Fluvoxamine eased long COVID fatigue over 90 days, and 157 hospitals named the routine tests worth dropping

The edition in brief

In a placebo-controlled adaptive trial of 399 Brazilian outpatients with fatigue 3 to 24 months after COVID-19, 60 days of fluvoxamine 100 mg twice daily lowered the Fatigue Severity Scale by 0.43 points at day 60 and 0.58 at day 90 against placebo, with a 99% posterior probability of superiority and fewer adverse events than placebo; metformin was stopped for futility with inconclusive results. Choosing Wisely Canada's Using Labs Wisely collaborative, now 157 hospitals, tracks eight low-value inpatient tests including coagulation profiles, AST, urea, CK-MB, folate, B12, ESR and urine cultures; most hospital projects combined education, audit and feedback and order-set changes. A meta-analysis of six trials (1,069 adults with moderate to severe sleep apnoea) found liraglutide or tirzepatide lowered the apnoea-hypopnoea index by about 10 events per hour, with very high heterogeneity, and does not replace CPAP. Hospitalists from 27 US tertiary hospitals reported benzodiazepines as the usual treatment for alcohol withdrawal, phenobarbital in 44% of medical wards, and little consensus. In a secondary analysis of a veterans' collaborative pain care trial, patients with possible substance use disorder improved as much as others in pain and opioid dose reduction. The fluvoxamine result is a single trial with a short horizon.