Fineberg, David, Moreau, Alain, Schneider-Futschik, Elena K et al. · ACS pharmacology & translational science · 2025 · DOI
This article explores whether metformin, a common diabetes medication, might help treat ME/CFS and Long COVID by fixing problems with how cells make energy and controlling inflammation. The authors explain that metformin could work by reducing harmful molecules in cells, improving how the body uses energy, and calming down overactive immune responses. However, they stress that metformin would likely work best as part of a combination treatment rather than as a single cure.
This review is important because it proposes a mechanistic rationale for repurposing an affordable, well-tolerated existing medication for ME/CFS and Long COVID—conditions that currently lack disease-modifying treatments. If metformin's proposed mechanisms are validated in clinical trials, it could offer symptomatic and functional benefit to millions of patients, particularly given its existing safety profile in other populations.
This is a perspective review, not a clinical trial, so it does not provide evidence that metformin actually improves symptoms or function in ME/CFS or Long COVID patients. The proposed mechanisms are theoretically plausible but remain untested in this population, and the review does not establish whether metformin's benefits would outweigh potential risks or drug interactions in practice. No patient data or efficacy outcomes are presented.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Fineberg, David, Moreau, Alain, Schneider-Futschik, Elena K, & Armstrong, Christopher W (2025). A Perspective on the Role of Metformin in Treating Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Long COVID.. ACS pharmacology & translational science. https://doi.org/10.1021/acsptsci.5c00229
BibTeX
@article{mecfsatlas-fineberg-2025-perspective-role,
author = {Fineberg, David and Moreau, Alain and Schneider-Futschik, Elena K and Armstrong, Christopher W},
title = {A Perspective on the Role of Metformin in Treating Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Long COVID.},
journal = {ACS pharmacology & translational science},
year = {2025},
doi = {10.1021/acsptsci.5c00229},
note = {PubMed: 41189723},
url = {https://www.mecfsatlas.com/evidence/fineberg-2025-perspective-role},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-25. https://www.mecfsatlas.com/evidence/fineberg-2025-perspective-role
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