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The antidepressant Fluvoxamine may prevent COVID-19 infection from worsening

Dorian Rosen and Alban Gaultier

A discovery by UVA researchers Dorian A. Rosen and Alban Gaultier led to a recent clinical trial that found that antidepressants may prevent COVID symptoms from worsening. Credit: Dan Addison Images, Virginia Communications University

The antidepressant fluvoxamine seems to prevent this from happening Covid-19 A trial based on research from the University of Virginia School of Medicine indicates that the infection may get worse and may help keep patients out of hospital.

A clinical trial conducted by Washington University School of Medicine in St. Louis compared fluvoxamine with a placebo in 152 adult outpatients with coronavirus. None of the participants who received fluvoxamine experienced “clinical deterioration” after 15 days, while six patients who received placebo did not notice. Of these six, four were hospitalized for periods ranging from four to 21 days. One of them remained on the ventilator for 10 days.

While the study size was small, the researchers say the results are statistically significant and that fluvoxamine requires further study as a treatment for COVID-19. They are planning to launch a bigger trial in the next few weeks.

“The patients who took fluvoxamine did not have severe breathing difficulties or required hospitalization for problems with lung function,” said Eric Linz, managing director of the University of Washington School of Medicine. Most of the research treatments for COVID-19 are aimed at patients most at risk of disease, but it is also important to find treatments that prevent patients from getting sick enough that they require additional oxygen or having to go to the hospital. Our study suggests that fluvoxamine may help fill this place. “

Fluvoxamine and COVID-19

University of Washington researchers launched a randomized, double-blind trial based on the discovery of UVA PhD, Alban Gaultier, and former graduate student Dorian Rosen. Gaultier and Rosen last year found that fluvoxamine might stop a deadly infection known as sepsis, in which the immune response gets out of control. They found that the drug reduced the production of cytokines, which have been linked to the deadly “cytokine storms” that are thought to occur in severe cases of COVID-19.

This association prompted the University of Washington team to investigate the possibility that fluvoxamine might have a protective effect in patients with COVID-19. They might have thought the drug could help prevent the immune system overreacts caused by this strange new coronavirus. And their work indicates that this may happen.

“Because elevated cytokine levels are associated with COVID-19 severity, testing fluvoxamine in a clinical trial made a lot of sense for us,” said Gaultier, from the Department of Neuroscience at UVA and its Center for Brain Immunology and Glia (BIG). “We are still unclear about how fluvoxamine works against SARS-CoV-2But research is underway to find the answer. “

The University of Washington team noted that recent research has raised questions about whether cytokines really play important roles in COVID-19 deaths. If not, the researchers say, fluvoxamine may have beneficial effects through another mechanism not yet understood.

“There are several ways in which this drug could work to help patients with COVID-19, but we think it likely may interact with the Sigma 1 receptor to reduce the production of inflammatory molecules,” said Angela M. Rersen of the University of Washington. “Previous research has demonstrated that fluvoxamine could reduce inflammation in animal models of sepsis, and may do something similar for our patients.”

The researchers stressed that there were several limitations to their research. In addition to its small size, the experiment was hampered by other factors, including that 20% of participants stopped answering surveys during the 15-day experiment. (The researchers determined that none of these participants requested hospitalization or emergency department visits, but they did not rule out that the participants sought treatment elsewhere, such as an urgent care clinic.)

Because of these limitations, the researchers say the trial results should not be treated as a measure of fluvoxamine’s effectiveness against COVID-19 but as an encouraging indication that the drug requires more testing.

“If a larger clinical trial (phase III) confirms the results, fluvoxamine would be an ideal treatment for newly diagnosed Covid patients,” Gautier said. “Fluvoxamine is not an experimental drug, it is cheap, safe and could be available as a first line of defense to empty hospitals overwhelmed by the COVID health crisis.”

The researchers published their findings in Journal of the American Medical Association. The University of Washington team consisted of Linzi, Calin Matar, Charles F. Zoromsky, Angela Stevens, Julie Schweiger, Ginger E. Nicole, J Philip Miller, Lee Yang, Michael Yingling, Michael S. Avidan and Resen. A list of the authors’ disclosures is included in the paper.

Reference: “Fluvoxamine versus placebo and clinical decline in outpatients with symptoms of COVID-19” by Eric J. Lenze, MD; Calin Matar, MD; Charles F Zuromsky, MD; Angela Stevens, BA; Julie Schweiger Ginger E Nicole, MD; Philip Miller, AB; Li Yang, MPH, MSIS; Michael Yingling, MS; Michael S Avidan, MBBCh and Angela M. Reiersen, MD, MPE, 12 November 2020, Journal of the American Medical Association.
DOI: 10.1001 / collector.2020.22760

The clinical trial was supported by the University of Washington’s Taylor Family Institute for Innovative Psychotherapy and the COVID-19 Early Treatment Fund. Additional support was provided by the University of Washington Center for Brain Research in Mood Disorders, and the Bantly Foundation and NIH grant UL1TR002345.



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