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Hiqa review says 'clear treatment pathway for Long Covid remains unknown'

No definitively effective treatments for the condition were identified in the review.

A REVIEW OF interventions to improve the symptoms of Long Covid by the Health Information and Quality Authority (Hiqa) has found that a clear pathway to treat the condition remains unknown.

The review was carried out at the request of the HSE.

Over 200 symptoms associated with the condition have been identified, but the most common are fatigue, respiratory and cardiac symptoms, neurological symptoms, muscular and joint pain and digestive symptoms.

Although many people will experience an improvement in their symptoms over time, some can experience symptoms lasting years.

The systematic review examined 57 randomised controlled trials that considered treatments for adults and symptoms of Long Covid. 

Hiqa said a wide range of pharmaceutical and non-pharmaceutical interventions were identified, with most only examined in single studies.

Of the 57 trials, 24 trials investigated the effectiveness of pharmaceutical interventions, eight looked at off-label interventions and 16 examined investigational and unauthorised interventions.

23 trials focused on non-pharmaceutical interventions. Of these, 11 were on supplements and alternative medicine, eight were on exercise, seven were on physiotherapy and physical rehabilitation, four were on olfactory training, two were on cognitive and neurorehabilitation and one trial was on psychological interventions

The studies were generally small with short follow-up periods, with the longest follow-up period being 20 weeks.

They also typically only included people who had symptoms of Long Covid for less than a year.

Where reported, interventions were found to be safe and tolerable, with no studies
reporting serious adverse events attributed to the interventions.

No definitively effective treatments were identified and there was limited reporting on the safety of these interventions.

“Overall, effective strategies remain elusive and the proposed interventions for people with Long Covid symptoms included in this review do not yet have sufficient evidence to support them,” the review states.

Hiqa’s deputy director of health technology assessment Michelle O’Neill said further research on the long-term safety and effectiveness of the interventions included in the review is required.

“Additionally, a better understanding of the pathophysiology of Long Covid would help researchers in designing more targeted interventions that address the complex nature of Long Covid,” she said.

“In the meantime, healthcare professionals should provide a holistic, person-centred approach to the assessment and management of people with Long Covid. This is important as symptoms of Long Covid are highly diverse, vary in severity, and can fluctuate over time.”

Hiqa said that there are hundreds of ongoing trials investigating potential interventions to manage the symptoms of Long Covid, which may lead to further evidence on potentially safe and effective interventions in due course.

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