Antidepressant Fluvoxamine May Reduce Risk of Hospitalization for COVID-19 Patients

Since the start of the pandemic, scientists have scoured a catalog of dozens of drugs in an attempt to find one that could have an effect against COVID-19 infections. These investigations have ended in large part in frustration. The only drug approved by the FDA to treat patients with COVID-19 to date is remdesivir. Most of the others have shown little or no efficacy and have fallen back into pharmaceutical obscurity. Others, like hydroxychloroquine and ivermectin, have found support among anti-vaccines and the far right, despite very alarming safety records.

But remdesivir may soon have company. A new clinical trial shows that fluvoxamine, typically prescribed to treat depression, anxiety, and obsessive-compulsive disorder, has shortened hospital stays for people with severe COVID infections.

The results, Posted in The Lancet Wednesday, could be a huge breakthrough in saving patients’ lives and shortening recovery from COVID, not least because fluvoxamine is incredibly cheap and can be administered orally.

“Scientifically and medically, I believe this treatment should now be considered a serious therapeutic option to reduce the risk of hospitalization and death in patients with COVID, especially in low-resource countries that have no ‘other means to deal with the pandemic, “Nicolas Hoertel, a psychiatrist at the University of Paris who was not involved in the study, told The Daily Beast. “This treatment is safe, well tolerated, inexpensive, easy to use and with a high level of evidence of high efficacy. It could be a game-changer with vaccines. “

Fluvoxamine was first introduced to the world in 1983 and has been approved by the FDA since 1994. It is a selective serotonin reuptake inhibitor, or SSRI. Unlike remdesivir, it does not have obvious antiviral properties. Edward Mills, co-author of the new study based at McMaster University in Canada, told The Daily Beast that the effects are probably anti-inflammatory.

This is the key, because in many severe cases of COVID, it is not the virus that kills – it is the body’s own immune response that hyperdrives and unleashes itself on healthy cells and tissues, to an incredibly fast pace.

To see if fluvoxamine could alleviate this storm of inflammation, Mills and his colleagues first tested it in a small clinical trial last year and found that fluvoxamine appeared to prevent severe progression of COVID when patients were treated early. These results were published in JAMA in November 2020. A parallel study by Hoertel and other French researchers also found that hospitalized COVID patients prescribed fluvoxamine had a lower risk of being intubated or dying.

This led to the selection of fluvoxamine for the TOGETHER trial, the largest double-blind randomized clinical trial to date to study the efficacy of eight pre-existing drugs against COVID-19. The fluvoxamine arm of the trial began in January 2021 and involved administering the drug to 741 COVID-positive Brazilian adults who were not vaccinated and were considered at high risk for serious infection. Another 756 COVID-positive participants received a placebo.

Participants treated with fluvoxamine were 32 percent less likely to require more than six days of hospitalization than their placebo counterparts, and saw an overall 5 percent reduction in the risk of prolonged hospitalization. Among the patients who took at least 80 percent of their drug doses, there was only one death in the fluvoxamine group, compared to 12 in the placebo group.

David Boulware, an infectious disease specialist at the University of Minnesota who was not involved in the new study, told The Daily Beast he “absolutely” believes we could see the drug playing a serious role against COVID almost at once.

“This is an existing FDA approved drug that is available in probably all US drug stores and is available worldwide,” he said. The cost for a 10-day course of treatment is around $ 10, ”well below the cost of current COVID treatments like monoclonal antibodies. Although less effective, Boulware believes that fluvoxamine can be used as a complementary treatment to further improve results.

Boulware raises the question of dosage: in the TOGETHER trial, about 25% could not tolerate 100 milligrams per day of fluvoxamine, and 15% could not tolerate the placebo (probably because they were just sick with the COVID). A dose of 50 milligrams is being studied in two US trials, and he believes it may have a better overall effect for patients.

The findings could also encourage health experts to enlist other SSRIs to fight COVID. Not all of them work with the same biochemistry as fluvoxamine, but one called fluoxetine is actually quite similar. Some first studies led by Hoertel were encouraging. And unlike fluvoxamine, fluoxetine is already on the World Health Organization’s Model List of Essential Medicines.

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