DIET & NUTRITION 
PATIENT EDUCATION 
OBESITY/WEIGHT MANAGEMENT 
EXERCISE/TRAINING 
LEGAL MATTERS 
GUIDELINES/RECOMMENDATIONS Long COVID fatigue remains one of the most disabling post-COVID sequelae, with limited evidence-based treatment options. The REVIVE-TOGETHER trial randomized 399 adults with persistent fatigue after SARS-CoV-2 infection to fluvoxamine, metformin, or placebo.
Clinical Considerations
- Fluvoxamine reduced fatigue and improved quality-of-life measures compared with placebo in adults with established long COVID.
- Investigators reported a 99% probability that fluvoxamine outperformed placebo for fatigue reduction.
- Metformin did not improve established long COVID fatigue despite previous evidence suggesting preventive benefits during acute infection.
- Bayesian adaptive methodology allowed early stopping of treatment arms once evidence thresholds were achieved.
Practice Applications
- Interpret findings as early randomized evidence for pharmacologic management of long COVID fatigue.
- Recognize benefits were demonstrated specifically for fatigue, not the full spectrum of long COVID symptoms.
- Monitor additional studies evaluating patient selection and durability of response.
- Avoid assuming efficacy extends to all long COVID manifestations.
