Long-COVID condition therapeutics: a multi-modal investigation of treatment evidence, off-label prescribing patterns, and clinical outcomes
Sebők Szilvia
Gyógyszertudományok és Egészségügyi Technológiák Tagozat
Dr. Zelkó Romána
SE Semmelweis Szalon
2026-01-06 14:00:00
Modern Trends in Pharmaceutical Scientific Research
Dr. Antal István
Dr. Zelkó Romána
Dr. Gadó Klára
Dr. Boncz Imre
Dr. Szabó Attila
Dr. Lengyel Miléna Bea
Dr. Vecsernyés Miklós
Introduction: Long COVID is a prevalent, multifaceted syndrome causing major therapeutic challenges and affecting millions worldwide. This dissertation critically examines both approved and off-label drug approaches, highlighting that—despite extensive research—effective pharmacological solutions remain elusive.
Objectives: This work (1) updated the Sebők et al, 2023 framework by assessing current scientific evidence on post-COVID pharmacological prevention and therapy; (2) evaluated Hungarian off-label prescribing trends for COVID-related indications against international practices; (3) characterized post-COVID medication usage, focusing on links with interstitial lung disease (ILD) development.
Methods: 2023 baseline data were revisited, adding new evidence from PubMed (2024–2025) and ClinicalTrials.gov. Nationwide NNGYK records of COVID-linked off-label drug requests (2020–05.2025) were analysed. Retrospective analysis compared 470 post-COVID outpatients (ILD-confirmed versus non-ILD) by descriptive statistics.
Results: Updated meta-analyses confirmed that vaccination moderately reduces long COVID risk (effectiveness 43–70% after ≥2 doses), with evident dose-response and mRNA vaccine superiority. Among ongoing therapeutic trials, few results have emerged; all completed studies consistently reported neutral or negative outcomes across targeted mechanisms. Hungarian off-label COVID requests dropped sharply from 87.9% (2020) to 0% (2025); only five post-COVID requests—each for pirfenidone in fibrosis—were submitted. Internationally, broader off-label use included naltrexone, antivirals, and immunomodulators. Compared to controls, ILD patients had higher medication use (73.1% vs 57.4%) and greater cardiovascular therapy reliance, also showing a strong age-medication correlation (r = 0.96, p < 0.001).
Clinical Implications: Despite significant research investment, no proven pharmacotherapy exists for long COVID. The gap between Hungarian regulatory policy and broader international practice may constrain patient access to potentially beneficial options. Future advancements require innovative therapeutics and biomarker-guided patient stratification to address the complex, multisystem nature of post-COVID syndrome.
