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GLP-1 receptor agonists in the management of COVID-19 and long COVID for patients with underlying metabolic disorders

Nigel Nicholls, Zdzisław J. Sabat, Michael Bewick, John Feeney

The College of Contemporary Health, London, UK
University of Central Lancashire, Preston, UK

Abstract

The COVID-19 pandemic has highlighted the need for effective treatments for individuals with metabolic disorders, such as obesity and type 2 diabetes (T2D), to severe illness, mortality and long-term complications. Recent studies, including findings from the SELECT trial of semaglutide on patients with obesity and cardiovascular disease, suggest that GLP-1 receptor agonists (GLP-1RAs), medications primarily used to treat obesity and T2D, may play a significant role in improving outcomes for these high-risk patients. We present the case for exploring the use of GLP-1RAs in managing not only the acute effects of COVID-19, but also in mitigating the long-term consequences of long COVID.

Keywords

• GLP-1 receptor agonists
• COVID-19
• long COVID
• metabolic disorders
• obesity
• type 2 diabetes

Introduction

GLP-1 receptor agonists (GLP-1RAs) are a short-acting insulin secretagogue that has been shown to improve glycaemic control in patients with T2D. They have also been associated with weight loss and cardiovascular benefits. The COVID-19 pandemic has exacerbated the burden of metabolic disorders, particularly in patients with obesity and T2D, who are at increased risk of severe COVID-19 infection.

Clinical trials to evaluate the efficacy of GLP-1RAs for different patient groups in treatment of long COVID are needed. Interdisciplinary collaboration between endocrinologists, immunologists, and virologists to explore the mechanisms by which GLP-1RAs modulate metabolic and inflammatory pathways in viral illnesses.

Long COVID

Long COVID, or post-acute sequelae of COVID-19 (PASC), is a term used to describe a broad spectrum of signs and symptoms that persist beyond the acute phase of COVID-19. Patients with long COVID may experience a range of symptoms including fatigue, cognitive dysfunction, and respiratory issues, which can significantly impact their quality of life.

GLP-1RAs could be considered as a preventive measure for high-risk groups such as those with obesity, pre-diabetes, T2D, or overweight with additional metabolic risk factors such as hypertension or central adiposity. This could help reduce the risk of severe illness, hospitalisation, complications and mortality in a large number of potentially vulnerable individuals before a safe and effective vaccine is available.

Clinical trials

1. GLP-1RA therapy for COVID-19 infection.
2. Clinical trials to evaluate the efficacy of GLP-1RAs in improving outcomes in acute COVID-19 and preventing long COVID in patients with underlying metabolic conditions.
3. Clinical trials to evaluate the efficacy of GLP-1RAs for different patient groups in treatment of long COVID.
4. Interdisciplinary collaboration between endocrinologists, immunologists, and virologists to explore the mechanisms by which GLP-1RAs modulate metabolic and inflammatory pathways in viral illnesses.

Conclusion

GLP-1 receptor agonists represent a promising adjunctive therapy for patients with metabolic disorders, particularly for high-risk populations affected by COVID-19 and long COVID. Their ability to modulate immune, endothelial and metabolic functions could provide significant benefits in managing the acute and long-term effects of COVID-19.

Conflicts of interest:

The authors have no conflicts of interest.

Acknowledgments:

No funding was received for this work.

References

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