Despite a highlight story on 60 Minutes last month, fluvoxamine, a drug typically used to treat obsessive-compulsive disorder (OCD), is still just a brief mention in the "cytokine inhibitors" section in the New York Times' "Coronavirus Drug and Treatment Tracker."For now, it makes sense. Fluvoxamine, a serotonin reuptake inhibitor (SSRI), has shown promise in two smaller studies, but larger trials have not been published yet.
Even if the drug becomes a more mainstream treatment for COVID-19, one expert says any demand surge is not expected to result in shortages.
COVID-19 Treatment Potential .
As 60 Minutes tells it, the first COVID-19–related fluvoxamine study began because Angela Reiersen, MD, MPE, was reflecting on potentially relevant medical studies when she herself was sick with COVID in March 2020. There was one that caught her attention: A 2019 Science Translational Medicine study that suggested fluvoxamine lowered inflammatory cytokine production and treated sepsis in mice.
"Mechanistically, we find that S1R [ER-resident protein sigma-1 receptor] restricts the endonuclease activity of the ER [endoplasmic reticulum] stress sensor IRE1 and cytokine expression but does not inhibit the classical inflammatory signaling pathways," write the researchers. "These findings could have substantial clinical implications, as we further find that fluvoxamine, an antidepressant therapeutic with high affinity for S1R, protects mice from lethal septic shock and dampens the inflammatory response in human blood leukocytes."
The same cytokine storm that is mentioned in this study is also an inflammation-causing symptom in COVID-19.
So, Reiersen mentioned it to her acquaintance Eric Lenze, MD, who became the lead author on a preliminary randomized clinical trial published in JAMA in November 2020, with Reiersen as senior author.
In that study, 80 participants with COVID-19 received 100 milligrams (mg) of fluvoxamine three times daily for 15 days, and 72 COVID-19 patients received a placebo. While 8.7% of the placebo group had to be hospitalized within 14 days because of worsening symptoms, none in the intervention group were. ...
