ST. LOUIS — A small study released by Washington University has shown that a long-used antidepressant may reduce the likelihood that COVID-19 will turn deadly.
The drug fluvoxamine, given to patients within a week of experiencing symptoms, seems to help prevent some of the most serious complications of the illness and make hospitalization and the need for supplemental oxygen less likely.
The study was published online in the Journal of the American Medical Association.
The research involved 152 patients infected with the coronavirus. Eighty were given fluvoxamine; the rest, a placebo. After two weeks, none of the patients who took the antidepressant experienced serious deterioration, results showed.
Six of the 72 patients given a placebo, however, became seriously ill, with four requiring hospitalization.
"The patients who took fluvoxamine did not develop serious breathing difficulties or require hospitalization for problems with lung function," said the paper's first author and psychiatrist Dr. Eric Lenze.
The study was conducted remotely. When patients with symptoms tested positive and enrolled in the study, research staff delivered the medication or inactive placebo to the patients' homes, along with thermometers, automatic blood pressure monitors and fingertip oxygen sensors.
"Most investigational treatments for COVID-19 have been aimed at the very sickest patients, but it's also important to find therapies that prevent patients from getting sick enough to require supplemental oxygen or to have to go to the hospital," Lenze said. "Our study suggests fluvoxamine may help fill that niche."
Fluvoxamine was approved in 1994 to treat patients with obsessive-compulsive disorder. The drug helps restore the brain's balance of serotonin, which regulates mood and social behavior.
Fluvoxamine is unique, however, in that it has also been found to interact with a protein important in the body's immune system response.
The disease caused by the coronavirus appears to have two key phases, said Dr. Caline Mattar, assistant professor in the university's infectious diseases division.
"The first is caused by the viral infection itself, which gives people a fever and a cough and makes them feel ill, among other symptoms," Mattar said. "The information we have so far suggests that the second phase of the illness can involve a life-threatening inflammatory reaction — what we call a 'cytokine storm.'"
Cytokines are molecules that coordinate the body's response against infection and trigger inflammation. The "storm" happens when production of those molecules goes into overdrive.
Washington U. researchers were drawn to study fluvoxamine because it binds to a receptor on immune cells that regulates inflammation by inhibiting the production of cytokines.
"Our goal is to help patients who are initially well enough to be at home and to prevent them from getting sick enough to be hospitalized," Mattar said. "What we've seen so far suggests that fluvoxamine may be an important tool in achieving that goal."
The researchers will begin a larger study in the next few weeks that involves patients throughout the country, Lenze said.
Fluvoxamine can cause side effects such as nausea, dizziness, and changes in sleep like insomnia; and people who take drugs like coumadin that promote bleeding or who already take psychiatric medications should consult with their doctor before adding fluvoxamine.
Researchers have not studied fluvoxamine for people who test positive for the virus but have no symptoms.
Lenze said doctors could prescribe the drug to patients, but he warned that the study's findings are preliminary and recommended that providers refer patients to clinical studies.
