Cheap antidepressant could help treat COVID-19, study finds

The drug fluvoxamine, commonly used to treat obsessive-compulsive disorder or depression, shows promise as a treatment for COVID-19, according to a new study.

The study, published Wednesday in the journal Lancet Global Health, found that high-risk patients who took the pills shortly after being diagnosed with COVID-19 were less likely to end up in hospital than others who took a placebo.

“I think almost everybody at an early stage of the infection will benefit from this,” said the study’s lead author, Ed Mills, a professor of health sciences at McMaster University.

The study involved about 1,500 people in Brazil who were randomly assigned to receive either fluvoxamine or a placebo after they had tested positive for COVID-19 and showed symptoms. The patients were all at high risk of developing complications from COVID-19 due to either advanced age or other comorbidities, Mills said.

Patients who took fluvoxamine were 32 per cent less likely to be hospitalized than those who took the placebo, the study found. Fluvoxamine patients were hospitalized 11 per cent of the time, compared to 16 per cent of placebo recipients. This effect increased when patients carefully took all of their drugs.

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“The absolute risk reduction is huge in the circumstance,” Mills said. “What we find is that you only need to treat 20 people to prevent one hospitalization.”

The drug is relatively cheap and accessible, too, Mills said, costing around $4 for a course of treatment. This means a hospitalization might be prevented for only around $80 to $100, according to Mills, “as opposed to thousands and thousands of dollars if somebody is hospitalized.”

Fluvoxamine belongs to the family of selective serotonin reuptake inhibitor drugs (SSRIs) and is currently approved in Canada and many other countries to treat depression and obsessive-compulsive disorder. But this drug has some other effects that made it worth investigating, Mills said.

“One of the other aspects of this particular drug, for me, is that it has immunomodulatory effects. In particular, it has anti-inflammatory effects,” he said.

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Dr. Emily McDonald, an associate professor of medicine and a scientist at the research institute of the McGill University Health Centre, who is also studying the effects of fluvoxamine on COVID-19, said the drug is an interesting candidate for treatment.

“It looks like it has all of those properties that we tend to like in anti-COVID medications,” she said. “It’s been shown to have antiviral properties in the lab, anti-inflammatory properties. It also has an antiplatelet effect, so that means that it decreases your chance of getting blood clots somewhat.”

So far, she said, while there haven’t been many trials involving the medication, they have generally been positive.

Dr. Isaac Bogoch, an infectious diseases specialist with Toronto General Hospital, said that while this research isn’t a “game-changer,” it might prove useful in some situations.

“This is something that might benefit the group of patients who are at risk of hospitalization, who are sick enough to at least receive some care and receive some medical attention with an outpatient COVID-19 infection,” he said, adding that he’d like to see more research before it is added to common clinical practice.

McDonald noted that the trial – which was conducted in Brazil – showed a higher rate of hospitalization in both the study and placebo groups than would be expected in a North American population. Finding out whether these results are transferrable to another population, especially a highly vaccinated one like Canada’s, would be valuable, she said.

Fluvoxamine is not currently indicated to treat COVID-19 in Canada, but Health Canada said it will examine any information sent to it by the clinical trial researchers.

“As the drug is already approved for use in Canada, there would not be any requirements to approve it again,” the regulator wrote in a statement. “If clinical trials are conclusive, the manufacturer will be permitted to add an indication on its product monograph indicating it is approved to treat COVID.

“Health Canada will look into the final results of this clinical trial and analyze data in a timely manner once submitted by the clinical trial holder. We can’t provide a timeline for completion, just indicate that HC will take the time it needs to make sure the benefits greatly outweigh the risks.”

Fluvoxamine does have side effects, like drowsiness or stomach trouble, and sometimes causes more serious issues, according to information on Medline Plus.

However, the drug is generally well-tolerated, McDonald said, while cautioning that it can interact badly with other medications and as such should only be taken under medical supervision.

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Mills said the next stage of research is to see whether fluvoxamine can be used in conjunction with other drugs to improve COVID-19 treatment.

“There’s a desperate need now to see whether or not this drug, in combination with other drugs, can give additive effects,” he said.

McDonald said it will also be helpful to find out whether other SSRI drugs can help with COVID-19, too, or if this effect is specific to fluvoxamine.

Although vaccines are the most important piece to get us out of the pandemic, Mills said, it’s important to have good, accessible treatments, too, for those who still catch the disease.

“The complex interventions for COVID, while there are some in the pipeline, they’re not going to solve that. They’re not going to be the solution,” he said.

“We need simple strategies. And that’s going to come from generic drugs and combinations of those generic drugs.”