COVID-19 clinical trials
Trials that have been completed and published
STOP COVID: Fluvoxamine showed promise in a double-blinded, 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
Overall, 65 persons opted to receive fluvoxamine 50mg twice daily and 48 declined. Incidence of hospitalization was 0% (0/65) with fluvoxamine and 12.5% (6/48) with observation alone. At 14 days, residual symptoms persisted in 0% (0/65) with fluvoxamine and 60% (29/48) with observation.
TOGETHER TRIAL: Repurposed Approved Therapies for Outpatient Treatment of Patients With Early-Onset COVID-19 and Mild Symptoms - Parallel assignment, 4-arm randomized control trial that includes a Fluvoxaminearm.https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00448-4/fulltext
1497 Brazilian adults participated in the study looking at the effect of early treatment with fluvoxamine on the risk of emergency care and hospitalization among patients with COVID-19. They used Bayesian analysis, which showed Bayesian credible interval [95% BCI]: 0·52-0·88), with a probability of Fluvoxamine superiority of 99·8% over placebo in reducing the need for hospitalization.
COVID-OUT TRIAL: Outpatient Treatment for SARS-CoV-2 Infection, a Factorial Randomized Trial, conducted by the University of Minnesota.
The primary outcome measures of hypoxia, ER visits, and hospitalizations in participants who received Fluvoxamine 50mg BID showed no significant benefit. Presented at NIH Grand rounds.
Fluvoxamine in the ICU: Safety and efficacy of fluvoxamine in COVID-19 ICU patients: An open-label, prospective cohort trial with matched controls among 51 ICU COVID-19 patients hospitalized in the University Hospital Dubrava and University Hospital Centre Zagreb, Croatia.
No statistically significant differences between groups were observed regarding the number of days on ventilator support, duration of ICU, or total hospital stay. However, overall mortality was lower in the fluvoxamine group, 58.8% (n = 30/51), than in the control group, 76.5% (n = 39/51), HR 0.58, 95% CI (0.36-0.94, P=.027). It appears fluvoxamine treatment in hospitalised ICU COVID-19 patients could have had a positive effect on mortality. https://bpspubs.onlinelibrary.wiley.com/doi/10.1111/bcp.15126
STOP COVID-2 (NCT04668950): Fluvoxamine for Early Treatment of Covid-19 (Stop Covid 2) - A decentralized, hub-and-spoke clinical trial conducted across the US and two provinces of Canada. The Data Safety Monitoring Board(DSMB) for the study recommended an early stop for futility due to a low case rate and difficulty recruiting patients, and treatment effects were observed.
South Korean trial(NCTO4711863): Fluvoxamine for Adults With Mild to Moderate COVID-19. A randomized, single-blind placebo control study of adult patients with symptomatic COVID-19 admitted to the community treatment center showed no significant differences in clinical deterioration between patients treated with fluvoxamine and placebo. https://icjournal.org/DOIx.php?id=10.3947/ic.2021.0142
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 Moderate SARS-CoV-2 (COVID-19) Infected Patients in Hungary(NCT04718480): A randomized, double-blind, placebo-controlled, adaptive two-stage design, human phase 2 study, with add-on treatment arrangement of fluvoxamine or placebo on top of standard of care, including antiviral and immunomodulant therapy and convalescent plasma therapy in serious cases as indicated by the investigator.
- 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.
- Thailand Study(NCT05087381): Randomized-controlled Trial of the Effectiveness of COVID-19 Early Treatment in Community used biomarkers to evaluate effectiveness. However, the study has been currently discontinued.
Fluvoxamine in NIH CVOID-19 treatment guidelines.
Mechanism of possible benefit?
A review of all the mechanisms of action of Fluvoxamine and its role in COVID-19
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"
- "Repurposing Sigma-1 Receptor Ligands for COVID-19 Therapy?"
