Contents

Fluvoxamine – background and a preliminary study

For at least the past 20 years, some scientists have been exploring the intersection of inflammation, depressive illness and the effect of antidepressants. Some research suggests that excess inflammation may contribute to many chronic conditions, including depression.

Antidepressants work by helping brain cells build up the chemical signals— neurotransmitters—that they use to communicate. However, emerging research suggests that antidepressants can also have modest anti-inflammatory activity. This may, at least in part, account for their beneficial effects.

Fluvoxamine belongs to a class of antidepressants called SSRIs (selective serotonin reuptake inhibitors). In addition to its anti-inflammatory activity, it may also reduce the risk of excessive blood clots.

In COVID-19

Infection with SARS-CoV-2, the virus that causes COVID-19, can cause mild or even no symptoms in some people. However, in other infected people, proteins produced by cells infected with SARS-CoV-2 can impair the functioning of the immune system. This can incite excessive levels of inflammation. If this inflammation is not contained, the immune system can degrade. Also, because cells of the immune system patrol different parts of the body, they can release inflammatory chemical messengers that trigger inflammation in tissues. Altogether, the inflammation caused by SARS-CoV-2 infection can lead to serious tissue injury in susceptible people.

Therefore, researchers are testing drugs that have anti-inflammatory activity in people who have symptoms of COVID-19. One of these drugs is fluvoxamine. Lab experiments with fluvoxamine and SARS-CoV-2 suggest that this drug has potential antiviral and anti-inflammatory effects. Fluvoxamine may also interfere with the ability of SARS-CoV-2-infected cells to produce new copies of this virus.

These lab experiments are interesting. However, they cannot reproduce the complexity of the human body with its multiple organ systems that interact with each other. Many compounds that appear promising in lab experiments with cells or animals subsequently fail to show benefit in studies with people. This failure is normal in the course of drug development. It also underscores the need for well-designed clinical trials so that the potential benefits of experimental drugs can be explored.

Research is planned or underway with fluvoxamine in people with early-stage COVID-19 in the U.S. and at McGill University in Montreal.

A preliminary study

A small randomized, placebo-controlled study of fluvoxamine was conducted in adults in the U.S. who were not hospitalized. Participants were recruited from Eastern Missouri and southern Illinois.

Upon entering the study, participants had recently been infected with SARS-CoV-2 and did not require hospitalization. Common symptoms of COVID-19 in participants included fatigue and loss of sense of smell. Participants were randomly assigned to receive one of the following interventions for 15 consecutive days:

  • fluvoxamine 100 mg three times daily – 80 people
  • placebo three times daily – 72 people

The study was made up of 72% women and 28% men and the average age of participants was 46 years old.

Results

None of the participants who took fluvoxamine deteriorated. In contrast, 8% of participants given placebo deteriorated. For the purposes of this study, researchers defined deterioration as any of the following:

  • shortness of breath
  • shortness of breath that required hospitalization
  • pneumonia that required hospitalization

Four out of six participants who deteriorated required hospitalization, but none of them died.

Bear in mind

This study was similar to a well-designed phase II study. It was small and there were not many people who deteriorated. Therefore, its findings should be viewed as promising but preliminary. The results of this study could be used to design a bigger trial to better understand the effects of fluvoxamine in early stage COVID-19. Our next report covers a large, well-designed study of fluvoxamine in COVID-19.

—Sean R. Hosein

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