Fluvoxamine for COVID-19

philipn authored on Feb. 1, 2021, 3:03 p.m.

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The skeletal formula of fluvoxamine. Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) which is being trialed for possible therapeutic use in COVID-19. Fluvoxamine showed promise in a randomized, placebo-controlled trial of 152 COVID-19 positive outpatients. In a paper published in November, 2020 in the Journal of the American Medical Association: Clinical deterioration occurred in 0 of 80 patients in the fluvoxamine group and in 6 of 72 patients in the placebo group (absolute difference, 8.7% [95% CI, 1.8%-16.4%] from survival analysis; log-rank P = .009). The fluvoxamine group had 1 serious adverse event and 11 other adverse events, whereas the placebo group had 6 serious adverse events and 12 other adverse events. -JAMA Fluoxetine has also shown anti-SARS-CoV-2 activity in vitro in Vero and Calu-3 cells. Mechanism of possible benefit? Sigma-1 receptor Mechanisms of potential benefit in COVID-19 may include sigma-1 receptor agonism. See "Fluvoxamine alleviates ER stress via induction of Sigma-1 receptor" and "Modulation of the sigma-1 receptor–IRE1 pathway is beneficial in preclinical models of inflammation and sepsis". "Repurposing of CNS drugs to treat COVID-19 infection: targeting the sigma-1 receptor" As SSRI An observational study of 7,345 hospitalized COVID-19 patients hinted at possible benefit of prior SSRI usage. As an anti-viral In an October, 2020 preprint, fluoxetine showed in vitro anti-SARS-CoV-2 activity in Vero and Calu-3 cells. News coverage Wired - How a Medication for OCD Ended Up in a Covid-19 Trial See also COVID-19 therapeutics	The skeletal formula of fluvoxamine. Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) which is being trialed for possible therapeutic use in COVID-19. COVID-19 clinical trials Fluvoxamine showed promise in a randomized, placebo-controlled trial of 152 COVID-19 positive outpatients. In a paper published in November, 2020 in the Journal of the American Medical Association: Clinical deterioration occurred in 0 of 80 patients in the fluvoxamine group and in 6 of 72 patients in the placebo group (absolute difference, 8.7% [95% CI, 1.8%-16.4%] from survival analysis; log-rank P = .009). The fluvoxamine group had 1 serious adverse event and 11 other adverse events, whereas the placebo group had 6 serious adverse events and 12 other adverse events. -JAMA Trials in progress Fluvoxamine Administration in Moderate SARS-CoV-2 (COVID-19) Infected Patients - Randomized, double-blind, placebo-controlled trial in 100 moderate COVID-19 hospitalized patients Fluvoxamine for Early Treatment of Covid-19 (Stop Covid 2) - An expansion of the smaller contactless (telemedicine) randomized control trial above to 1100 participants. Early treatment, outpatient. Fluvoxamine for Adults With Mild to Moderate COVID-19 - Randomized control trial of 400 patients admitted to community treatment centers in South Korea. Mild to moderate symptoms. Repurposed Approved Therapies for Outpatient Treatment of Patients With Early-Onset COVID-19 and Mild Symptoms - Parallel assigment, 4-arm randomized control trial that includes a Fluvoxamine arm. Early treatment, outpatient. 2724 participants total across 4 arms. Mechanism of possible benefit? Sigma-1 receptor Mechanisms of potential benefit in COVID-19 may include sigma-1 receptor agonism. See "Fluvoxamine alleviates ER stress via induction of Sigma-1 receptor" and "Modulation of the sigma-1 receptor–IRE1 pathway is beneficial in preclinical models of inflammation and sepsis". "Repurposing of CNS drugs to treat COVID-19 infection: targeting the sigma-1 receptor" As SSRI An observational study of 7,345 hospitalized COVID-19 patients hinted at possible benefit of prior SSRI usage. As an anti-viral In an October, 2020 preprint, fluoxetine, a related SSRI, showed in vitro anti-SARS-CoV-2 activity in Vero and Calu-3 cells. News coverage Wired - How a Medication for OCD Ended Up in a Covid-19 Trial See also COVID-19 therapeutics

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Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) which is being trialed for possible therapeutic use in COVID-19.

Fluvoxamine showed promise in a randomized, placebo-controlled trial of 152 COVID-19 positive outpatients. In a paper published in November, 2020 in the Journal of the American Medical Association:

Clinical deterioration occurred in 0 of 80 patients in the fluvoxamine group and in 6 of 72 patients in the placebo group (absolute difference, 8.7% [95% CI, 1.8%-16.4%] from survival analysis; log-rank P = .009). The fluvoxamine group had 1 serious adverse event and 11 other adverse events, whereas the placebo group had 6 serious adverse events and 12 other adverse events. -JAMA

Fluoxetine has also shown anti-SARS-CoV-2 activity in vitro in Vero and Calu-3 cells.

Mechanism of possible benefit?

COVID-19 clinical trials

Fluvoxamine showed promise in a randomized, placebo-controlled trial of 152 COVID-19 positive outpatients. In a paper published in November, 2020 in the Journal of the American Medical Association:

Clinical deterioration occurred in 0 of 80 patients in the fluvoxamine group and in 6 of 72 patients in the placebo group (absolute difference, 8.7% [95% CI, 1.8%-16.4%] from survival analysis; log-rank P = .009). The fluvoxamine group had 1 serious adverse event and 11 other adverse events, whereas the placebo group had 6 serious adverse events and 12 other adverse events. -JAMA

Trials in progress

Fluvoxamine Administration in Moderate SARS-CoV-2 (COVID-19) Infected Patients - Randomized, double-blind, placebo-controlled trial in 100 moderate COVID-19 hospitalized patients
Fluvoxamine for Early Treatment of Covid-19 (Stop Covid 2) - An expansion of the smaller contactless (telemedicine) randomized control trial above to 1100 participants. Early treatment, outpatient.
Fluvoxamine for Adults With Mild to Moderate COVID-19 - Randomized control trial of 400 patients admitted to community treatment centers in South Korea. Mild to moderate symptoms.
Repurposed Approved Therapies for Outpatient Treatment of Patients With Early-Onset COVID-19 and Mild Symptoms - Parallel assigment, 4-arm randomized control trial that includes a Fluvoxamine arm. Early treatment, outpatient. 2724 participants total across 4 arms.