Early Treatment With Fluvoxamine May Reduce Severe COVID-19 Outcomes: Review
Early treatment with higher doses of the SSRI fluvoxamine may reduce COVID-19 clinical deterioration, mortality, and long-COVID complications.
An antidepressant commonly used to treat obsessive-compulsive disorder (OCD) may significantly reduce the risk of clinical deterioration in COVID-19 patients, according to new research published in Scientific Reports.
The authors defined clinical deterioration as needing hospitalization after testing positive for COVID. About 7 percent of patients who took fluvoxamine needed hospitalization after testing positive for COVID-19, whereas about 19 percent of those who did not take fluvoxamine required hospitalization, the authors found.
Eight of the studies analyzed were placebo-controlled and used proper blinding methods. The STOP COVID trial was among the first to explore repurposing fluvoxamine for COVID-19. In this trial, 80 patients received 300 milligrams of fluvoxamine daily. None experienced clinical worsening of their symptoms, while six out of 72 patients in the placebo group did.
Another early trial, the TOGETHER trial, was significantly larger than the STOP COVID trial and involved 1,497 participants—741 of whom received 200 milligrams of fluvoxamine daily and 756 of whom received a placebo.
The study found that 11 percent of patients in the fluvoxamine group versus 16 percent of patients in the placebo group needed observation for COVID-19 in an emergency setting for more than six hours or were transferred to a tertiary hospital. Moreover, there were 17 deaths in the fluvoxamine group and 25 deaths in the placebo group.
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In the STOP COVID 2 trial, initiated in late 2020, researchers found that a lower 100-milligram dose twice daily would also effectively reduce COVID-19 hospitalization.
Open-Label and Retrospective Studies Favor Fluvoxamine
In an early open-label study on fluvoxamine, researchers investigated the drug’s effects on intensive care unit (ICU) patients with COVID-19. They did not find that fluvoxamine reduced ICU time or time on ventilators but did find a statistically significant improvement in mortality in those treated with fluvoxamine.
Open-label studies are not blinded, meaning participants know they are receiving fluvoxamine, and no placebo drug is given to patients in the placebo group.
Fluvoxamine May Reduce Mortality
Since open-label studies may not provide complete data, the researchers also conducted a meta-analysis using only “gold standard” placebo-controlled double-blind studies.
The meta-analysis examined seven studies involving 5,080 patients. Just over 9 percent of the standard-care group and 6 percent of the fluvoxamine-treatment group experienced clinical deterioration.
The researchers also investigated the effect of fluvoxamine on COVID-19-related mortality in 12 studies involving 7,722 patients. Results showed that 4.8 percent in the standard-care group died, compared to about 1.6 percent in the fluvoxamine group. Among five studies that reported deaths in either group, fluvoxamine demonstrated greater benefits than the placebo or standard care.
How Fluvoxamine Works
Fluvoxamine is a generic selective serotonin reuptake inhibitor (SSRI) approved by the U.S. Food and Drug Administration (FDA) to treat OCD and depression. It is also known to have anti-inflammatory properties and gained popularity during the pandemic for its potential to treat COVID-19, reduce mortality, and potentially mitigate long-COVID symptoms.
Dr. Syed Haider, a physician who has treated thousands of COVID-19 patients, told The Epoch Times he is one of the first physicians to begin widely prescribing fluvoxamine for COVID-19. He saw the benefits of using it early in the pandemic in severe cases that needed “everything we could throw at them,” he said.
“It was very early for me personally, and I had only thus far seen about 10 or 20 patients for acute COVID-19,” said Dr. Haider. One of his patients had been hospitalized.
“After I added fluvoxamine to the protocol, the next few hundred patients had no hospitalizations for COVID-19, though one young male was briefly admitted due to a severe psychological adverse reaction to fluvoxamine itself, though that quickly wore off,” he added.
As time went on, Dr. Haider said it became apparent that a minority of patients couldn’t tolerate the side effects of fluvoxamine and stopped taking it, while others were concerned about the potential impacts of taking a psychiatric drug.
Side effects of fluvoxamine include nausea, diarrhea, indigestion, and neurological symptoms such as asthenia (weakness), insomnia, anxiety, headache, and, rarely, suicidal ideation.
Fluvoxamine May Reduce Long-COVID Complications
All but one of the studies reviewed by researchers found that fluvoxamine may reduce long-COVID complications. In a placebo-controlled, double-blinded study investigating neuropsychiatric symptoms in mildly to moderately affected long-COVID patients, researchers found fewer neuropsychological symptoms in those who used the drug. Additionally, fluvoxamine-treated patients experienced less fatigue and depression.
In follow-up data of the STOP COVID 1 and 2 trials, researchers found that most trial patients reported that they had not fully recovered. Those who received fluvoxamine during the acute COVID-19 trial were about half as likely to report having recovered less than 60 percent. According to the authors, other reviewed studies suggested SSRIs may be beneficial for treating long COVID due to their anti-inflammatory properties.
