Review Treatable traits for long COVID, 2023, Lewthwaite et al

[Andy]

Abstract

Long COVID, or post-acute COVID-19 sequelae, is experienced by an estimated one in eight adults following acute COVID-19. Long COVID is a new and complex chronic health condition that typically includes multiple symptoms that cross organ systems and fluctuate over time; a one-size-fits-all approach is, therefore, not likely to be appropriate nor relevant for long COVID treatment. ‘Treatable Traits’ is a personalized medicine approach, purpose-built to address the complexity and heterogeneity of complex chronic conditions.

This comprehensive review aimed to understand how a treatable traits approach could be applied to long COVID, by first identifying the most prevalent long COVID treatable traits and then the available evidence for strategies to target these traits. An umbrella review of 22 systematic reviews identified 34 symptoms and complications common with long COVID, grouped into eight long COVID treatable trait clusters: neurological, chest, psychological, pain, fatigue, sleep impairment, functional impairment and other.

A systematic review of randomized control trials identified 18 studies that explored different intervention approaches for long COVID prevention (k = 4) or management (k = 14). While a single study reported metformin as effective for long COVID prevention, the findings need to be replicated and consensus is required around how to define long COVID as a clinical trial endpoint. For long COVID management, current evidence supports exercise training or respiratory muscle training for long COVID treatable traits in the chest and functional limitation clusters.

While there are studies exploring interventions targeting other long COVID treatable traits, further high-quality RCTs are needed, particularly targeting treatable traits in the clusters of fatigue, psychological, pain and sleep impairment.

Open access, https://onlinelibrary.wiley.com/doi/10.1111/resp.14596

 

[Hutan]

‘Treatable Traits’ is a personalized medicine approach, purpose-built to address the complexity and heterogeneity of complex chronic conditions.

Does anyone else find the choice of the word 'trait' rather odd here?
* a distinguishing quality or characteristic, typically one belonging to a person.
Similar: characteristic, attribute, feature, quality, essential quality, property, distinction, idiosyncrasy, peculiarity, quirk, foible, singularity, oddity, eccentricity, abnormality, mark, trademark, hallmark, earmark, mannerism, ..habit, tendency
* a genetically determined characteristic.

The word makes it sound as though the fatigue or functional limitation is something intrinsic to the person, rather than a symptom that is a consequence of a disease.

For long COVID management, current evidence supports exercise training or respiratory muscle training for long COVID treatable traits in the chest and functional limitation clusters.

The authors are from a Centre of Excellence - Treatable Traits, a consortium of people involved in respiratory medicine.

Treatable Traits is a personalised medicine strategy for chronic airway diseases. At the core of the Treatable Traits concept is the recognition that not all people with airway diseases are the same. Within individuals clinical, biological and functional presentation of diseases vary. This is often referred to as heterogeneity. Treatable Traits is an approach that characterises this individuality and allows for the implementation of targeted treatments to address it.

Treatable Traits involves a multidimensional assessment of ‘traits’ and the application of personalised medicine according to the identified traits.

Treatable traits are phenotypic or endotypic characteristics which can include comorbidities (such as anxiety, vocal cord dysfunction and reflux), risk factors (such as smoking and bone density) and self-management skills (such as adherence and inhaler technique). To be considered a trait each characteristic must be clinically relevant, identifiable and measurable using validated trait identification markers, and treatable. Treatable Traits are recognised within three domains: pulmonary traits, extrapulmonary traits and behavioural/risk-factors.

I can see what they are doing, and it makes some sense e.g. is the failure of the treatment approach due to the poor adherence or the inhaler technique of the person? But I find the approach rather questionable in the context of Long covid where the 'treatments' don't count for much.

I can't think more, so will just post this and hope it makes sense.

 

[CRG]

Paper from the TT team: Treatable traits: a new paradigm for 21st century management of chronic airway diseases: Treatable Traits Down Under International Workshop report

I think this interesting. Whether or not TT is applicable to areas other than respiratory diseases requires testing, on that basis I'd see the study in LC as appropriate.