Low-dose naltrexone use for the management of post-acute sequelae of COVID-19 2023 Bonilla et al

Highlights

• The off-label use of low-dose naltrexone (LDN) is a potential drug intervention for the management of post-COVID conditions.
  
  
• LDN has anti-inflammatory and immunomodulatory properties which may benefit those with PASC where persistent inflammation is the causative pathway.
  
  
• LDN warrants testing in rigorous randomized, placebo-controlled clinical trials.

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.

Open access, https://www.sciencedirect.com/science/article/pii/S1567576923012912