Fluticasone Nasal
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Leronlimab for long COVID
LERONLIMAB
What is leronlimab?
Leronlimab is a medication used to treat the human immunodeficient virus (HIV). It works by blocking the entry of HIV into cells, halting the virus’s replication [1]. The FDA does not approve Leronlimab, which is currently an investigational product. The timing of FDA approval is currently unknown.
Can leronlimab be used in long-COVID?
Since leronlimab is an antiviral medication, researchers theorize it may play a role in treating long-COVID. Patients with long-COVID often deal with symptoms such as fatigue, shortness of breath, and cognitive dysfunction. These symptoms may occur following initial recovery from a COVID-19 episode or persist from the initial illness [2]. Although not actively infected, patients with long-COVID are thought to shed the virus in the body continuously. This constant shedding leads to an overresponse of the immune system, causing increased inflammation.
Leronlimab is thought to bind to a protein that increases inflammation. This binding helps regulate the immune response to COVID-19, thereby slowing inflammation [3]. One study concluded that the immune response normalized in patients treated with leronlimab [4].
Further research needs to be conducted to prove the use of leronlimab in long-term COVID; however, early studies show promise. Leronlimab, unlike other therapies that only treat symptoms, may help eradicate the virus from the body.
References:
1https://clinicalinfo.hiv.gov/en/drugs/leronlimab/patient
3https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8277229/
4https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9659683/
Pitavastatin for long COVID
PITAVASTATIN
What is pitavastatin (Livalo)?
Pitavastatin is part of a class of drugs commonly referred to as statins. Its role is to reduce the amount of cholesterol made by the liver. Cholesterol is comprised of HDL, the “good” cholesterol, and LDL, the “bad” cholesterol. The body uses cholesterol to make various hormones and other substances. However, if a person has too much LDL, it can cause a buildup in the arteries, leading to stroke, heart attack, or other health problems.
How does pitavastatin relate to long-COVID?
Pitavastatin possesses anti-inflammatory and modifying effects on the immune system (1). A recent study conducted in vitro (in test tubes) showed that simvastatin reduced levels of pro-inflammatory proteins and inhibited human cells from being infected with COVID-19 (2). However, statins can also upregulate or increase an enzyme called ACE2. ACE2 is how COVID-19 makes its way into the cells, leading to an influx of disease ( 3).
For those who suffer from long-COVID, the effects of statins may prolong illness even further. Highlights of long-COVID include chronic fatigue, exercise intolerance, and muscle weakness. Muscle weakness or muscle pain (myalgia) is also a primary side effect associated with the use of statins. Therefore, many believe that statins are exaggerating long-COVID in patients. Additionally, statins can decrease the amount of CoQ10 available for use by the body. CoQ10 is an antioxidant that has a role in cell energy production (4). For those suffering from long-COVID and already with a decreased energy reserve, statin use could only exacerbate this problem further.
Although currently, there is no definitive answer regarding the role of pitavastatin use in patients with long-COVID, the consensus is to aid on the side of caution. A benefit versus risk scenario for every patient should be warranted for providers to assess whether the cardio-protective use of statins outweighs the prolonged effects of long-COVID in patients.
References:
1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9520195/
2https://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1011050
3https://jamanetwork.com/journals/jama/fullarticle/2780872
4 https://www.mdpi.com/2077-0383/12/14/4659
Active Clinical Trials: Long COVID, statin | Card Results | ClinicalTrials.gov
Brain HQ for long COVID
BRAIN TRAINING PROGRAMS: BRAIN HQ
What are brain training programs like BrainHQ?
BrainHQ is an interactive online program that offers a variety of exercises to help train the brain to improve cognitive tasks such as memory, attention, and speed.1 Tasks adapt to a level of difficulty that is optimal for the user. Each level takes less than five minutes to complete. BrainHQ has 29 online exercises for attention, brain speed, memory, people skills, navigation, and intelligence. Users can customize their exercises to their needs and schedule. BrainHQ is available as a free online resource at various libraries in the US.
