Selective Serotonin Reuptake Inhibitors may Influence COVID-19
                    Prognosis through Antioxidant and Cytoprotective Pathways Mediated by Sigma 1
                    Receptor Agonism

Papadopoulos, Konstantinos I.; Papadopoulou, Alexandra; Aw, Tar Choon

doi:10.1055/a-1909-2198

Cited by 1 publication

(1 citation statement)

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“…Another σ1R agonist, citalopram downregulates miR-155 and upregulates SIRT1 expression 76 . Given that fluvoxamine is a more potent S1R agonist than citalopram (Ki = 17.0 nM vs. Ki = 403.8 nM) 77 , it is expected to have a more substantial effect on miR-155. This could explain why very high doses of fluvoxamine (300 mg) might be ineffective, as they could excessively lower miR-155 in patients with already low levels, negatively impacting prognosis.…”

Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis, investigating dose and time of fluvoxamine treatment efficacy for COVID-19 clinical deterioration, death, and Long-COVID complications

Prasanth,

Wannigama,

Reiersen

et al. 2024

Sci Rep

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There have been 774,075,242 cases of COVID-19 and 7,012,986 deaths worldwide as of January 2024. In the early stages of the pandemic, there was an urgent need to reduce the severity of the disease and prevent the need for hospitalization to avoid stress on healthcare systems worldwide. The repurposing of drugs to prevent clinical deterioration of COVID-19 patients was trialed in many studies using many different drugs. Fluvoxamine (an SSRI and sigma-1 receptor agonist) was initially identified to potentially provide beneficial effects in COVID-19-infected patients, preventing clinical deterioration and the need for hospitalization. Fourteen clinical studies have been carried out to date, with seven of those being randomized placebo-controlled studies. This systematic review and meta-analysis covers the literature from the outbreak of SARS-CoV-2 in late 2019 until January 2024. Search terms related to fluvoxamine, such as its trade names and chemical names, along with words related to COVID-19, such as SARS-CoV-2 and coronavirus, were used in literature databases including PubMed, Google Scholar, Scopus, and the ClinicalTrials.gov database from NIH, to identify the trials used in the subsequent analysis. Clinical deterioration and death data were extracted from these studies where available and used in the meta-analysis. A total of 7153 patients were studied across 14 studies (both open-label and double-blind placebo-controlled). 681 out of 3553 (19.17%) in the standard care group and 255 out of 3600 (7.08%) in the fluvoxamine-treated group experienced clinical deterioration. The estimated average log odds ratio was 1.087 (95% CI 0.200 to 1.973), which differed significantly from zero (z = 2.402, p = 0.016). The seven placebo-controlled studies resulted in a log odds ratio of 0.359 (95% CI 0.1111 to 0.5294), which differed significantly from zero (z = 3.103, p = 0.002). The results of this study identified fluvoxamine as effective in preventing clinical deterioration, and subgrouping analysis suggests that earlier treatment with a dose of 200 mg or above provides the best outcomes. We hope the outcomes of this study can help design future studies into respiratory viral infections and potentially improve clinical outcomes.

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Section: Discussionmentioning

confidence: 99%