Fluvoxamine vs Placebo and Clinical Deterioration in Outpatients With Symptomatic COVID-19: A Randomized Clinical Trial

In this double-blind study (n=152), fluvoxamine (100mg TDS) was associated with a lower rate of clinical deterioration over 15 days (0/80 vs 6/72 placebo; absolute difference of 8.7% [95% CI 1.8%-16.4%]; p=0.009). Larger trials with more definitive outcome measures are needed.

SPS commentary:

Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) with high affinity for the σ-1 receptor (S1R). It has been shown in previous studies to reduce damaging aspects of the inflammatory response during sepsis, through the S1R-IRE1 pathway.

The authors note the various limitations of this study, including its small size, conduct within a single geographic area, the small number of endpoints, the short duration of follow-up, and the fact that 20% of participants stopped responding to surveys during the 15-day trial (it was confirmed that these did not require hospitalisation or a visit to an emergency department, but they could have received care at an alternative urgent care centre).  Larger, longer-term trials with a more heterogeneous population are required to confirm these positive findings.

Journal of the American Medical Association