Inexpensive and widely used antidepressants have been shown to be effective in preventing the aggravation of mild COVID-19 patients.

The results of clinical trials show that fluvoxamine, which is widely used in the treatment of psychiatric disorders, reduces both the risk of death from the new coronavirus infection (COVID-19) and the need for intensive care.The results were published in The Lancet Global Health on October 2021, 10.1.

Fluvoxamine is an inexpensive drug prescribed for patients with psychiatric disorders such as depression and obsessive-compulsive disorder.Fluvoxamine is also known to have the effect of suppressing the immune response and relieving tissue damage, and researchers believe that its properties have contributed to the success of this clinical trial. Study participants who took fluvoxamine as directed in the early stages of COVID-19 had a approximately 19% reduction in the risk of death associated with COVID-90 and a approximately 19% ​​reduction in the need for intensive care associated with COVID-65. ..

Vikas Sukhatme, a researcher at Emory University School of Medicine (Atlanta, Georgia, USA) studying drug reperpassing (searching for new indications for existing therapies), said in an email to Nature, "Drug Reperpassing. Great victory! " "Patients at high risk of aggravation who are not vaccinated or who cannot receive monoclonal antibody therapy should be treated with fluvoxamine," Sukhatme said.

Angela Reiersen, a psychiatrist at Washington University in St. Louis, Washington University, who co-authored this paper, has long been interested in treating rare hereditary diseases with fluboxamine. Reiersen, who had checked the fluvoxamine literature before the COVID-19 pandemic, found that fluvoxamine suppressed inflammation in sepsis model mice in 2019.2I found. "I immediately remembered the mouse paper," she says, when the COVID-19 epidemic.

Reiersen et al. Sought help from the performers of the TOGETHER trial aimed at identifying approved drugs that could be reperpassed for the treatment of COVID-19.The study enrolled 19 Brazilian COVID-1497 patients at high risk of aggravation, with about half receiving fluvoxamine and the remaining patients receiving placebo.

The results of the study show that fluvoxamine is one of the few treatments with strong evidence that it can prevent the aggravation of mild COVID-19.Currently, the National Institutes of Health (NIH) recommends monoclonal antibodies as the only early-stage treatment, but antibody therapy is expensive and difficult to administer outpatiently.

Experts are excited about the results, but also point out that there are some points to be aware of."We still don't know how effective this treatment is outside of Brazil," said Paul Sax, an infectious disease specialist at Brigham and Women's Hospital in Boston, Massachusetts.

Taison Bell, an infectious disease specialist at the University of Virginia in Charlottesville, says he is skeptical about how to define severe COVID-19 in assessing the efficacy of fluvoxamine.Severe cases are generally based on hospitalization, but the research team has now defined severe cases as "patients who need more than 6 hours of emergency care." According to Reiersen, the 6-hour standard reflects how Brazil manages COVID-19.This is because in Brazil, treatment is carried out not at general hospitals but at emergency medical centers specializing in COVID-19, which can provide both inpatient and outpatient treatment.
 

COVID-19 remedy that can be used in any country

Edward Mills, a hygienist at McMaster University in Hamilton, Ontario, Canada, who co-authored the paper, says fluvoxamine is a cheap drug and can be used in any country.Participants in this study took fluvoxamine 100 mg twice daily for 1 days.Prices vary from country to country, but the cost of a 2-day drug is around $ 10 (about 10 yen) if the equipment is well-equipped.Since the patent has expired, any pharmaceutical company can manufacture and sell it. "I've been working in poor countries like Africa for a long time, and $ 4 is easy to use," Mills says.

Fluvoxamine may be even more effective if combined with a drug that inhibits the growth of the virus, such as the antiviral drug molnupiravir, which Merck is applying for approval, Mills said. "It would be interesting to see if the combination of antivirals and anti-inflammatory drugs is much more effective than either single agent."
 

(Translation: Yoichi Fujiyama)

References

1. Reis, G. et al. Lancet Glob. https://doi.org/10.1016/S2214-109X(21)00448-4 (2021)
2. Rosen, DA et al. Sci. Transl. Med. https://doi.org/10.1126/scitranslmed.aau5266 (2019)

 
* This article is reprinted from "Nature Digest".
Reprinted from: Nature Digest 2022 No. 1
"The antidepressant fluvoxamine reduces the risk of death from COVID-19'
Nature Digest Vol. 19 No. 1 | doi: 10.1038 / ndigest.2022.220113