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October 31, 2026
Marianne Waldenfels
A new German study involving 323 post-COVID patients investigated whether a medication that has been used for decades can relieve severe fatigue. The findings could help advance the search for a targeted treatment.
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For people with post-COVID, even a trip to the shops, a longer conversation, or a few minutes of physical activity can push them to their limits. The exhaustion can be so severe that even simple everyday tasks become almost impossible. Yet there is still no medication proven to reliably relieve it.
Now, researchers at the university hospitals of Würzburg, Tübingen, and Kiel have investigated whether a familiar, inexpensive drug that has been used for decades could help: prednisolone, a corticosteroid. The study involved 323 adults with post-COVID. Published on October 24, 2026, in the journal eClinicalMedicine, the findings offer new insights into the treatment of post-COVID fatigue — while raising important questions about what constitutes a meaningful improvement.
The so-called PreVitaCOV study was led by Prof. Ildikó Gágyor from the Institute of General Practice at Würzburg University Hospital. The approach was deliberately practice-oriented: "People with post-COVID come to us first at the general practice. That's why it was important to us to test a therapy right where patients are being treated — using medications that have been around for decades, are affordable, and are readily available," explains Gágyor in a statement from the University of Würzburg.
A total of 323 adults participated, the majority of whom were women. Their confirmed COVID-19 infection was at least twelve weeks in the past, and they continued to suffer from typical post-COVID symptoms. Participants were recruited through general practices and treated at the three study centers. They were randomly assigned to one of four groups and received the following for 28 days:
Neither the participants nor the study team knew who was receiving which treatment. The rationale: cortisone has anti-inflammatory properties and could suppress persistent inflammatory processes that are thought to be a possible cause of post-COVID. B vitamins were investigated because of their importance to the nervous system.
The study measured how much symptoms changed across five areas: fatigue, shortness of breath, cognitive function and concentration, anxiety, and depression .
After four weeks, participants who had received prednisolone reported a statistically significantly greater reduction in symptoms than those who had not received cortisone. The difference was most pronounced for fatigue — the pathological exhaustion that many of those affected find particularly debilitating.
For B vitamins, on the other hand, no notable benefit could be demonstrated. Those taking vitamin B supplements in the hope of a boost in energy will find no support for this in the study. All medications tested were similarly well tolerated across the groups.
However, prednisolone's advantage fell well short of what would have been required for a clinically meaningful improvement. Furthermore, it disappeared once the medication was stopped.
"A recommendation for the widespread use of prednisolone cannot be derived from our study — the effect is too small for that, and it disappeared again after stopping," said Prof. Hanna Kaduszkiewicz from the University Medical Center Schleswig-Holstein in Kiel.
This is where the crucial distinction lies between a statistical result and a genuine treatment success. "Statistically significant" means that an observed difference is unlikely to be due to chance alone, according to the statistical criteria applied. Whether it is large enough to meaningfully improve the daily lives of those affected is an entirely separate question.
For precisely this reason, the researchers had established a benchmark in advance. Symptoms were recorded using a standardized questionnaire system called PROMIS. A medication was to be considered clinically meaningful if it improved the overall score by at least three points more than the placebo.
Prednisolone fell short of this threshold. Whether those affected would actually perceive the change as noticeable relief therefore remains unclear.
The short treatment duration of four weeks adds another limitation. For people who have been suffering from post-COVID for months or years, an effective therapy would need to offer benefits that extend beyond the period of use, or that can at least be safely sustained over the longer term.
PreVitaCOV is not the only recent study to have tested cortisone in post-COVID. In July 2026, the results of the MYOFLAME-19 study — led by Prof. Valentina Puntmann and Prof. Eike Nagel of Goethe University Frankfurt — were published in Nature Communications .
The study examined 279 post-COVID patients with confirmed mild inflammation of the heart. Participants received either the blood pressure medication losartan combined with low-dose prednisolone, or a placebo, for 16 weeks.
Here too, the results were modest: the primary endpoint — an improvement in cardiac pump function — narrowly missed statistical significance. For fatigue, there was a trend in favor of the treatment, but this also failed to reach statistical significance. The authors explicitly regard their findings as a foundation for further studies. MYOFLAME-19 was co-funded by the pharmaceutical company Bayer.
The two studies examined different patient groups and treatment approaches. Nevertheless, neither has so far provided convincing evidence that cortisone is an effective standard treatment for post-COVID. Whether certain subgroups might benefit more remains an open question.
Prednisolone is available by prescription only, and for good reason. Depending on the dose and duration of use, cortisone can, among other things, raise blood sugar and blood pressure, disrupt sleep, affect mood, and increase susceptibility to infections. With longer-term use, additional risks emerge, including effects on bone health.
The study authors themselves stress that any potential benefit must be weighed against the side effects of longer-term treatment. People suffering from post-COVID should therefore not take prednisolone on their own initiative, but should discuss a possible course of treatment with their general practitioner or a post-COVID outpatient clinic.
As long as an effective drug therapy is lacking, professional medical societies primarily recommend adapted energy management, known as pacing. The goal is to distribute physical and mental activities in a way that avoids exceeding the individual's exertion threshold as much as possible.
This is especially important for people with post-exertional malaise (PEM), in whom symptoms can worsen significantly after exertion. The German S1 guideline on Long/Post-COVID therefore recommends activity levels tailored to the individual's symptoms. An increase in activity is only appropriate if it does not trigger a worsening.
Whether a targeted treatment can be developed from these findings remains to be seen. For people whose daily lives have been dominated by severe fatigue for months or years, even a noticeable improvement would represent a major step forward. This new study shows that cortisone cannot yet fulfill that hope. It could, however, help identify which patients might benefit from an anti-inflammatory approach.
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