Trial Report Ten sessions of hyperbaric oxygen versus sham treatment in patients with long covid HOT-LoCO…, 2025, Kjellberg et al.

Would the placebo have been adequate? Would people have been able to tell whether they were getting normal air, rather than oxygen?

Edit: And low pressure rather than high pressure air?

 

You're right, it doesn't - I misread the abstract and thought it said that the HBOT showed 'no more than' short-term benefits, rather than 'showed no more benefits'.

 

It took them 6 months to get the null results through peer review. Good thing it was published at least.

 

Bullet points added.
They also used an Oura ring for HRV and sleep tracking.

 

It might be personal preference, but I really wish they included more graphs.

 

I’ve heard of stories where people pushed themselves to do it and ended up having permanent worsenings of the illness… (which they attributed to overexerting because they were convinced HBOT would work)

 

Not read the paper, but wanted to commend this publication of null results, we need to be able to rule out as much as possible these distractions syphoning money and time from patients desperately seeking anything to help.

We need health care to be more upfront about the current lack of evidence for any evidenced treatment for ME/CFS and Long Covid meeting the diagnostic criteria for ME/CFS. This lack of honesty not only wastes resources it also undermines patients making meaningful adaptations.

 

Isn't 40 sessions commonly done for HBOT & LC or ME? 8 Weeks of 5 sessions/week. The 10 sessions discussed here seem quite little in comparison.

Current trials (all doing 40 sessions):

https://clinicaltrials.gov/study/NCT06452095
https://clinicaltrials.gov/study/NCT06267300
https://clinicaltrials.gov/study/NCT06159309
https://clinicaltrials.gov/study/NCT06118138
https://clinicaltrials.gov/study/NCT06082518

 

https://clinicaltrials.gov/study/NCT06452095

• Blinded placebo

https://clinicaltrials.gov/study/NCT06267300

• CAU control and crossover if positive results in intervention arm

https://clinicaltrials.gov/study/NCT06159309

• No control

https://clinicaltrials.gov/study/NCT06118138

• No control

https://clinicaltrials.gov/study/NCT06082518

• Waitlist control

The last four trials seems like a waste of time and resources.

 

From the paper, linebreaks added:

HBOT with 40 sessions at 2.0 atmospheres absolute (ATA), 90 min with 5 min air breaks every 20 min has been shown to improve neurocognitive function and symptoms.

Clinical improvement was associated with changes on MRI and improvement of myocardial function in long covid in a randomised, placebo-controlled trial.10 11

A longitudinal follow-up of selected subjects from the phase II trial suggests a sustained effect for 3 months but high-grade evidence for long-term efficacy compared with a control group is missing.12

HBOT has previously been suggested to be effective in chronic fatigue syndrome with only 15 sessions.13 Two case series with 32 patients suggest efficacy from 10 sessions at 2.2–2.4 ATA, 75–105 min with two 5 min air breaks, but no Randomised Controlled Trials (RCTs) are published on this dose.

A shorter treatment with 10–15 sessions has become increasingly popular off-label for long covid.14

The rationale for using fewer and less frequent sessions for long covid is based on the hyperoxic–hypoxic paradox with downstream regulation of hypoxia and inflammatory pathways,15previous clinical experience from severe COVID-19 and experimental research.16 17

 

That's not the point I'm making. I never said their trial design is optimal, I merely used them as examples for 40 sessions seemingly being the latest or most used protocol. Hence, 10 sessions seemed little.

 

I never said you said so. I just made a comment on the design of the trials.

Please see my other comment where I’ve read the paper to answer your question.

 

And I never said that you said that I said... I guess you see this rhetoric leads us nowhere.

From your other comment I read their reasoning, but personally not convinced their reasoning makes much sense. Thanks for the excerpt!

 

What doesn’t make sense to you?

It seems to me like they’ve observed clinically and empirically that a lower dose might be effective, and they believe there is a rationale for it, so they wanted to test if it was.

Is it the rationale that you don’t agree with?

 

Yessir.

 

Can you elaborate?

 

This is exactly what the psychobehaviorists exploit when they go for within group differences that ultimately barely differ between groups. Even more so when they do like PACE and cross over the arms, then do a post-hoc analysis anyway. Although there seems to be a slight benefit from HBOT, it doesn't seem significant. If this were a BPS study, it would have been hailed as promising.

It's probably a lot easier for journals to be interested in publishing null results about treatments they don't expect, or want, to work. Similar to Garner's early review of plasmapheresis, published by Cochrane because they don't want it to be an effective treatment, whereas for psychobehavioral stuff they badly want it to be true, and don't have the same interest in null results.

The difference with the patient community is that we accept that treatments don't work, and leave them behind. At the time it started being suggested, there were lots of posts on the LC sub-reddit. I maybe remember 1-2 in the last 2 years. Because we have all the stakes, we are eager to abandon things that don't work, have no investment in them.