LCAC treatment and trial tracker — eight-treatment pilot

Revision: Reviewer preparation, 13 October 2026.

Source check: 13 October 2026, America/Toronto. Status: research draft; independent clinical review not performed.

This pilot records what selected primary sources support. It is not an exhaustive review, prescribing guide or clinical recommendation. Candidate therapies and institutional campaigns are assessed separately.

Ensitrelvir — established Long COVID

Public summary: PREVAIL-LC has posted randomized results. Its small size and the absence of a posted between-group statistical analysis require cautious interpretation.

Confirmed study facts

PREVAIL-LC (NCT06161688) randomized 40 adults at one US centre to a five-day regimen or placebo. The registry is active, not recruiting; UCSF also says it is not accepting new patients. Results were first posted 2 April 2026. Primary completion is actual; overall completion remains estimated.

The day-10 PROMIS-29 physical health summary values are 43.6 (95% CI 41.7–45.4) for ensitrelvir and 41.6 (39.7–43.4) for placebo, with 20 participants per group. No between-group analysis is supplied in that outcome record. These arm values must not be presented as demonstrating statistical significance or clinical benefit. No serious adverse events are reported in either 20-person group through the stated two-month reporting window; that small observation does not establish safety.

Sources: Registry and results; UCSF.

Limits and publication gates

The posted analysis plan is now checked: primary comparison uses ANCOVA with the mean screening/baseline score as covariate. The registry describes baseline-adjusted day-10 means but does not supply the primary between-group CI or p-value. The primary-outcome description contains an unresolved placeholder. A full results publication was not identified in this pilot's searches; this is not proof that none exists. The plan was finalized 21 February 2025, after the registry's 20 December 2024 primary-completion date. Unblinding timing is unknown; dates alone do not establish outcome switching. The protocol includes PEM assessment and exertional tests; severe/housebound applicability and safeguards remain unresolved. Protocol and SAP, SAP section 4.1.

Canadian marketing authorization, coverage, supply and a drug-specific supported access process remain unverified. Health Canada's general SAP process involves practitioner requests and manufacturer supply; it is not a confirmation of access to this drug. SAP guidance.

Related LCAC campaign should remain separate from the evidence summary.

Obeldesivir — acute-COVID evidence, direct Long COVID question unresolved

Public summary: The identified phase 3 trials treated acute COVID-19. They do not demonstrate benefit for people with established Long COVID.

Confirmed findings and search boundary

A ClinicalTrials.gov API query combining intervention “obeldesivir” and condition “Long COVID” returned zero matches on the check date. A broader intervention-only search returned six records: NCT06682234, NCT06585150, NCT05996744, NCT05715528, NCT06784973 and NCT05603143. Their listed conditions concerned filovirus, RSV or acute COVID; none was identified as established Long COVID treatment. Wording and single-registry coverage limit this finding. Reproducible all-condition query.

OAKTREE (NCT05715528), a completed acute-COVID trial, reported median symptom-alleviation times of 5.9 versus 6.0 days; hazard ratio 1.099, 95% CI 0.997–1.211, p=0.068. The primary clinical endpoint did not reach statistical significance. A reduction in viral RNA was reported as a secondary outcome. That physiological observation must not be converted into a Long COVID treatment claim.

Sources: Published abstract; Registry.

BIRCH (NCT05603143) is terminated, not simply completed. Published primary-analysis events were 0/211 versus 1/207 for acute-COVID hospitalization or all-cause death by day 29 (p=0.32). The study stopped early with few events; the authors describe it as underpowered.

Sources: Published abstract; Registry.

Limits and publication gates

Keep both trials in a clearly labelled contextual section, outside counts of established Long COVID treatment trials. The all-condition registry search is complete for the named intervention; aliases, other registries and unpublished plans can still be missed.

Gilead still described obeldesivir as investigational in its 12 June 2026 statement. Canadian marketing, Long COVID supply and coverage remain unverified. Acute-COVID trial authorization must not be confused with marketing approval. No manufacturer message has been sent in this task.

Related LCAC campaign asks a research question; the tracker does not presume benefit.

