The antidepressant fluvoxamine may prevent exacerbation of COVID-19 infection

The findings by UVA researchers Dorian A. Rosen and Alban Gaultier have led to recent clinical trials that found that antidepressants may stop exacerbating COVID symptoms.Credit: Photo by Dan Addison, Faculty of Communication Studies, University of Virginia

The antidepressant fluvoxamine seems to prevent COVID-19 (new coronavirus infection) (# If there is no character limit, add parentheses when it first appears Studies based on studies at the University of Virginia School of Medicine suggest that it may help prevent the infection from getting worse and keep patients away from the hospital.

A clinical trial conducted by Washington University in St. Louis School of Medicine compared fluvoxamine with placebo in 152 adult outpatients infected with the coronavirus. None of the participants who received fluvoxamine saw “clinical deterioration” after 15 days, but 6 patients who received placebo did. Of those six, four were hospitalized for a period ranging from 4 to 21 days. One had been on a ventilator for 10 days.

Although the size of the study was small, the researchers stated that the results were statistically significant and that fluvoxamine needed further study as a treatment for COVID-19. They plan to launch larger trials in the coming weeks.

“Patients who took fluvoxamine did not develop severe dyspnea or require hospitalization due to lung function problems,” said Eric J. Renze, a doctor of medicine at the University of Washington School of Medicine. .. “Most clinical trial treatments for COVID-19 are aimed at very ill patients, but treatments that prevent them from getting sick enough to require oxygenation or to go to the hospital. It’s also important to find out. Our research suggests that fluboxamine may help fill that niche. “

Fluvoxamine and COVID-19

Researchers at the University of Washington have begun a randomized, double-blind study based on the findings of UVA’s Dr. Alban Vaultier and former graduate student Dr. Dorian A Rosen. Last year, Gaultier and Rosen discovered that fluvoxamine could stop a deadly inflammation known as sepsis. In sepsis, the immune response becomes uncontrollable. The drug they determined reduced the production of cytokines associated with a potentially deadly “cytokine storm,” which is thought to occur in severe cases of COVID-19.

That relationship has led a team at the University of Washington to investigate the potential benefits of fluvoxamine in protecting patients with COVID-19. Perhaps they thought the drug might help prevent an immune system overreaction caused by this strange new coronavirus. And their work suggests that it may be.

“It makes a lot of sense for us to test fluvoxamine in clinical trials because elevated cytokine levels are associated with the severity of COVID-19,” said UVA’s Department of Neuroscience and its brain immunology. Gaultier of the Academic and Glia Center (BIG) said. “The mechanism of action of fluvoxamine is still unknown. SARS-CoV-2However, research is underway to find the answer. “

A team at the University of Washington pointed out that a recent study raises questions about whether cytokines really play a key role in the death of COVID-19. If not, researchers say fluvoxamine may have beneficial effects by other mechanisms that are not yet understood.

“There are several ways this drug may work to help patients with COVID-19, but we say it may interact with the Sigma-1 receptor to reduce the production of inflammatory molecules. I think, “said Angela M. Liarsen, MD, MD, University of Washington. “Past studies have shown that fluvoxamine can reduce inflammation in animal models of sepsis, which may be the same in our patients.”

Researchers emphasized that their research has some limitations. In addition to its small size, other factors hindered the trial, including 20% ​​of participants stopped responding to the survey during the 15-day trial. (Researchers have determined that none of these participants require hospitalization or visits to the emergency department, but denying that participants sought treatment elsewhere, such as in an emergency clinic. I could not do it.)

Due to these limitations, researchers should treat the results of the study as a promising indicator that the drug requires further testing, not as a measure of the efficacy of fluvoxamine against COVID-19. It states that there is.

“If results are confirmed in a larger clinical trial (Phase III), fluvoxamine will be the perfect treatment for newly diagnosed COVID patients,” Gaultier said. “Fluvoxamine is not an drug. It is cheap, safe and could be used as the first line of defense to avoid burdening hospitals overwhelmed by the COVID health crisis.”

Researchers make their discoveries Journal of American Medical Association.. The Washington University team includes Lenze, Caline Mattar, Charles F. Zorumski, Angela Stevens, Julie Schweiger, Ginger E. Nicol, and J. It consisted of PhilipMiller, Lei Yang, Michael Yingling, Michael S. Avidan and Reiersen. A list of author disclosures is included in the paper.

See: “Fluvoxamine vs. Placebo and Clinical Exacerbations in Outpatients with Symptomatological COVID-19”, Eric J. Lenze, MD; Caline Mattar, MD; Charles F. Zorumski, MD; Angela Stevens, BA; Julie Schweiger; Ginger E. Nicole, MD; J. Philip Miller, AB; Layeran, MPH, MSIS; Michael Yingling, MS; Michael S. Avidan, MBBCh and Angela M. Reiersen, MD, MPE, November 12, 2020, Journal of American Medical Association..
DOI: 10.1001 / jama.2020.22760

The clinical trial was supported by the Taylor Family Institute for Innovative Psychiatric Treatment at the University of Washington and the COVID-19 Early Treatment Fund. Additional support was provided by the University of Washington Center for Mood Disorder Brain Research, Bantry Foundation, and National Institutes of Health grant UL1TR002345.