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Postural orthostatic tachycardia syndrome is characterized by an unexpected increase in heart rate, dizziness, fatigue, or a combination of these symptoms.

Treatments for Long COVID-Related Neurological Symptoms in Trials

Trials will test at least three treatments for long COVID symptoms, such as fast heart rate, dizziness, and fatigue

National Institutes of Health
Published:Mar 12, 2024
|2 min read
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Some two Phase 2 clinical trials to test the safety and effectiveness of three treatments for adults with autonomic nervous system (ANS) dysfunction from long COVID have begun. The ANS acts largely unconsciously and regulates bodily functions, such as heart rate, digestion, and respiratory rate. Symptoms associated with ANS dysfunction have been among those that patients with long COVID say are most burdensome. 

The trials are part of the National Institutes of Health’s (NIH’s) Researching COVID to Enhance Recovery (RECOVER) Initiative, a nationwide research program to fully understand, diagnose, and treat long COVID. Other RECOVER Phase 2 clinical trials testing treatments to address viral persistence and neurological symptoms, including cognitive dysfunction (like brain fog), launched in July 2023.

“As a long COVID patient, I know firsthand how disruptive and frightening symptoms, including rapid heart rate, dizziness, and fatigue can be. Patient representatives across RECOVER have also shared that these symptoms are some of the most debilitating symptoms of long COVID,” said Heather Marti, co-chair of the RECOVER National Community Engagement Group. “These trials are giving me and others with long COVID hope that it will restore our health and get us back to the lives we so desire.”

What will the clinical trials investigate?

The two trials, collectively known as RECOVER-AUTONOMIC, are testing three potential treatments in adults who, following COVID-19, now have postural orthostatic tachycardia syndrome (POTS). An autonomic nervous system disorder, POTS is characterized by unexpected fast heart rate, dizziness, fatigue, or a combination of these symptoms when a person stands up from sitting or lying down. 

The trials will initially examine three potential treatments:

  • Gamunex-C, a form of intravenous immunoglobulin (IVIG), contains antibodies to help the body protect itself against infection from various diseases and is given by intravenous infusion.

  • Ivabradine, an oral medication that reduces heart rate.

  • Coordinator-guided, non-drug care that includes a series of activities managed through weekly phone calls with a care coordinator—such as wearing a compression belt and eating a high-salt diet—generally recommended for patients with POTS to counteract excessive loss of fluids.  

“Patients who develop POTS after having COVID-19 are often severely limited by their symptoms, and there are no proven effective treatments,” said Christopher Granger, MD, Duke University Medical Center, who is co-leading RECOVER-AUTONOMIC. “These interventions were selected because they have shown potential benefit in treating symptoms for POTS. The theory we’re testing is that they might also help individuals with long COVID.”  

Participants will first be randomly assigned to receive either IVIG, ivabradine, or a placebo. Participants will then be randomly assigned a second time to receive either coordinator-guided, non-drug care or what is considered the usual non-drug care for POTS following COVID-19, such as diet and lifestyle recommendations. RECOVER-AUTONOMIC is an adaptive clinical trial, meaning if additional potential interventions emerge, they can quickly be added and studied in the trial.

Researchers plan to enroll 380 total participants at 50 sites across the United States. Teams at the trial sites will recruit participants from their health systems and surrounding communities. 

Diversity among the trial participants is a high priority for RECOVER. The team chose study sites based on geographic location, their connections to communities, and their track records to support diverse and inclusive representation.

- This press release was originally published on the National Institutes of Health website