrexone; PASC; Post-acute sequelae of COVID-19; Treatment.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: V.C.M. has received investigator-initiated research grants (to the institution) and consultation fees (both unrelated to the current work) from Eli Lilly, Bayer, Gilead Sciences, and ViiV. GM has received research funding from Genentech, Roche, Merck, Pfizer, Redhill, Cognivue, and consultations fees (all unrelated to this work) from Merck, Janssen, Gilead, Theratechnologies, and ViiV. LG has received research funding from Pfizer and advisory fees from United Healthcare. HB has received research funding from Pfizer and advisory fees from United Healthcare. LE reports serving on the advisory boards for AstraZeneca and Regeneron. All other authors report no potential conflicts.

Figures

Figure 1.
Figure 1.
Plot box interquartile of the Likert score (0–5) based on the severity of each seven. selected symptoms (Headache, fatigue, brain fog, unrefreshing sleep, sleep abnormalities, post-exertional malaise, and lightheadedness) before (left) and after (right) a Low Dose of Naltrexone. Supplementary Material. In the bottom the Sankey diagram compares the FSS (I-V) before (left) after (right) LDN and the thickness of the arrows represents the magnitude of the change and the direction of FSS changes.
See this image and copyright information in PMC

References

    1. NIH. COVID-19 Treatment Guidelines. April, 20 2023; https://www.covid19treatmentguidelines.nih.gov/
    1. NIH. RECOVER: Researching COVID to Enhance Recovery. April, 23 2023; https://recovercovid.org
    1. Couzin-Frankel J Clues to long COVID. Science. Jun 17 2022;376(6599):1261–1265. doi:10.1126/science.add4297 - DOI - PubMed
    1. Choutka J, Jansari V, Hornig M, Iwasaki A. Unexplained post-acute infection syndromes. Nat Med. May 2022;28(5):911–923. doi:10.1038/s41591-022-01810-6 - DOI - PubMed
    1. Bruun KD, Amris K, Vaegter HB, et al. Low-dose naltrexone for the treatment of fibromyalgia: protocol for a double-blind, randomized, placebo-controlled trial. Trials. Nov 15 2021;22(1):804. doi:10.1186/s13063-021-05776-7 - DOI - PMC - PubMed