Ivabradine — Long COVID-associated POTS

Public summary: RECOVER investigators reported reduced heart rate without a statistically significant improvement in the principal orthostatic symptom outcome. This is a symptom/associated-condition assessment, not a treatment conclusion for all Long COVID.

Confirmed evidence distinctions

RECOVER-AUTONOMIC's ivabradine appendix (NCT06305806) lists 181 participants and completed status. Investigators described three months of treatment and another three months of follow-up, with factorial assignment to coordinated or usual care. Their announcement and seminar report distinguish heart-rate reduction from symptom outcomes. Numerical estimates are now verified in the investigator's ACC.26 slides, slides 14 and 16: primary symptom difference −0.14 (95% CI −0.72 to 0.43), p=0.63; standing-minus-supine heart-rate change difference −3.95 beats/min (−6.78 to −1.12), p=0.007. These remain conference evidence; the full journal efficacy report and comparative harms were not identified in this scoped check.

The slides describe a prespecified interaction (p=0.004): drug versus placebo difference −1.03 (−1.83 to −0.23) under coordinated care, versus 0.72 (−0.09 to 1.52) under usual care. Those contrasts compare drug with placebo within care assignments; they are not direct comparisons between two ivabradine groups.

Sources: Appendix registry; RECOVER announcement; July seminar.

The parent NCT06305780 has posted results, but the reviewed primary result is enrolment: 200 IVIG plus 181 ivabradine participants. It is not a separate efficacy result or an independent ivabradine trial. Its safety rows with zero participants at risk are not interpretable as zero-event safety estimates. Platform results.

An earlier uncontrolled 55-person study reported that 43 participants felt better within seven days. Without a comparator, that percentage cannot estimate treatment benefit beyond placebo, fluctuation or other influences. Its “COVID-associated POTS” population also requires applicability review against an established Long COVID definition. Study abstract.

COVIVA (NCT05481177) now has unknown overall status; its last registry verification was November 2023, although a location still says recruiting. Do not advertise it as open. The institutional MiCOR project listing names COVIVA but supplies no current recruitment confirmation. The 2025 linked article is a protocol, not efficacy results. Registry; Protocol.

Canadian access and publication gates

Health Canada lists Lancora as marketed; the reviewed monograph indication is specified chronic heart failure, not Long COVID/POTS. Ontario limited-use code 538 has heart-failure eligibility criteria; Long COVID/POTS alone does not meet this listed indication. Other routes/provinces are unverified. Product record; Monograph.

Retrieve the complete randomized efficacy report and safety data; reconcile the prespecified care interaction with a full report and do not substitute it for the overall result. Confirm COVIVA's current recruitment from an institution/investigator before listing it as open.

Paxlovid

Evidence status: Three published randomized trials; no significant primary benefit.

STOP-PASC, PAX LC and RECOVER-VITAL did not show statistically significant improvement on their primary Long COVID outcomes with the tested regimens. These findings concern established Long COVID, not treatment of a new acute infection.

STOP-PASC: symptoms at 10 weeks

A 15-day course did not significantly improve the pooled six-symptom primary outcome versus placebo plus ritonavir. The publication randomized 155 people; the registry count of 168 includes those who consented and were screened.

Sources: STOP-PASC randomized trial (2024); STOP-PASC registry.

PAX LC: physical health at day 28

Adjusted difference −0.55 PROMIS-29 points (95% CI −2.32 to 1.21; p=0.54), after 15 days of treatment. No significant primary benefit.

Sources: PAX LC randomized trial (2025).

RECOVER-VITAL: symptoms at day 90

The August 2026 publication reported no significant primary benefit with either 15 or 25 days in cognitive, autonomic or exercise/PEM phenotypes. For 25 days, adjusted differences in clinically significant improvement were 3.2 percentage points (95% CI −10.4 to 16.8), −6.4 (−18.5 to 5.7) and −7.8 (−19.5 to 3.8), respectively.

Sources: RECOVER-VITAL randomized trial (August 2026).