How can brain training programs like BrainHQ help alleviate certain long COVID symptoms?
Cognitive symptoms of long COVID include brain fog (trouble thinking clearly or remembering) and difficulty focusing on tasks. The SARS-CoV-2 virus can directly infect the central nervous system and damage brain tissue, which is hypothesized to lead to cognitive impairment. In addition, the virus possesses a spike protein that studies have associated with memory loss after COVID.2 This spike protein can activate neuroinflammation and ultimately lead to memory impairment.
Brain training programs like BrainHQ are intended to promote brain plasticity, which rewires the brain to make physical changes that improve learning. BrainHQ exercises can increase the activation of brain regions for specific cognitive functions and build neural connections over time.3
What evidence supports using brain training programs like BrainHQ for long COVID?
Studies using BrainHQ exercises and assessments have found benefits such as faster visual and auditory processing, better memory, faster neural timing, fewer dangerous driving moves, and better mood. BrainHQ has been used in hundreds of published studies for a wide range of conditions such as ADHD, autism spectrum disorder, bipolar, dementia, depression, diabetes, heart failure, MS, Parkinson’s, schizophrenia, and more.4 For instance, BrainHQ has been studied in breast cancer survivors and showed improvements in immediate and delayed memory and speed of processing.5
The RECOVER-NEURO trial is actively recruiting to investigate BrainHQ as a possible treatment to improve memory, attention, and brain processing speed for long COVID patients. It is also being studied with an online goal management training program or transcranial direct current stimulation to increase activity in specific brain parts.6
In summary, BrainHQ is an extensively studied brain training program that has shown benefits in cognitive function. Ongoing research will help to determine its effectiveness for long COVID patients.
References:
1) Brain Training That Works. BrainHQ. 2023. Accessed November 8, 2023. https://www.brainhq.com/?utm_source=google&utm_medium=cpc&utm_campaign=brand&utm_content=46467711%2B327060831330&utm_term=brainhq&gad=1&gclid=Cj0KCQiAgK2qBhCHARIsAGACuznJ-tHxC4VThBFhINIfiVtv6u6_fD8D7r0ROAIYzFvqR12JHHWXlVoaAumfEALw_wcB&v4=true&fr=y
3) The Proven Benefits of BrainHQ. BrainHQ. 2023. Accessed November 8, 2023. https://www.brainhq.com/world-class-science/the-proven-benefits-of-brainhq/
4) Hundreds of Published Studies. BrainHQ. 2023. Accessed November 8, 2023. https://www.brainhq.com/world-class-science/information-researchers/
5) Evidence-Based Cancer Control Programs (EBCCP). National Cancer Institute. March 29, 2023. Accessed November 8, 2023. https://ebccp.cancercontrol.cancer.gov/programDetails.do?programId=27852796
6) RECOVER-NEURO Clinical Trial. RECOVER: Researching COVID to Enhance Recovery. 2023. Accessed November 8, 2023. https://trials.recovercovid.org/neuro
Active Clinical Trials: Long COVID, brain training | Card Results | ClinicalTrials.gov
Decong
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Lisdexamfetamine for long COVID
LISDEXAMFETAMINE
What is lisdexamfetamine, and how does it work?
Lisdexamfetamine is a stimulant medication that belongs to the drug class amphetamines. This medication acts on the central nervous system (CNS) by increasing levels of two chemicals, dopamine and norepinephrine, in the brain. Norepinephrine is thought to play a role in the body’s stress response and helps to regulate sleep, alertness, and blood pressure. Dopamine plays a crucial role in movement and affects motivation, perception of reality, and the ability to experience pleasure [1]. By increasing these levels of chemicals, it leads to an increase in focus and attention. Lisdexamfetamine is a controlled substance and does have the potential for abuse if used in a manner inconsistent with how it is prescribed.
