In a preliminary study of COVID-19 patients with mild-to-moderate disease who were attempting to recover in their homes, researchers at Washington University School of Medicine have found that the anti-depressant drug fluvoxamine seems to prevent some of the most serious complications of the illness, and makes hospitalization and the need for supplemental oxygen less likely.

The study involved 152 people infected with SARS-CoV-2, the virus that causes COVID-19. Researchers compared the outcomes of those treated with fluvoxamine to the outcomes of those given an inactive placebo. After 15 days, none of the 80 people who had received the drug experienced serious clinical deterioration. Meanwhile, six of the 72 given placebo (8.3%) became seriously ill, with four requiring hospitalization.

FLUVOXAMINE—SHOWN IN THE MOLECULAR FORMULA ABOVE—IS OFTEN USED TO TREAT OBSESSIVE-COMPULSIVE DISORDER AND DEPRESSION. Image courtesy of Shutterstock

“The patients who took fluvoxamine did not develop serious breathing difficulties or require hospitalization for problems with lung function,” says the study’s first author, Eric Lenze, MD, Washington University psychiatrist at Barnes-Jewish Hospital. “Most investigational treatments for COVID-19 have been aimed at the very sickest patients, but it’s also important to find therapies that prevent patients from getting sick enough to require supplemental oxygen or to have to go to the hospital. Our study suggests fluvoxamine may help fill that niche.”

Fluvoxamine is used commonly to treat obsessive-compulsive disorder (OCD), social anxiety disorder and depression. It is in a class of drugs known as selective serotonin-reuptake inhibitors (SSRIs), but unlike other SSRIs, fluvoxamine interacts strongly with a protein called the sigma-1 receptor. That receptor also helps regulate the body’s inflammatory response.

“There are several ways this drug might work to help COVID-19 patients, but we think it most likely may be interacting with the sigma-1 receptor to reduce the production of inflammatory molecules,” says Angela Reiersen, MD, Washington University psychiatrist at Barnes-Jewish Hospital and the study’s senior author. “Past research has demonstrated that fluvoxamine can reduce inflammation in animal models of sepsis, and it may be doing something similar in our patients.”

Our goal is to help patients who are initially well enough to be at home and to prevent them from getting sick enough to be hospitalized.

Reiersen says the drug’s effects on inflammation could prevent the immune system from mounting an overwhelming response, which is thought to occur in some people with COVID-19 who seem to improve after a few days of illness and then worsen. Many of those patients end up hospitalized, and some die.

In an innovative twist to research during the pandemic, the study was conducted remotely. When a symptomatic patient tested positive for COVID-19 and enrolled in the study, research staff delivered the medication or inactive placebo to them, along with thermometers, automatic blood pressure monitors and fingertip oxygen sensors.

STAFF OF THE HEALTHY MIND LAB PACK MEDICATION AND MEDICAL EQUIPMENT FOR PARTICIPANTS IN A COVID-19 CLINICAL TRIAL. Photo by Matt Miller, Washington University School of Medicine

“Our goal is to help patients who are initially well enough to be at home and to prevent them from getting sick enough to be hospitalized,” says Caline Mattar, MD, Washington University infectious diseases specialist at Barnes-Jewish Hospital. “What we’ve seen so far suggests that fluvoxamine may be an important tool in achieving that goal.”

For two weeks, study participants took either the antidepressant drug or placebo sugar pills while having daily interactions with members of the research team via phone or computer. That allowed participants to report on their symptoms, oxygen levels and other vital signs. If they suffered shortness of breath or were hospitalized for pneumonia, or their oxygen saturation levels fell below 92%, their conditions were considered to have deteriorated.

“The good news is that not a single person taking the active medication experienced deterioration,” Reiersen says. “We believe this drug may be the reason, but we need to study more patients to make sure.”

The researchers will begin a larger study in the next few weeks. Lenze, the director of the Healthy Mind Lab at the School of Medicine, is an expert in using mobile and internet technology to conduct clinical trials. He says that although this initial study involved people in the St. Louis region, the next phase of research will involve participants from throughout the country.

“We bring the study to the patients, giving them tools to monitor their health at home,” Lenze says. “Our hope is that we can keep these patients healthy enough to avoid hospitalization.”