Reported harms

PAX LC reported drug-related events in 35/46 treated participants versus 27/49 controls, commonly altered taste; no serious events through six weeks. RECOVER-VITAL Table 3 reports any adverse event in 212/323 (25-day), 204/320 (15-day) and 185/320 (placebo–ritonavir). Treatment-related serious events affected one participant per group. These descriptive counts do not establish equivalent safety.

Sources: PAX LC randomized trial (2025); RECOVER-VITAL randomized trial (August 2026).

Trial records and burden

• STOP-PASC (NCT05576662): COMPLETED; registry updated 2025-09-04, checked 2026-10-13. Trial completed; not recruiting. 15 days; primary assessment at 10 weeks. Five clinic visits over 15 weeks. Registry enrolment 168 corresponds to consent and screening in the publication; 155 were randomized. Registry.
• PAX LC (NCT05668091): COMPLETED; registry updated 2024-12-02, checked 2026-10-13. Trial completed; not recruiting. 15 days; primary assessment at day 28. Decentralized US trial with no required site visits. Registry.
• RECOVER-VITAL (NCT05965726): COMPLETED; registry updated 2026-03-27, checked 2026-10-13. Trial completed; not recruiting. 15 or 25 days; primary assessment at day 90. Symptom and performance assessments. Registry.

Limitations

• Results concern the studied regimens and populations; they do not rule out every antiviral strategy or subgroup.
• Full-report review confirms that 31 participants belonged to multiple symptom clusters; the phenotype counts must not be summed as unique people. Table 3 supplies arm-level safety counts. Independent clinical interpretation remains pending.
• Acute treatment and prevention trials are excluded from the Canadian Long COVID treatment recruitment filter.

Canada

Health Canada authorized Paxlovid for acute COVID-19 in people at high risk of severe disease. That does not establish a Long COVID indication or coverage for extended courses. Important drug interactions require clinician/pharmacist review.

Sources: Health Canada: Paxlovid acute-COVID authorization; Health Canada: Paxlovid interactions.

Next evidence check: Monitor corrections and new outcome or harms reports; independent clinical review can be added later.

Low-dose naltrexone (LDN)

Evidence status: Observational findings; randomized results pending.

A small retrospective study reported symptom improvements, but it cannot establish treatment benefit. The Canadian randomized trial is completed with no registry results posted; LIFT also studies LDN.

Retrospective symptom and function changes

Among 59 people with paired questionnaires, LDN use was associated with improvements in fatigue, PEM, sleep and function. Composite symptom scores improved in 32 and worsened in 19. This selected, uncontrolled analysis cannot separate medication effects from other changes.

Sources: Bonilla et al.: retrospective LDN cohort (2023).

Canadian randomized evidence

The BC trial enrolled 160 participants and completed in February 2026. Its primary outcome measures fatigue at 16 weeks. No registry results were posted when checked; completion and the published protocol are not outcome evidence.

Sources: BC low-dose naltrexone trial registry.

LIFT: shared trial with pyridostigmine

One four-arm trial tests LDN, pyridostigmine, their combination and placebo in ME/CFS with orthostatic intolerance, including eligible Long COVID patients. No results posted. The planned 160 participants are shared across the trial. An August 2026 peer-reviewed protocol describes the study design, not treatment results or confirmed current recruitment. An August 2026 peer-reviewed protocol describes the study design, not treatment results or confirmed current recruitment.

Sources: LIFT registry.

Trial records and burden

• BC low-dose naltrexone trial (NCT05430152): COMPLETED; registry updated 2026-03-20, checked 2026-10-13. Trial completed; not recruiting. 16-week trial with fatigue questionnaires and blood measures. Completed. Registry.
• LIFT (NCT06366724): RECRUITING; registry updated 2025-10-22, checked 2026-10-13. Registry says recruiting but was last updated October 2025; estimated September 2026 primary completion has passed. Current availability requires confirmation. Approximately three months, three in-person Boston visits and four virtual visits; two submaximal cardiopulmonary exercise tests, blood and urine collection. Exertional testing can be burdensome with PEM; discuss accommodations and suitability with the study team. 160 total across four arms shared between LDN and pyridostigmine; not 160 per drug. Registry.