How can lisdexamfetamine be used in long-COVID?
Sufferers of long-COVID often deal with “brain fog,” a persistent cognitive defect resulting in memory problems, poor focus, and decreased ability to concentrate. Although the reasoning is still unclear, researchers think COVID-19 may linger in the brain for months afterward. Even though it does not cause an active infection, it is a foreign substance in the body. This leads to constant attack by the immune system, causing inflammation. Over time, the continuous inflammation manifests as “brain fog” symptoms [2].
Stimulants, such as lisdexamfetamine, can improve focus, attention span, and even fatigue. A case study completed in 2022 showed benefits when using lisdexamfetamine, along with other agents, to help reduce “brain fog” [3]. Although there have been no formal studies conducted on using lisdexamfetamine for “brain fog,” one provider stated he has been using it, in conjunction with behavioral exercises, as a treatment option. He saw improved memory, attention, fatigue, and concentration difficulties [4].
Although current recommendations do not advocate for the use of stimulants to treat long-COVID or symptoms of long-COVID, for those suffering from “brain fog” or fatigue, it may be an attractive option to those looking for symptom management.
References:
1https://americanaddictioncenters.org/antidepressants-guide/ndris#
3https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10102822/
4https://www.ohsu.edu/sites/default/files/2023-02/PCR23-Mon-18-AndersonWM.pdf
Prednisone for long COVID
PREDNISONE
What is prednisone (Deltasone)?
Corticosteroids, often called steroids, are a class of medication used to decrease inflammation. Steroids, like prednisone, reduce the production of chemicals that cause inflammation [1]. They are used in a variety of disease states when inflammation is abundant. Steroids should be used for the shortest duration and lowest dose possible and should not be stopped abruptly. Doing so could lead to withdrawal symptoms or a flare-up if used for an autoimmune condition such as rheumatoid arthritis.
Can prednisone treat long-COVID?
Patients dealing with symptoms of long-COVID may see some beneficial results with the use of prednisone. In long-COVID, it is theorized that the body is under constant inflammation via a cytokine storm, an overresponse of the immune system. Although a person is not actively infected with COVID-19, the body still sheds the virus. Since COVID-19 is a foreign material, the immune response is invoked, resulting in inflammation [2]. Since prednisone decreases inflammation, it could alleviate some of the symptoms of long-COVID, such as “brain fog, chronic fatigue, and exercise intolerance.
Although there have been few studies testing prednisone’s effectiveness in treating long-COVID, the limited results show promise. In one study on 14 patients, researchers looked at the immune response before and after treatment with prednisone for four days. Results showed the immune response decreased and was maintained for at least four months following therapy [2]. A second study found that treatment with tapering steroids improved breathing, increased oxygen levels, and decreased inflammation on chest X-rays [3].
Prednisone may offer symptom improvement for patients suffering from side effects of long-COVID, however, there has been no evidence it treats the disease state itself. It may be an attractive option to patients as it is relatively affordable and for a short duration, may help with lung capacity and oxygen levels. A conversation with a healthcare provider can offer additional insight as to whether prednisone would be a potential therapy option for long-COVID.
References:
1https://my.clevelandclinic.org/health/drugs/4812-corticosteroids
3https://pubmed.ncbi.nlm.nih.gov/34730322/
Lumosity for long COVID
BRAIN TRAINING PROGRAMS: Lumosity
What are brain training programs like Lumosity?
Lumosity provides research-based brain training games to improve memory, processing speed, and problem-solving for people of all ages and skill levels.1 Users can choose from more than 50 games in the following categories: speed, memory, attention, flexibility, problem-solving, word, and math. The games are intended to be adaptive and have personalized difficulty. Each game is also derived from a clinically-based assessment that could be done in a research lab.
How can brain training programs like Lumosity help alleviate certain long COVID symptoms?
