Early research suggests that fluvoxamine, an FDA approved medication for depression and obsessive compulsive disorder, can be an effective early treatment for COVID-19. Fluvoxamine, created 37 years ago, is an inexpensive and widely available generic drug. It's in a class of drugs called Selective Serotonin-Reuptake Inhibitors (SSRIs). SSRIs appear to activate a central nervous system protein that plays a role in regulating inflammatory responses. Small clinical and observational studies show that repurposing fluvoxamine to treat coronavirus prevents some of the most serious complications related to inflammation, and keeps people from hospitalization.
Serendipity and Science
In March, as the coronavirus began to devastate the world, Dr. Nicolas Hoertel, associate professor of psychiatry at Paris University and a psychiatrist at a hospital in Paris, noticed that far fewer of his patients had symptomatic COVID-19 than did the caregivers in the unit. After consulting with other hospital employees around Paris, Dr. Hoertel and his colleagues published a large COVID-19 and the drug with the greatest sigma-1 activation in the study (fluoxetine in that case) had the greatest protection. The study states that antidepressants “could be associated with lower risk of death or intubation in hospitalized patients with COVID-19.”
Read: Association between SSRI Antidepressant Use and Reduced Risk of Intubation or Death in Hospitalized Patients with Coronavirus Disease 2019: a Multicenter Retrospective Observational Study
At the same time, Angela Reiersen, a psychiatrist at Washington University in St. Louis was exploring a similar theory. Recalling research published in 2019 suggesting fluvoxamine reduced damaging aspects of the inflammatory response during sepsis, Dr. Reiersen wondered if the drug could have similar effects on Covid-19 patients. She teamed up with colleague Dr. Eric Lenze and developed a study design.
With support from CETF, a randomized, double-blind and fully remote outpatient clinical trial was conducted. The trial included 152 people, all of whom were 18 years or older, symptomatic, and diagnosed with mild forms of COVID-19. Participants were randomly assigned (1:1) to take either Fluvoxamine or a placebo. In this trial, of the 80 participants who received the drug, no patients hit the endpoint of clinical deterioration (defined as reaching blood oxygen saturation level of less than 92% and shortness of breath requiring supplemental oxygen), versus 6 people out of 72 who got the placebo and did reach the clinical endpoint.
In summary, all fluvoxamine-treated patients did not meet the study endpoint. The study appeared as the lead story in JAMA on November 12, 2020. The Editors noted that they chose this study from more than 10,000 COVID submissions received since February 2020. The study was the third-most popular article on JAMA for the month of December 2020.
