Antidepressant Cuts COVID-19 Hospitalizations by up to 73 Percent

A 10-day course of the inexpensive antidepressant fluvoaxamine cut the risk of COVID-19-related hospitalization by 32 percent in infected patients with comorbidities, a research team in Brazil has found.

And patients who took the drug as prescribed were 66 percent less likely to be hospitalized for the infection than patients who took a placebo, reported Gilmar Reis of the Pontifical Catholic University of Minas Gerais and colleagues in the journal Lancet Global Health.  The drug also more than halved mortality, from 2 percent in the placebo group to less than 1 percent in the treatment group.

The intervention was so successful that an independent Data Safety Monitoring Committee stopped the randomization phase of the trial. The study is continuing in an open-label format, the team said. Twenty patients would have to take the medication to prevent one patient’s hospitalization.

The results are particularly intriguing given the study population. The TOGETHER trial was conducted in Brazil, and 95 percent of the study population was of mixed race. COVID-19 study cohorts in the U.S. typically lean heavily to white patients. This is problematic, given that racial and ethnic minorities are more likely to have the medical comorbidities that increase the risk of poor COVID-19 outcomes.

The cohort comprised 1,497 patients with PCR-proven COVID-19 infections and at least one underlying medical condition, including obesity, hypertension, or respiratory, cardiac, or kidney disease. They received either placebo or 100 mg fluvoxamine twice a day for 10 days. The primary outcome was a composite endpoint of COVID-19 emergency room stays of at least 6 hours or hospitalizations.  The emergency room stay was included as a proxy for hospitalization because when the study was conducted, Brazilian hospitals were often full, so many COVID-19 patients received care in extended ER admissions.

It’s important to note that fluvoxamine didn’t score on any of the secondary endpoints of viral clearance, number of hospital days, overall mortality, days on ventilation or time to recovery in the intention-to-treat analysis.

This is the second time fluvoxamine has shown potential as a COVID-19 treatment. Last November, a smaller randomized study (152 patients) found that the drug prevented clinical deterioration in patients who took it relative to placebo (DID, Nov. 16, 2020).

The investigators aren’t quite sure how the drug mediates disease response, but proposed three possibilities:

• Fluvoxamine exerts anti-inflammatory effects by preventing the release of several interleukins — proteins that are important in disease-driven inflammation.
• It appears to also have antiplatelet activity. COVID-19 can cause diffuse clotting. Fluvoxamine is a selective serotonin reuptake inhibitor. When serotonin moves into platelets, clotting potential is increased.
• Fluvoxamine increases melatonin levels, although the investigators didn’t speculate how increased melatonin might play into disease response.

On GoodRx, a 90-day supply of fluvoxamine averages about $100, making a 10-day supply right around $11.

Read the Lancet Global Health study here: bit.ly/3jOFD8C. — Michele G. Sullivan