Limitations

• Observational findings are vulnerable to selection bias, missing follow-up and confounding.
• LIFT’s population is narrower than Long COVID as a whole.
• Comprehensive comparative harms and formal certainty assessment are pending.

Canada

The BC trial used compounded low-dose capsules and is completed. Routine Canadian access, compounding costs and coverage are unverified. LIFT is based in Boston; Canadian participation is not established.

Sources: BC low-dose naltrexone trial registry; LIFT registry.

Next evidence check: Check for BC trial results and obtain a current LIFT recruitment update; assess randomized harms alongside benefit.

Intravenous immunoglobulin (IVIG)

Evidence status: Small observational signal; randomized results pending.

A small nonrandomized study reported improvement in post-COVID small-fibre neuropathy. RECOVER-AUTONOMIC’s IVIG trial is completed with no posted results. An NIH neurological study enrols by invitation.

Small-fibre neuropathy case-control study

Neuropathic symptom response was reported in 9/9 IVIG-treated patients versus 3/7 untreated patients (p=0.02). This small retrospective, nonrandomized comparison cannot establish efficacy for Long COVID broadly.

Sources: McAlpine et al.: post-COVID small-fibre neuropathy (2024).

RECOVER-AUTONOMIC IVIG

The randomized IVIG appendix enrolled 200 people and completed in June 2026. No results posted when checked. The shared platform’s enrolment totals are not efficacy or usable comparative safety findings.

Sources: RECOVER-AUTONOMIC IVIG registry; RECOVER-AUTONOMIC platform results — enrolment.

NIH neurological trial

The registry lists enrolment by invitation with 45 planned participants and requires prior study participation. It is not an open Canadian recruitment opportunity. No results posted.

Sources: NIH neurological Long COVID IVIG study registry.

Trial records and burden

• RECOVER-AUTONOMIC IVIG (NCT06305793): COMPLETED; registry updated 2026-07-31, checked 2026-10-13. Trial completed; not recruiting. Repeated IV infusions over nine months, followed by three months of follow-up; orthostatic symptoms assessed at nine months. Registry.
• NIH neurological Long COVID IVIG study (NCT05350774): ENROLLING_BY_INVITATION; registry updated 2026-10-13, checked 2026-10-13. No Canadian site listed; cross-border eligibility not established. Invitation-only NIH study requiring prior protocol participation. Procedures include infusion courses, lumbar puncture, tilt testing and neurological assessments; up to four months. Registry.

Limitations

• Biopsy-confirmed small-fibre neuropathy and selected trial populations do not represent all Long COVID.
• An observational response comparison is not a randomized treatment effect.
• Full comparative harms are pending; absent results do not establish safety.

Canada

No Canadian site is listed in these two selected trials. Routine Canadian eligibility, product access and provincial funding for Long COVID are not established in this review.

Sources: RECOVER-AUTONOMIC IVIG registry; NIH neurological Long COVID IVIG study registry.

Next evidence check: Check for RECOVER IVIG results and assess efficacy, adverse events and subgroup applicability together.

Pyridostigmine

Evidence status: Trial listed as recruiting; current availability unconfirmed.

LIFT tests pyridostigmine alone and with LDN in people with ME/CFS and orthostatic intolerance, including qualifying Long COVID patients. No results are posted. Current recruitment needs confirmation.

LIFT factorial trial

The planned 160-person, four-arm trial measures function and exercise-related physiology. It is shared with the LDN entry, not a second independent trial. Registry status says recruiting, but its October 2025 update is old and estimated primary completion has passed. An August 2026 peer-reviewed protocol describes the study design, not treatment results or confirmed current recruitment. An August 2026 peer-reviewed protocol describes the study design, not treatment results or confirmed current recruitment.

Sources: LIFT registry.

Trial records and burden

• LIFT (NCT06366724): RECRUITING; registry updated 2025-10-22, checked 2026-10-13. Registry says recruiting but was last updated October 2025; estimated September 2026 primary completion has passed. Current availability requires confirmation. Approximately three months, three in-person Boston visits and four virtual visits; two submaximal cardiopulmonary exercise tests, blood and urine collection. Exertional testing can be burdensome with PEM; discuss accommodations and suitability with the study team. 160 total across four arms shared between LDN and pyridostigmine; not 160 per drug. Registry.