Possible mechanisms common with other antidepressants
The Enzyme Hypothesis: Fluvoxamine inhibits acid Sphingomyelinase which is needed for viruses to enter the cell -Targeting the endolysosomal host-SARS-CoV-2 interface by clinically licensed functional inhibitors of acid sphingomyelinase (FIASMA) including the antidepressant fluoxetine. Emerging Microbes and infections vol 9, 2020. https://pubmed.ncbi.nlm.nih.gov/32975484/
Ceramide-door theory: Ceramides, which act as doors to let the virus enter the cells are also inhibited because of inhibition of enzyme Acid Sphingomyelinase by Fluvoxamine. Pharmacological Inhibition of Acid Sphingomyelinase Prevents Uptake of SARS-CoV-2 by Epithelial Cells. Cell Reports Medicine Nov 2020. https://pubmed.ncbi.nlm.nih.gov/33163980/
The Lysosome theory: Fluvoxamine has lysosomotropic properties which inhibit movement and dissemination of virus particles in the lysosome pathway in the cells of the body. Widely available lysosome targeting agents can be considered as potential therapy for COVID-19. International Journal of Antimicrobial Agents. Aug 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275137/
Increasing Melatonin levels in the brain. Fluvoxamine increases nighttime levels of melatonin 2-3 times through its inhibition of the melatonin-metabolizing liver enzymes CYP1A2 and CYP2C19.Fluvoxamine, Melatonin and COVID-19. Psychopharmacology, Jan https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779245/
Modulating endocytic trafficking of SARS-CoV-2 spike protein. https://www.biorxiv.org/content/10.1101/2021.06.15.448391v1
As an antidepressant
An observational study of 7,345 hospitalized COVID-19 patients hinted at possible benefit of prior antidepressant 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.
Other methods of possible benefit
- Kaiser Health News - Scientists Seek Covid Treatment Answers in Cheap, Older Drugs
- 60 Minutes - Finding a possible early treatment for COVID-19 in a 40-year-old antidepressant
- Wired - How a Medication for OCD Ended Up in a Covid-19 Trial
- ScienceNews - The antidepressant fluvoxamine could keep mild COVID-19 from worsening
- Washington Post - Existing drugs could help treat covid-19. How do we know when to use them?
- Inverse.com - A surprising treatment for COVID-19 could be the key to stopping virants
- LA Times: https://www.latimes.com/california/story/2021-02-03/can-common-antidepressant-help-covid-19-fight
- Science News: https://www.sciencenews.org/article/covid-19-coronavirus-antidepressant-fluvoxamine-treatment
- Health Affairs Blog: https://www.healthaffairs.org/do/10.1377/hblog20210208.174907/full/
- Scientific American: https://www.scientificamerican.com/article/these-drugs-might-prevent-severe-covid1/#:~:text=Fluvoxamine%2C%20a%20pill%20used%20for,the%20drug%20experienced%20worsening%20symptoms.
- STAT News: https://www.statnews.com/2020/11/12/pill-fluvoxamine-to-treat-ocd-anxiety-may-prevent-covid-19-from-worsening-preliminary-study-suggests/
- Elemental: https://elemental.medium.com/psychiatric-drugs-could-be-the-key-to-treating-covid-19-cb6d703e2d0f
- CNN: https://www.cnn.com/2021/01/11/health/fluvoxamine-covid-19-treatment-study/index.html
- CNN Health: https://www.cnn.com/2021/02/27/health/covid-19-drug-repurposing-gupta/index.html
- California Healthline- https://californiahealthline.org/news/article/fluvoxamine-antidepressant-covid-treatment-repurposed-drugs-generics/
Notes on side effects & interactions
- "What we know about fluvoxamine for COVID-19 and how to prescribe. Providers thinking about using fluvoxamine will find this information helpful. " - Dr. Eric Lenze, one of the researchers who is running the fluvoxamine trials (above).
- Website dedicated to fluvoxamine & caffeine information.
- COVID-19 therapeutics
- Fluvoxamine with Melatonin: The authors of this article suggest coadministration of Fluvoxamine and Melatonin can be beneficial. Fluvoxamine, Melatonin and COVID-19. Psychopharmacology, Jan 2021 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779245/
- Repurposing of psychiatric drugs: "What Were You Before the War?" Repurposing Psychiatry During the COVID-19 Pandemic https://pubmed.ncbi.nlm.nih.gov/32271506/
- TOGETHER Trial is one of the largest randomized clinical trials in the world evaluating the effectiveness of repurposed drugs, such as ivermectin, fluvoxamine in the early treatment of COVID-19. https://www.halifaxexaminer.ca/featured/whats-the-deal-with-ivermectin-and-covid/