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

Hector Bonilla; Lu Tian; Vincent C Marconi; Robert Shafer; Grace A McComsey; Mitchel Miglis; Philip Yang; Andres Bonilla; Lauren Eggert; Linda N Geng

doi:10.1016/j.intimp.2023.110966

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

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

Authors

Hector Bonilla¹, Lu Tian², Vincent C Marconi³, Robert Shafer⁴, Grace A McComsey⁵, Mitchel Miglis⁶, Philip Yang⁷, Andres Bonilla⁸, Lauren Eggert⁹, Linda N Geng¹⁰

Affiliations

¹ Division of Infectious Diseases & Geographic Medicine, L-134 Stanford University, 300 Pasteur Dr., Palo Alto, CA 94305, United States. Electronic address: Hbonilla@stanford.edu.
² Department: Biomedical Data Science, Stanford University, Professor X347 MSOB, Palo Alto, CA 94305, United States.
³ Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, United States; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, United States; Atlanta Veterans Affairs Health Care System, Decatur, GA, United States; Health Sciences Research Building, 1760 Haygood Dr NE, Room W325, Atlanta, GA 30322, United States.
⁴ Division of Infectious Diseases & Geographic Medicine, Stanford University, 3652 Biomedical Innovations Building, 3rd Floor, Palo Alto, CA 94305, United States.
⁵ Department of Pediatrics and Medicine, Case Western Reserve University and University Hospitals of Cleveland, 11100 Euclid Ave., Cleveland, OH 44106, United States.
⁶ Department of Neurology and Neurological Sciences, Stanford University, Stanford University, 213 Quarry Road, Palo Alto, CA 94304, United States.
⁷ Department: Medicine - Med/Cardiovascular Medicine, Stanford University, 300 Pasteur Dr # H2157, Palo Alto, CA 94305-2200, United States.
⁸ Department of Molecular, Cell and Developmental Biology, University of Michigan, Ann Arbor, MI, United States.
⁹ Division of Pulmonary and Critical Care Medicine, 300 Pasteur Dr Rm H3143 MC 5236, Palo Alto, CA 94305-2200, United States.
¹⁰ Department of Medicine - Primary Care and Population Health, Stanford University, 211 Quarry Rd Ste 205 MC 5987, Palo Alto, CA 94304, United States.

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.

MeSH terms

COVID-19*
Disease Progression
Humans
Naltrexone / therapeutic use
Post-Acute COVID-19 Syndrome
SARS-CoV-2

Substances

Naltrexone

Abstract

MeSH terms

Substances

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