Cheap antidepressant may reduce Covid-19 hospitalisations by a third

A cheap, widely available antidepressant that has been prescribed for almost three decades could help reduce coronavirus hospital admissions by 32 per cent, according to a large clinical trial.

The study, published in the Lancet Global Health, examined whether fluvoxamine could be repurposed to tackle the coronavirus. Experts selected the drug – traditionally used to treat mental health conditions including depression and obsessive-compulsive disorders – because of its ability to reduce inflammation.

This is critical because many of the complications resulting from Covid-19 infections are triggered when the immune system goes into overdrive, known as a cytokine storm, as it attempts to tackle the virus. Anti-inflammatories can dampen this response.

In the randomised control trial, 741 coronavirus patients in Brazil were given fluvoxamine twice a day for 10 days while 756 received a placebo. The participants – who were unvaccinated, had been recently infected with Covid and were at risk of severe disease due to underlying health issues, such as diabetes – were then tracked for 28 post treatment.

Of those who received fluvoxamine, 79 spent were admitted to hospital, compared to 119 in the control group – reducing the chance of severe illness by a third.

Experts did concede that the exact dosage may not yet have been perfected, as some patients struggled to take the drug and dropped out.

But, of those who largely followed the doctors’ orders, the benefits were even more apparent: one patient given the fluvoxamine died, compared with 12 people who took the placebo.

'Inexpensive, widely available and effective'

The trial, led by researchers in Canada, the United States and Brazil, is the largest to date assessing the value of fluvoxamine at tackling Covid, but builds on several smaller studies with promising results.

Experts say the findings could have significant implications in lower income countries. While IV treatments cost around $2,000 and Merck Sharp & Dohme's antiviral has a price tag of roughly $700, a 10 day course of fluvoxamine would be just $4.

“Covid-19 still poses a risk to individuals in countries with low resources and limited access to vaccinations,” said Dr Edward Mills, a professor at McMaster University in Canada and co-author of the paper.

“Identifying inexpensive, widely available, and effective therapies against Covid-19 is therefore of great importance, and repurposing existing medications that are widely available and have well-understood safety profiles is of particular interest.”

The authors, however, note that fluvoxamine isn't on the World Health Organization's list of essential medicines, while scientists not involved in the research said it is not yet clear whether the drug would have the same impact among those who are vaccinated or those who do are not at high risk of Covid-19 complications.

“While promising, particularly as this product is inexpensive and could be made widely available, the impact on more severe outcomes remains uncertain,” said Penny Ward, a visiting professor in pharmaceutical medicine at King’s College London.

“Given the level of protection against severe disease offered by vaccination, the potential additional benefit of this agent in alleviating breakthrough infection and illness is uncertain as vaccinated patients were excluded from the trial.”

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