Fluoxamine COVID-19 treatment
There have been several recent studies suggesting fluvoxamine may be beneficial when treating COVID-19 patients. Most of these reports are small trials that lack the statistical power to provide a solid answer. This has changed with the TOGETHER trial consortium who have been evaluating several different potential treatments shown in the table below. They also undertook a study investigating treatment with Ivermectin that was "stopped for futility".
The results of the Fluvoxamine trial have now been published "Effect of early treatment with fluvoxamine on risk of emergency care and hospitalisation among patients with COVID-19: the TOGETHER randomised, platform clinical trial" DOI. This appears to be a large (741 patients were allocated to fluvoxamine and 756 to placebo) well conducted blinded trial. The average age of the patients was 50 years, 42% male 58% female. Primary end points were related to hospitalisation. They enrolled only participants with diagnosed COVID-19 and less than 7 days of symptom onset using a commercially available COVID-19 rapid antigen test.
The proportion of patients observed in a COVID-19 emergency setting for more than 6 h or transferred to a teritary hospital due to COVID-19 was lower for the fluvoxamine group compared with placebo (79 [11%] of 741 vs 119 [16%] of 756).
The mechanism of action is uncertain but the initial hypothesis was based on the anti-inflammatory action of fluvoxamine. Fluvoxamine is a Selective serotonin reuptake inhibitor (SSRI), however if does have other activities CHEMBL1409/
SMILES = COCCCC/C(=N\OCCN)c1ccc(C(F)(F)F)cc1.O=C(O)/C=C\C(=O)O
It is worth noting Fluvoxamine is not an antiviral but it may act via anti-inflammatory effects that likely stem from its regulation of S1R, which modulates innate and adaptive immune responses and Fluvoxamine may serve to dampen cytokine storms. There have been reviews of the potential mechanism of action DOI.