Cognitive symptoms of long COVID include brain fog (trouble thinking clearly or remembering) and difficulty focusing on tasks. The SARS-CoV-2 virus can directly infect the central nervous system and damage brain tissue, which is hypothesized to lead to cognitive impairment. In addition, the virus possesses a spike protein that studies have associated with memory loss after COVID.2 This spike protein can activate neuroinflammation and ultimately lead to memory impairment.
Programs like Lumosity may help with cognitive symptoms of long COVID by training the brain over multiple sessions to improve memory and processing time. As users improve their ability to complete the cognitive tasks for each game, these tasks boost memory and attention in daily activities.
What evidence supports using brain training programs like Lumosity for long COVID?
The founder of Lumosity conducted a randomized study of 4,715 participants who either completed the brain training program for 15 minutes a day for five days per week or online crossword puzzles. After ten weeks, they found that those who used Lumosity improved more on assessments of working memory, short-term memory, processing speed, problem-solving, fluid reasoning, and overall cognitive function.3
Another study conducted in Saudi Arabia had 51 healthy participants randomized to use either Lumosity for 15 minutes a day, at least seven days per week, for three weeks or no brain training as a control. The study found a statistically significant difference in attention-switching tasks and motor speed between the Lumosity and control groups.4
However, some argue that brain training programs such as Lumosity only improve a user’s ability to complete specific tasks assessed in the games with little transferability to overall cognitive performance. One study found no evidence of improvement in decision-making behavior, brain response, or cognitive task performance using Lumosity versus playing online video games.5
Thus, the evidence for Lumosity is controversial and may not be as effective in improving overall cognitive function. Lumosity has also been used anecdotally by long-term COVID patients, but it has not yet been formally studied in this patient population.
References:
1) Discover what your mind can do. Lumosity. 2023. Accessed November 9, 2023. https://www.lumosity.com/en/
Active Clinical Trials: Long COVID, brain training | Card Results | ClinicalTrials.gov
Health Insurance for Individuals
Hi
Lovastatin for long COVID
LOVASTATIN
What is lovastatin (Mevacor, Altoprev)?
Lovastatin is part of a class of drugs commonly referred to as statins. Its role is to reduce the amount of cholesterol the liver makes. Cholesterol comprises HDL, the “good” cholesterol, and LDL, the “bad” cholesterol. The body uses cholesterol to make various hormones and other substances. However, if a person has too much LDL, it can cause a buildup in the arteries, leading to stroke, heart attack, or other health problems.
How does lovastatin relate to long-COVID?
Lovastatin possesses anti-inflammatory and modifying effects on the immune system (1). A recent study conducted in vitro (in test tubes) showed that simvastatin reduced levels of pro-inflammatory proteins and inhibited human cells from being infected with COVID-19 (2). However, statins can also upregulate or increase an enzyme called ACE2. ACE2 is how COVID-19 makes its way into the cells, leading to an influx of disease ( 3).
For those who suffer from long-COVID, the effects of statins may prolong illness even further. Highlights of long-COVID include chronic fatigue, exercise intolerance, and muscle weakness. Muscle weakness or muscle pain (myalgia) is also a primary side effect associated with the use of statins. Therefore, many believe that statins are exaggerating long-COVID in patients. Additionally, statins can decrease the amount of CoQ10 available for use by the body. CoQ10 is an antioxidant that has a role in the cells’ energy production (4). For those suffering from long-COVID and already with a decreased energy reserve, statin use could only exacerbate this problem further.
Although currently, there is no definitive answer regarding the role of lovastatin use in patients with long-COVID, the consensus is to aid on the side of caution. A benefit versus risk scenario for every patient should be warranted for providers to assess whether the cardio-protective use of statins outweighs the prolonged effects of long-COVID in patients.
References:
1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9520195/
2https://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1011050
3https://jamanetwork.com/journals/jama/fullarticle/2780872
4 https://www.mdpi.com/2077-0383/12/14/4659
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