Oral minocycline therapy as first-line treatment in patients with Myalgic encephalomyelitis and long COVID: A pilot study, 2024, Miwa

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Oral minocycline therapy as first-line treatment in patients with Myalgic encephalomyelitis and long COVID: A pilot study

Kunihisa Miwa

[In Press, Journal Pre-proof]

Background
Myalgic encephalomyelitis (ME) is associated with long COVID and also untoward sequelae after anti-coronavirus vaccination. Recently, oral minocycline therapy has been reported to ameliorate symptoms in patients with ME, particularly at the initial stage of the disease.

Methods
Oral minocycline (100 mg × 2 on the first day, followed by 100 mg/day for 41 days) was administered to 55 patients with ME that emerged during the “Corona era,” including 19 patients with long COVID and 5 patients diagnosed with untoward sequalae following coronavirus vaccination.

Results
Acute adverse effects including nausea and/or dizziness caused four (7 %) patients to discontinue treatment in the first few days. Among the other 51 patients who completed therapy, favorable effects were observed, including a decrease in performance status score or index for restricted activities of daily living ≥2 points in 41 (80 %) patients.

Disease duration was inversely associated with the favorable therapeutic effects (p = 0.02) and the disease duration within 6 months was significantly associated with the favorable therapeutic effects (27/30, 90 %, p = 0.02, hazard ratio: 3.6, 95 % confidence interval, 1.210.6).

The favorable effects were observed in 16 (89 %) of 18 patients with long COVID. Significant amelioration of subjective symptoms of fatigue, post-exertional malaise, unrefreshing sleep, brain fog, disequilibrium, orthostatic intolerance, and neuropathic pain were observed.

Conclusions
Oral minocycline was effective at ameliorating symptoms in patients with ME including long COVID and post-coronavirus vaccination sequalae. It represents an effective first-line therapeutic option for these patients in the initial stage.

Link | PDF (eNeurologicalSci) [Open Access]
 
Oral minocycline was effective at ameliorating symptoms in patients with ME including long COVID
I recall 15 years or so ago mentioning a similar phenomenon, but involving one of the tetracyclines' effect on MS, with one of my doctors. I seem to remembering him being dismissive and suggesting those MS patients probably were misdiagnosed. I didn't respond one way or the other, but I didn't agree.
 
Disease duration was inversely associated with the favorable therapeutic effects (p = 0.02) and the disease duration within 6 months was significantly associated with the favorable therapeutic effects (27/30, 90 %, p = 0.02, hazard ratio: 3.6, 95 % confidence interval, 1.210.6).
Was there a control group? because otherwise this just fits with “natural recovery” trends.
 
The present study has some limitations. First, the design was not a double-blind randomized controlled trial; therefore, possible placebo effects could not be excluded. Second, many patients were included with a short disease duration (<6 months) and no systematic reports on the natural course of disease within the first 6 months were available. Therefore, it cannot be excluded that accentuated improvement of some symptoms may include, in part, the natural course of disease during the early stage.
 
Oral minocycline was effective at ameliorating symptoms in patients with ME including long COVID and post-coronavirus vaccination sequalae. It represents an effective first-line therapeutic option for these patients in the initial stage.
Yeah, "effective first-line therapeutic option" seems a brave and premature call based on a study that even the authors describe as 'a pilot study' and that was unblinded and had no controls.

We have a treatment thread on antibiotics:
Antibiotics
It mentions a study in Q-fever Fatigue syndrome. Long term doxycycline, CBT and a placebo were all equally unhelpful at long term followup.
 
I tried it. No effect on me. That was maybe 8-12 years into my ME, so not their "early stage" category. As Yann04 points out, the "early stage" category might simply be the category that has a natural remission rate ... that just happens to make their theory look good.
 
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