Efficacy and safety of fluvoxamine for the treatment of COVID-19 patients: A systematic review and meta-analysis

Cheema, Huzaifa Ahmad; Jafar, Uzair; Elrashedy, Asmaa Ahmed; Shahid, Abia; Awan, Rehmat Ullah; Ehsan, Muhammad; Ayyan, Muhammad; Sahra, Syeda

doi:10.1016/j.jinf.2022.10.012

Cited by 14 publications

(13 citation statements)

References 10 publications

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“…This study has limitation. From the results of several meta-analyses, there is an ongoing debate over the beneficial effects of fluvoxamine for COVID-19 [96][97][98][99][100][101][102][103]. A recent meta-analysis using 6 randomized clinical trials and 5 observational studies demonstrated that the medium dose (100 mg twice daily) of fluvoxamine, but not low dose (50 mg twice daily), was associated with a 21% reduction in the risk of hospitalization, and a 28% reduction in the risk of mortality [104].…”

Section: Limitationmentioning

confidence: 99%

Overview of the potential use of fluvoxamine for COVID-19 and long COVID

Hashimoto

2023

Discov Ment Health

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Coronavirus disease 2019 (COVID-19) has presented a serious worldwide threat to public health since its emergence in late 2019. From a safety point of view, drug repurposing has received particular attention. Several clinical studies have demonstrated that the use of fluvoxamine, a selective serotonin reuptake inhibitor with potent sigma-1 receptor agonism, in the early-stage of infection might be associated with the prevention of clinical deterioration in individuals with SARS-CoV-2 infection, although several reports have shown that a low dose of fluvoxamine may be ineffective. There is increasing evidence that SARS-CoV-2 can cross the blood–brain barrier, resulting in a number of psychiatric and neurologic symptoms in COVID-19 survivors. Importantly, about half of COVID-19 survivors experience a variety of long-term sequelae, including psychiatric and neurologic symptoms, known as long COVID. In this priority review, the author presents an overview of the potential use of fluvoxamine in the treatment of COVID-19 and long COVID.

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Section: Limitationmentioning

confidence: 99%

Overview of the potential use of fluvoxamine for COVID-19 and long COVID

Hashimoto

2023

Discov Ment Health

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“…alternative therapeutic strategies to treat COVID-19 in diverse clinical settings; however, attempts to repurpose medications for COVID-19 have largely been met with failure. 11,12 Globally, as of 6 December 2022, there have been 642 million confirmed cases of COVID-19, including 6.6 million deaths, reported to WHO. 13 Clinical manifestations include fever, cough, dyspnoea, and neurological and dermatological symptoms; while anxiety, depression, hair loss, palpitations and chest pain have been reported to persist as long COVID symptoms in COVID-19 survivors.…”

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confidence: 99%

Quercetin for the treatment of COVID‐19 patients: A systematic review and meta‐analysis

Cheema

Sohail

Fatima

et al. 2023

Reviews in Medical Virology

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Currently approved therapies for COVID‐19 are mostly limited by their low availability, high costs or the requirement of parenteral administration by trained medical personnel in an in‐hospital setting. Quercetin is a cheap and easily accessible therapeutic option for COVID‐19 patients. However, it has not been evaluated in a systematic review until now. We aimed to conduct a meta‐analysis to assess the effect of quercetin on clinical outcomes in COVID‐19 patients. Various databases including PubMed, the Cochrane Library and Embase were searched from inception until 5 October 2022 and results from six randomized controlled trials (RCTs) were pooled using a random‐effects model. All analyses were conducted using RevMan 5.4 with odds ratio (OR) as the effect measure. Quercetin decreased the risk of intensive care unit admission (OR = 0.31; 95% confidence interval (CI) 0.10–0.99) and the incidence of hospitalisation (OR = 0.25; 95% CI 0.10–0.62) but did not decrease the risk of all‐cause mortality and the rate of no recovery. Quercetin may be of benefit in COVID‐19 patients, especially if administered in its phytosome formulation which greatly enhances its bioavailability but large‐scale RCTs are needed to confirm these findings.

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“…To close, at the moment of the writing this manuscript, to our awareness this is not only one of the largest studies but also providing mortality similar to the highly funded TOGETHER trial ( Cheema et al, 2022 ). In our opinion fluvoxamine should be implemented as the standard of care in the early outpatient treatment for low-income individuals and nations.…”

Section: Discussionmentioning

confidence: 97%

Impact of fluvoxamine on outpatient treatment of COVID-19 in Honduras in a prospective observational real-world study

et al. 2022

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Background: The COVID-19 pandemic has impacted millions of lives globally. While COVID-19 did not discriminate against developed or developing nations, it has been a significant challenge for third world countries like Honduras to have widespread availability of advanced therapies. The concept of early treatment was almost unheard of when early outpatient treatments utilizing repurposed drugs in Latin American countries began showing promising results. One such drug is fluvoxamine, which has shown tremendous potential in two major studies. As a direct result, fluvoxamine was added to the standard of care in a major medical center outpatient COVID-19 clinic.Methods: This is a prospective observational study performed at the Hospital Centro Médico Sampedrano (CEMESA) in San Pedro Sula, Cortes, Honduras in the COVID-19 outpatient clinic. All patients were at least 15 years of age who had presented with mild or moderate signs and symptoms of COVID-19, and who also had a documented positive SARS-CoV-2 antigen or Reverse Transcription Polymerase Chain Reaction (RT-PCR) were included in the study. These patients then were all prescribed fluvoxamine. The cohort of patients who decided to take fluvoxamine were compared for primary endpoints of mortality and hospitalization risk to the cohort who did not take fluvoxamine. Patients were then monitored for 30 days with the first follow up at 7 days and the second follow up at 10–14 days of symptom onset. Categorical variables were compared by Pearson Chi-square test. The Relative risk was calculated using regression models. Continuous variables were compared by t-test and Wilcoxon rank-sum tests.Results: Out of total 657 COVID-19 cases, 594 patients took fluvoxamine and 63 did not take fluvoxamine. A total of five patients (0.76 percent) died, with only one death occurring in the fluvoxamine group. Patients who received fluvoxamine had a significantly lower relative risk of mortality (RR 0.06, p 0.011, 95% CI 0.007–0.516). There was a lower relative risk of hospitalization in the patients who in the fluvoxamine group. (−10 vs. 30 hospitalizations, RR 0.49, p = 0.035, 95% CI 0.26–0.95). There was 73 percent reduction in relative risk of requiring oxygen in the fluvoxamine group (RR 0.27, p < 0.001, 95% CI 0.14–0.54 Mean lymphocytes count on the first follow-up visit was significantly higher in the fluvoxamine group (1.72 vs. 1.38, Δ 0.33, p 0.007, CI 0.09–0.58).Conclusion: The results of our study suggest that fluvoxamine lowers the relative risk of death, hospitalization, and oxygen requirement in COVID 19 patients.

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Efficacy and safety of fluvoxamine for the treatment of COVID-19 patients: A systematic review and meta-analysis

Cited by 14 publications

References 10 publications

Overview of the potential use of fluvoxamine for COVID-19 and long COVID

Overview of the potential use of fluvoxamine for COVID-19 and long COVID

Quercetin for the treatment of COVID‐19 patients: A systematic review and meta‐analysis

Impact of fluvoxamine on outpatient treatment of COVID-19 in Honduras in a prospective observational real-world study

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