Apr 01, 2026
3 min read
An international clinical trial identifies fluvoxamine as an evidence-based treatment against one of the most devastating symptoms after infection with the SARS-CoV-2 virus....
An international clinical trial identified fluvoxamine as an evidence-based treatment option for one of the most disabling symptoms following infection with the SARS-CoV-2 virus.The treatment shows significant improvement in patients' quality of life.
A research team led by McMaster University (Ontario, Canada) has identified one of the first drugs consistently shown to significantly reduce fatigue in people with Covid-19, a precursor to millions of people suffering from persistent symptoms years after the pandemic began.
A randomized, placebo-controlled clinical trial found that fluvoxamine, an inexpensive and widely available antidepressant, significantly reduced fatigue and quality of life in adults with persistent Covid.The results were published March 31, 2026, in the Annals of Internal Medicine.
Fatigue is the most common and debilitating symptom of prolonged Covid, leaving many people unable to work, care for their families or return to their normal lives.Despite its global impact, there are some treatments that have been proven to be effective.
Fluvoxamine has shown consistent and relevant benefits and, because it is widely used and well understood, has clear potential for clinical use.
“This is an important step for patients who have been waiting for evidence-based options,” said lead author Edward Mills, McMaster Professor of Health Research Methods, Evidence and Impact and co-principal investigator of the study.“Fluvoxamine” demonstrates consistent and relevant benefits and, as it is already widely used and well understood, has potential for clinical use.
The study was led by scientists from Canada, Brazil and the United States, as well as clinical sites in the city of Belo Horizonte and the state of Minas Gerais, Brazil.The REVIVE-TOGETHER research team includes collaborators from McMaster University, University of British Columbia, Stanford University, University of Pittsburgh, Duke University, Georgetown University and several Brazilian institutions.
The study included 399 adults in Brazil who experienced fatigue for at least 90 days after a confirmed SARS-CoV-2 infection.Participants were randomly assigned to receive fluvoxamine (sold under the brand name Luvox), metformin (a common diabetes drug), or a placebo for 60 days.
"We wanted to see if two drugs that are available, widely available and affordable can help. Both have biological bases that suggest a possible effect against the persistent fatigue of Covid, but nothing has been rigorously tested for this purpose in a proper clinical trial," explains Mills.
The authors found that fluvosamine reduced fatigue more than placebo, and the evidence suggested that the drug was 99% likely to be superior to placebo.The drug also improved the quality of life in many indicators.
Previous studies have shown that metformin reduces the risk of developing chronic covid when used in the acute phase of infection, and this study suggests that it may not have a relevant benefit in the treatment of fatigue in patients with long-established covid.
The study used an adaptive progressive Bayesian design, which allowed the researchers to stop certain experimental arms once the results were final, an approach that speeds up the generation of evidence without sacrificing scientific rigor.
"The trial used a sophisticated adaptive design that allowed more efficient inference than traditional studies and earlier stopping when the evidence was sufficient, a methodological innovation as important as the results themselves," said lead author Gilmar Reis, Cardresearch researcher at the Brazilian Center for Clinical Research in Belo Horizonte.Reis is also a part-time associate professor at McMaster.
Chronic Covid remains a major public health challenge, affecting an estimated 65 million people worldwide.However, due to the lack of treatments with proven efficacy most clinical guidelines recommend only supportive care such as activity dosing and symptom management.
The authors say that although fluvoxamine is the best indication for treatment fatigue, the duration of Covid is linked to many symptoms and biological mechanisms.More studies are needed to determine which patients are most effective, how the drug works, and how it combines with other emerging treatments.
"This study provides doctors with the first convincing evidence of a medicine that can help reduce the persistent fatigue of Covid. Patients want something they can try today, and this discovery brings us closer to that reality", concludes Jamie Forrest, co-author and postdoctoral fellow at the University of British Columbia.
Gilmar Reis et al."Effect of fluvoxamine and metformin on fatigue in patients with prolonged COVID: an adaptive randomized trial."Annals of Internal Medicine, 2026.
