In small study, antidepressant prevents clinical deterioration in patients with COVID-19
Use of the antidepressant fluvoxamine in patients with COVID-19 was associated with a slightly lower likelihood of clinical deterioration over 15 days in a small study, according to results published in JAMA.
“Fluvoxamine is a safe, widely available medication which is inexpensive and easy to use,” Eric Lenze, MD, professor of psychiatry at Washington University School of Medicine, told Healio. “If it prevents deterioration in COVID-19, patients who develop symptoms and test positive could take this medicine and reduce their risk for developing shortness of breath and hypoxia — signs of lung injury that frequently lead to hospitalization.”
Lenze and colleagues conducted a double-blind, randomized, contactless clinical trial to determine the effects of fluvoxamine vs. a placebo among 152 outpatients with COVID-19. The primary outcome was clinical deterioration within 15 days of randomization. The researchers defined clinical deterioration as shortness of breath or hospitalization for shortness of breath or pneumonia and an oxygen saturation below 92% or the need for supplemental oxygen to reach a saturation of 92% or higher.
They included patients who were not hospitalized and living in the community with onset of COVID-19 symptoms within 7 days and an oxygen saturation level of 92% or higher. All participants were from the St. Louis area and were recruited between April 10, 2020, and Aug. 5, 2020.
A total of 80 participants received 100 mg of fluvoxamine and 72 received placebo three times a day for 15 days. None of the patients in the treatment arm showed clinical deterioration, compared with six patients in the placebo arm.
“Fluvoxamine prevented deterioration but did not reduce symptoms more quickly than placebo. We're not sure why not. Perhaps the symptoms of COVID-19 are so heterogeneous that it's hard to use them as an outcome,” Lenze said.
In terms of how an antidepressant would benefit patients with COVID-19, the researchers said a “potential mechanism for immune modulation is sigma-1 receptor (S1R) agonism.”
“If fluvoxamine is determined to be effective in treating COVID-19, the underlying mechanism needs further clarification,” they wrote. “The study was prompted by a hypothesis involving the influence of fluvoxamine on the S1R-[inositol-requiring enzyme 1-sigma] pathway. Anti-inflammatory (cytokine reduction) actions resulting from S1R activation would fit with recent findings of benefits of other anti-inflammatory drugs, such as colchicine and corticosteroids, for COVID-19.”
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