Fluvoxamine

Fluvoxamine (FLV) is a Selective Serotonin Reuptake Inhibitor (SSRI) that’s been used as an anti-depressant and treatment for obsessive compulsive disorder(OCD). It was first discovered in 1983 and approved by the US FDA in 1994.

Fluvoxamine for Covid 19 Treatment

Mechanism of Action
  • stabilize platelets to prevent clotting and serotonin release.
  • increases endogenous levels of melatonin, which has anti-inflammatory effects at higher concentrations.
  • inhibits inflammatory cytokines and sepsis by activating the anti-inflammatory Sigma-1 receptor, and it may even block entry of COVID-19 into human cells.
Story of Discovery

Angela Reiersen was the first to propose Fluvoxamine as a treatment for Covid-19 in March 2020. Reierson remembered learning about the ability of FLV to protect mice from lethal septic shock and dampen the inflammatory response in human blood leukocytes from a 2019 journal article in Science Translational Medicine.1)

The first published paper that proposed FLV's S1R agonist mechanism of action against Covid-19 was “What Were You Before the War?” Repurposing Psychiatry During the COVID-19 Pandemic.2)

Trials

The COVID-19 Early Treatment Fund (CETF) funded the first randomized control trial(RCT) for Fluvoxamine for Covid-19.3)

The first RCT results of fluvoxamine (FLV) against Covid-19 was published in JAMA on November 12, 2020 and found that “Clinical deterioration occurred in 0 of 80 patients in the fluvoxamine group and in 6 of 72 patients in the placebo group.” 4)

A large observational analysis (n=7345) of hospitalized French patients found that those on SSRI's had a substantially reduced risk of death from COVID. 5)

A prospective cohort study of FLV for Covid-19 concluded that the rate of “hospitalization was 0% (0 of 65) with fluvoxamine and 12.5% (6 of 48) with observation (P = .005).” 6)

The Lancet published results in October 27, 2021 of the Together RCT. The trial concluded that “Treatment with fluvoxamine … reduced the need for hospitalisation”7)

A pre-print Meta-Analysis posted on December 21, 2021 concluded that FLV has a high probability of preventing hospitalization from Covid-198)

Presentations

The TOGETHER Study Shows that Fluvoxamine Reduces Risk of Prolonged Hospitalization by Certara

Dr. Eric Lenze gave a presentation on FLV for Covid on 20 Aug 20219)

Dr. Pater Attia's instagram post on fluvoxamine Dr. Peter Attia describes how one of the physicians in his practice tried to prescribe fluvoxamine for a patient who had just gotten COVID. They called in the prescription to a CVS in California, and the pharmacist told them they would not fill it because it was not part of the “official COVID guideline.”

On March 7, 2021 CBS's 60 Minutes aired an episode on FLV called Finding a possible early treatment for COVID-19 in a 40-year-old antidepressant

The TOGETHER Study on Fluvoxamine Was Not Free of Errors, Either

A First Look at the Numbers by Alexandros Marinos

This article is part of a series on the TOGETHER trial. More articles from this series here.10)

Today, I'll show you one more example of how the TOGETHER trial outputs seem quite willing to blur various boundaries, and always in ways in which help them promote their desired outcome. This particular example is from the fluvoxamine arm of the study.

In a way, you can see this as a demonstration of how tugging at a fairly small thing that looks strange can unearth a whole world of concerning issues about a trial. So let’s see 11)

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