A clinical trial conducted by Washington University School of Medicine in St. Louis actually evidences the potential that fluvoxamine, an antidepressant, may actually prevent COVID-19 infections from worsening. This trial is based on recent research that originates from the University of Virginia School of Medicine. The recent clinical trial compared fluvoxamine with a placebo in 152 adult outpatients infected with SARS-CoV-2, the virus behind COVID-19. Interestingly, none of the 80 participants who received fluvoxamine became seriously ill after 15 days, while six patients in the placebo arm did become ill. Out of the six, four were hospitalized for up to 21 days while one patient was on a ventilator for 10 days. Although there are limitations to this small study, investigators prepare for more clinical trials to pursue this potentially novel way to fight the novel coronavirus.
What is Fluvoxamine?
Sold under the trade name Luvox et al, this antidepressant of the selective serotonin reuptake inhibitor (SSRI) class is primarily used for the treatment of obsessive-compulsive disorder (OCD). The drug is also used to treat depression and anxiety disorders such as panic disorder, social anxiety disorder and post-traumatic stress disorder.
The drug was developed originally by Kali-Duphar, a unit of Solvay Pharmaceuticals, in Belgium and later part of Abbot Laboratories and thereafter Jazz Pharmaceuticals. It was approved by the U.S. FDA in 1994 as Luvox.
During the COVID-19 pandemic, it has been an agent used in several clinical trials associated with drug repurposing research associated with the prevention of the deadly cytokine storm, a complication at times present with severe COVID-19.
The Discovery: Is Fluvoxamine Linked to COVID-19?
Researchers from the University of Virginia discovered last year that this drug may actually deter the production of cytokines, which of course, have subsequently been linked to the dangerous cytokine storms: these are associated with some severe COVID-19 cases. Alban Gaultier and former graduate student Dorian A. Rosen found that fluvoxamine may possibly stop the deadly inflammation known as sepsis, in which the immune response spirals out of control, reported the University of Virginia News recently.
The Recent Study
It was the University of Virginia breakthrough that led the team at Washington University to investigate the potential of fluvoxamine as a protective agent for patients infected with COVID-19. Could it be that the agent could prevent the immune system from overreactions triggered by SARS-CoV-2?
The recent study, although small in size, yielded statistically significant results, according to investigators. So much so that the researchers suggest the results warrant more investigation associated with treating COVID-19. The team plans a much larger clinical trial within weeks.
The Washington University investigators led the randomized, double-blinded trial based again, on the discovery by University of Virginia’s Alban Gaultier and former graduate student Dorian A. Rosen.
Dr. Eric J. Lenze, Washington University School of Medicine, reported, “The patients who took fluvoxamine did not develop serious breathing difficulties or require hospitalization for problems with lung function,” reported the investigator.
He emphasized that although most therapies under investigation are of interest as treatments for the most ill COVID-19 patients, Dr. Lenze shares that “…It’s important to find therapies that prevent patients from getting sick enough to require supplemental oxygen or to have to go to the hospital.” This is a very important niche.
Still Lots of Uncertainty
Washington University investigators are not certain about many aspects associated with COVID-19. For example, recent research questions the importance of cytokine storms in COVID-19 deaths. If, in fact, cytokine storms are not actually a factor, then the apparent efficacy of fluvoxamine would be explained by some other mechanism as of yet not understood.
For example, Dr. Angela M. Reiersen with Washington University suggested that “There are several ways this drug might work to help COVID-19 patients, but we think it most likely may be interacting with the sigma-1 receptor to reduce the production of inflammatory modules.” She continued, “Past research has demonstrated that fluvoxamine can reduce inflammation in animal models of sepsis, and it may be doing something similar in our patients.”
As reported by Josh Barney at the University of Virginia News, a number of limitations require further research, from small trial size to the fact that 20% of the trial participants failed to complete participation (e.g. didn’t fully answer surveys during the 15-day trial).
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