An antidepressant drug, fluvoxamine, in high-risk outpatients with early diagnosed Covid-19 may reduce the risk of needing prolonged hospital observation and hospitalization. This is what emerges from a study whose results are published in ‘The Lancet Global Health’, the largest conducted so far on this molecule.
From the Together study – a randomized trial that investigates the efficacy of repurposed treatments for Covid-19 among Brazilian high-risk adult outpatients – it emerges that, of the 741 participants who were treated with fluvoxamine in an emergency setting for Covid, 79 requested medical treatment for more than 6 hours or were hospitalized, compared with 119 of the 756 participants who received placebo. The results, the experts explain, represent “an important step” in understanding the role of fluvoxamine as a treatment for outpatients with Covid and in the search for affordable, widely available and effective therapies against the disease.
“Recent developments and vaccination campaigns have proved important in reducing the number of new symptomatic cases, hospitalizations and deaths due to Covid. However – notes Edward Mills of McMaster University, principal co-researcher of the work – the disease still represents a risk to people in countries with limited resources and limited access to vaccinations. Identifying inexpensive, widely available and effective therapies is therefore of great importance, and it is of particular interest to reuse existing drugs that are widely available and have well-understood safety profiles “. Fluvoxamine is a selective serotonin reuptake inhibitor (Ssri), currently used to treat mental health conditions such as depression and obsessive-compulsive disorders. It was chosen for its anti-inflammatory properties. According to Angela Reiersen, a psychiatric associate at Washington University in St. Louis and co-author, “fluvoxamine can reduce the production of inflammatory molecules called cytokines, which can be triggered by Sars-CoV-2 infection.”
The Together study evaluates the effectiveness of 8 repurposed treatments for Covid on high-risk adult outpatients. The trial started in June 2020, the fluvoxamine arm in January 2021, and a cohort of symptomatic Brazilian adults who tested positive for the Covid test, unvaccinated and with at least one additional criterion for high risk was recruited. A quota of 741 participants received 100 milligrams of fluvoxamine 2 times a day for 10 days and 756 received a placebo. Patients were observed for 28 days after treatment.
Among those who received fluvoxamine, 79 needed an extended stay for more than 6 hours in an emergency setting or hospitalization, compared to 119 in the placebo group. These results demonstrated an absolute reduction in the risk of prolonged hospitalization / emergency care extension of 5%, with a relative risk reduction of 32%. Although mortality was not a primary outcome of the study, in a secondary “per protocol” analysis of patients who took at least 80% of the drug doses, one death occurred in the fluvoxamine group, compared with 12 in the group. placebo.
“Our results are consistent with previous and smaller studies – comments Gilmar Reis, principal co-investigator of the study – Given the safety, tolerability, ease of use, low cost and widespread availability of fluvoxamine, these results may have an important influence on national and international guidelines on the clinical management of Covid-19 “.