Fluvoxamine may reduce the odds of COVID-19 patient hospitalization
A new systematic review and meta-analysis of three randomized clinical trials with 2,196 patients suggests that early use of the antidepressant fluvoxamine reduces the risk of all-cause hospitalization in symptomatic adult outpatients.
Fluvoxamine, a selective serotonin reuptake inhibitor used to treat conditions such as obsessive compulsive disorder, also activates the sigma-1 receptor, which quells inflammation, the researchers noted.
McGill University researchers in Montreal led the study, which was published yesterday in JAMA Network Open. They extracted study data from the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov on Nov 12, 2021. All three clinical trials recruited unvaccinated COVID-19 outpatients with symptoms who had tested positive within 7 days of diagnosis but did not require supplemental oxygen.
The relative risk [RR] of a 50% chance of fluvoxamine effectiveness against hospitalization was 0.78, while it was 0.73 for an 85% chance of efficacy against hospital admission. A sensitivity analysis yielded an RR of 0.75.
Depending on the scenario, the odds of any link with reduced hospitalization after fluvoxamine treatment were 94.1% to 98.6%, and the probability of a moderate association were 81.6% to 91.8%.
Previous studies of fluvoxamine in COVID-19 patients have generated mixed results, and the Infectious Diseases Society of America recently recommended against its use in COVID-19 outpatients except in clinical trials. The study authors said, however, that widely available, safe, inexpensive options such as fluvoxamine, which costs about $1 a day, are needed for the prevention of COVID-19 hospitalization.
"Ongoing randomized trials are important to evaluate alternative doses, explore the effectiveness in vaccinated patients, and provide further refinement to these estimates," they wrote. "Meanwhile, fluvoxamine could be recommended as a management option, particularly in resource-limited settings or for individuals without access to SARS-CoV-2 monoclonal antibody therapy or direct antivirals."
Apr 6 JAMA Netw Open study
Home use of pulse oximeters for COVID-19 not linked to better outcomes
Asking COVID-19 patients to use a pulse oximeter at home to measure oxygen levels was no better than asking if they experienced shortness of breath in determining outcomes, according to new research in the New England Journal of Medicine.
The study was based on results seen in COVID Watch, a study from the University of Pennsylvania that sent text messages and monitoring prompts to patients with COVID-19 who were well enough to stay home to recover. The program launched in March 2020, with 28,500 patients using the program in the subsequent 2 years.
Previous studies showed that COVID Watch was linked with a 68% reduction in mortality. In this study, a randomized controlled trial was developed using 2,000 patients who were assigned either a pulse oximeter or the standard care without home oxygen measurements.
There were no significant mortality outcomes with patients using the oximeter, even when the patient population was divided by age, race, and sex. The authors wrote there was no significant between-group difference in the number of days that patients were alive and out of the hospital at 30 days (mean, 29.4 days in the pulse oximetry group and 29.5 days in the standard program group).
Having a pulse oximeter also did not lessen patient anxiety, the authors of the study said.
"Compared to remotely monitoring shortness of breath with simple automated check-ins, we showed that the addition of pulse oximetry did not save more lives or keep more people out of the hospital," said the study's co-lead author, Anna Morgan, MD, medical director of the COVID Watch program, in a University of Pennsylvania press release.
Apr 6 N Engl J Med study
Apr 6 University of Pennsylvania press release