Limitations

• Trial registration cannot establish benefit.
• Eligibility requires ME/CFS and orthostatic intolerance; applicability to all Long COVID is uncertain.
• Exercise testing and travel may limit participation for people with PEM or severe illness.

Canada

LIFT is based in Boston with no Canadian site listed. Cross-border eligibility, routine Canadian prescribing access and coverage are not verified here.

Sources: LIFT registry.

Next evidence check: Confirm whether LIFT is accepting participants and check for results; count this shared trial once.

Upadacitinib

Evidence status: Canadian sites listed as recruiting; no results posted.

LC-REVITALIZE tests upadacitinib and pirfenidone against matched placebo. Its registry lists recruiting sites in Montreal and Sherbrooke. No results are posted; availability of the upadacitinib arm needs confirmation.

LC-REVITALIZE platform

The initial phase plans 348 participants across two drugs and placebo groups. The primary outcome tracks the worst baseline symptom domain during follow-up; the registry specifies enrolment through month six. This is not an upadacitinib-only sample, and authorization to run a trial is not evidence of benefit.

Sources: LC-REVITALIZE registry; Health Canada: LC-REVITALIZE authorization.

Trial records and burden

• LC-REVITALIZE (NCT06928272): RECRUITING; registry updated 2026-10-06, checked 2026-10-13. Registry lists Canadian sites as recruiting; site and specific drug-arm availability require confirmation. Three months of study medication with follow-up to six months. Confirm eligibility, visits, monitoring and the locally available drug arm with the study team. 348 across upadacitinib, pirfenidone and matched placebo groups in the initial platform phase; not 348 on upadacitinib. Registry.

Limitations

• No randomized efficacy or safety results posted when checked.
• Eligibility criteria and exclusions limit who can participate.
• A recruiting site listing does not guarantee an open local drug arm, eligibility or enrolment.

Canada

Health Canada lists an authorized LC-REVITALIZE trial. ClinicalTrials.gov lists IRCM in Montreal and CRCHUS in Sherbrooke as recruiting (updated 6 October 2026). Confirm the site, eligibility and upadacitinib arm with the study team. Routine Long COVID access and coverage are not established. Recherche Santé Québec also lists these locations as open but identifies ClinicalTrials.gov as its data source; this is not independent site confirmation. Recherche Santé Québec also lists these locations as open but identifies ClinicalTrials.gov as its data source; this is not independent site confirmation.

Sources: LC-REVITALIZE registry; Health Canada: LC-REVITALIZE authorization.

Next evidence check: Confirm Canadian site and drug-arm availability; monitor registry changes and first results.

Data structure and maintenance

The accompanying JSON separates interventions, trial/appendix/platform records, outcome findings, access facts, source records, reproducible searches and a review queue. Unknown values remain explicit. A boolean “has results” is inadequate: the data identifies enrolment-only, efficacy, protocol and investigator-presentation sources.

The browser preview includes all eight summaries, trial status, limitations and sources as static HTML. JavaScript adds filters, text/theme controls and dataset download; content remains readable without it. The pilot is noindexed and does not alter the production navigation.

Expansion follow-up

• Obtain BC LDN and RECOVER IVIG outcomes and harms.
• Confirm current LIFT recruitment and Canadian LC-REVITALIZE drug-arm availability.
• RECOVER-VITAL phenotype overlap and arm-level harms now verified; obtain independent clinical interpretation.

Next actions

Live preview: https://deploy-preview-18--longcovidaction.netlify.app/research-pilot/ . No launch deadline, external contact, recurring automation or production release has been created by this pilot.

Back to the tracker

Review update — 13 October 2026

Full-report source checks now resolve RECOVER-VITAL phenotype overlap and add comparative harms. Recruitment confirmation and independent clinical interpretation remain pending.

RECOVER-VITAL full report · LIFT protocol · Quebec trial listing

Reviewer checklist and remaining actions