A: Maybe. Maybe not. The evidence is promising, but we still need more information.
⬇️ Read on for the why, what we know, and what we don’t yet know.
WHY THIS WORKS?
Recently, people have focused on using medications that already exist to help treat people who have COVID-19 and help them get better sooner. One group of medications that may be able to decrease the negative effects of having COVID-19 include medications known as Sigma-1 Receptor Ligands (Sig-1R) ligands. Some antidepressants fit into this category and have recently been studied, especially Luvox (Fluvoxamine). Luvox has previously been researched in lab, animal, and human models to understand if it can be an effective treatment for decreasing the negative effects of other coronaviruses and even cancer.
The reason this may work is because Luvox is a Sig-1R ligand. Sig-1R is located on the endoplasmic reticulum (ER) inside the cytoplasm of the cell. If you need a quick refresher on where this is, please see here. In simple terms, the ER is involved with helping the virus to replicate. By using a Sig-1R ligand, this could be interrupted. Researchers are still trying to understand how this works with Luvox. It could be explained by its role in decreasing the anti-inflammatory response (i.e. cytokine production), direct antiviral action (by harming the virus itself or eating it up – lysosomal or macrophagal properties), or by anti platelet properties that antidepressants have (by helping to stop blood clots from forming). It is not yet clear how this works, but these are some potential ways Luvox helps people with COVID-19 get better sooner.
WHAT WE KNOW (BRIEFLY):
In an early randomized controlled trial (RCT) in 2020 of 152 adult outpatients with COVID-19, of the 80 people who received high doses of Luvox (100mg three times a day) none (0%) had clinical worsening of symptoms (going to hospital or needing oxygen) in the 15 days measured. Of the 72 people who did not receive Luvox, 6 had clinical worsening of symptoms (8.3%). This difference was significant but it was a small sample. Another study of 113 people who tested positive for SARS CoV-2 showed similar results. Of the 65 people who received Luvox (50mg twice daily), none were hospitalized (0%) or had worse symptoms in the 14 days of follow up. Of the 48 people who did not receive Luvox, 6 people got worse (12.5%). The two groups were fairly similar. This study also had a small sample.
In a more recent and larger study of 1497 people completed in Brazil, 741 people were given Luvox and 756 received a placebo. The researchers measured the main event of hospitalization or long stay in the emergency room (ER) and compared the likelihood that people from each group would have one of these events. People received 100mg of Luvox twice daily. Among people in the Luvox group, 79 people were hospitalized or stayed longer in the ER (11%) compared to 119 people in the placebo group (16%). Based on the statistical analysis in the study, Luvox appeared to be associated with lower risk of hospitalization or longer stay in the ER.
In all studies, people who received Luvox did not seem to have more adverse events (bad side effects related or unrelated to the medication) than people who did not receive Luvox.
WHAT WE DON’T KNOW:
We don’t know exactly how Luvox works-there are some hypotheses, but it is not clear. This may or may not be problematic since we are still also learning a great deal about SARS CoV-2.
We also don’t know if medications that are widely available like Prozac (Fluoxetine) could work similarly. One recent observational study suggests that this might be the case, but there are many factors that are still not known about this (And this study in particular measured a different outcome, death.)
Finally, we need more information before we can draw conclusions that would influence clinical care. It isn’t clear WHO will benefit the most from receiving a treatment like Luvox, WHEN one should receive it, and at WHAT dose benefits can be achieved. We also don’t know IF the reduction of risk of hospitalization should be what is measured or if there are also other outcomes that may be important to consider with respect to Luvox treatment.
Still, Luvox is relatively low cost when compared to other treatments. It may be an option for lower resource settings as a way to increase access to treatments that can reduce the risk of worsening illness and even death as a result of COVID-19 disease.
THE BOTTOM LINE:
It is too soon to tell if Luvox may improve outcomes for people with COVID-19. We need to know more about many factors and we need more data from studies to understand who will benefit, at what dose and which other treatments we should use, and how we should measure the benefits.
➡️ Luvox may be beneficial for some people in the future. But for now, we should stick to the approved treatments.
Stay safe. Stay sane.
With Love,
Those Nerdy Girls
Additional Links:
Infectious Disease Society of America COVID-19 Treatment Guidelines
