Common antidepressant, $4 per course and it works
Effect of early treatment with fluvoxamine on risk of emergency care and hospitalisation among patients with COVID-19: the TOGETHER randomised, platform clinical trial
https://clinicaltrials.gov/ct2/show/NCT04727424
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00448-4/fulltext
https://www.togethertrial.com
Background
Potential therapeutic role of fluvoxamine
TOGETHER trial for acutely symptomatic patients
To assess the efficacy of fluvoxamine versus placebo
In preventing hospitalisation
Methods
Placebo-controlled
Randomised
Double blind
Adaptive platform trial
(Factoring in analyses at key points
So study design parameters like sample size, dosage, or patient selection can be adjusted accordingly)
https://www.parexel.com/experience/adaptive-flexible-trials?KW=adaptive%20trial%20design&AG=%7Badgroup%7D&CS=MSS&utm_source=google&utm_medium=paid&utm_campaign=mss&utm_term=adaptive%20trial%20design&utm_content=106310559248&gclid=CjwKCAjw2vOLBhBPEiwAjEeK9t9AW3N8ysMeIkLgKabG5MRPEtJD9EJsq8hzBhnQ0ztDLPPUm5gppBoCe_oQAvD_BwE
High-risk symptomatic Brazilian adults
Age ranges and 58% female
Confirmed positive for SARS-CoV-2
Within 7 days from first symptoms or diagnosis
Patients from 11 clinical sites in Brazil
Patients were randomly assigned (1:1)
Fluvoxamine (100 mg twice daily for 10 days), n = 741
Placebo, n = 756
Primary outcome
Hospitalisation, retention or transfer
Up to 28 days post-random assignment
Findings, Jan 20 to Aug 5, 2021
The proportion of patients observed in a COVID-19 emergency setting for more than 6 h
Or transferred to a teritary hospital due to COVID-19 (87%)
Lower for the fluvoxamine group compared with placebo
Fluvoxamine group
79 [11%] of 741
Placebo group
119 [16%] of 756
Relative risk 0·68
95% credible interval, 0·52–0·88
Probability of superiority, 99·8%
Fluvoxamine group
17 deaths
Placebo group
25 deaths
Odds ratio [OR] 0·68
95% credible interval, 0·36–1·27
No significant differences in number of treatment emergent adverse events among patients in the fluvoxamine and placebo groups
Fluvoxamine group
84 stopped taking
Placebo group
64
The absolute number of serious adverse events associated with fluvoxamine was lower than for placebo
this might reflect the modulatory effect of fluvoxamine on systemic inflammation
Mechanism?
Anti-inflammatory
Preventing cytokine storm
Antiplatelet activity
Increasing plasma levels of melatonin
It is now crucial to establish whether a class effect exists?
Interactions with vaccines, improved effect?
stopped taking
https://bnf.nice.org.uk/drug/fluvoxamine-maleate.html
For Adult
Initially 50–100 mg daily
Source