Antidepressants re-used for patients with coronavirus infection.
In a preliminary study of COVID-19 patients with mild to moderate illness who have tried to recover in their homes, researchers from the Washington University School of Medicine in St. Louis found that the drug fluvoxamine appears to prevent some of the most serious complications of the disease and hospitalization and the need for supplemental oxygen are less likely.
The study, a collaboration between the Department of Psychiatry and the Infectious Diseases Division, involved 152 patients infected with EARS-CoV-2, the virus that causes COVID-19. Researchers compared the outcomes of those treated with fluvoxamine with those of those who received an inactive placebo. After 15 days, none of the 80 patients who received the drug experienced severe clinical deterioration. Meanwhile, six of the 72 patients receiving placebo (8.3%) became seriously ill, four of whom required hospitalization.
The study will be published online Nov. 12 in the Journal of the American Medical Association.
“The patients who used fluvoxamine did not have severe respiratory problems and did not need hospitalization for lung function problems,” said the paper’s first author, Eric J. Lenze, managing director, Wallace and Lucille’s professor of psychiatry. Renard said. ‘Most investigative treatments for COVID-19 have been aimed at the sickest patients, but it is also important to find therapies that prevent patients from becoming ill in need of supplemental oxygen or having to go to hospital. Our study suggests that fluvoxamine may help fill the niche. ”
Fluvoxamine is commonly used to treat obsessive-compulsive disorder (OCD), social anxiety disorder and depression. It is in a class of drugs known as selective serotonin reuptake inhibitors (SSRIs), but unlike other SSRIs, fluvoxamine has a strong effect with a protein called the sigma-1 receptor. That receptor also helps regulate the body’s inflammatory response.
“There are several ways this drug can work to help COVID-19 patients, but we think it probably interacts with the sigma-1 receptor to reduce the production of inflammatory molecules,” said Angela M Reiersen, MD director, said associate professor of psychiatry. “Previous research has shown that fluvoxamine can reduce inflammation in animal models of sepsis, and that it may do something similar in our patients.”
Reiersen said the effect of the drug on inflammation can prevent the immune system from eliciting an overwhelming response, presumably occurring in some COVID-19 patients that apparently improves after a few days of illness and then worsens. Many of the patients are eventually admitted to the hospital, and some die.
In an innovative twist for research during the pandemic, the study was done remotely. When a symptomatic patient tested positive and enrolled in the study, research staff delivered the medication or inactive placebo to them, along with thermometers, automatic blood pressure monitors, and oxygen sensors on the fingers.
“Our goal is to help patients who are initially good enough to be at home and to prevent them from getting sick enough to be admitted to the hospital,” said Caline Mattar, MD, associate professor of medicine in the Infectious Diseases Division. . “What we have seen so far suggests that fluvoxamine may be an important tool for achieving this goal.”
The subjects took the antidepressant or placebo sugar pills for two weeks while interacting daily with members of the research team – via telephone or computer. This has enabled patients to report their symptoms, oxygen levels and other vital signs. If patients have had shortness of breath or have been admitted to hospital for pneumonia, or if oxygen saturation levels have dropped below 92%, their conditions are considered debilitated.
“The good news is that not one person using the active medication has experienced deterioration,” Reiersen said. “We believe this remedy may be the reason, but we need to study more patients to make sure.”
The researchers will begin a larger study within the next few weeks. Lenze, the director of the Healthy Mind Lab at the School of Medicine, is an expert in using mobile and Internet technology to conduct clinical trials. He said that although this initial study included patients in the St. Louis region involved, the next phase of the investigation will involve patients from across the country.
“We bring the study to the patients and give them tools to monitor their health at home,” Lenze said. “Our hope is that we can keep these patients healthy enough to avoid hospitalization.”
Read Antidepressant Fluvoxamine May Prevent Exacerbation of COVID-19 Infections for more information on this research.
Reference: “Fluvoxamine versus placebo and clinical deterioration in outpatients with symptomatic COVID-19” by Eric J. Lenze, MD; Caline Mattar, Managing Director; Charles F. Zorumski, Managing Director; Angela Stevens, BA; Julie Schweiger; Ginger E. Nicol, Managing Director; J. Philip Miller, AB; Lei Yang, MPH, MSIS; Michael Yingling, MS; Michael S. Avidan, MBBCh and Angela M. Reiersen, MD, MPE, 12 November 2020, Journal of the American Medical Association.
Lenze EJ, Mattar C, Zorumski CF, Stevens A, Schweiger J, Nicol GE, Miller JP, Yang L, Yingling M, Avidan MS, Reiersen AM. Fluvoxamine versus placebo and clinical deterioration in outpatients with symptomatic COVID 19: a randomized clinical trial. JAMA, 12 November 2020.
This work was supported by the Taylor Family Institute for Innovative Psychiatric Research, the Bantly Foundation, the Center for Brain Research in Mood Disorders at Washington University, and the COVID-19 Early Treatment Fund. Additional support from the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH). Award number UL1 TR002345.