Since the beginning of this pandemic, doctors and researchers have been working hard to treat Covid-19 patients, as there were large numbers of patients in hospitals for over a year. Therefore, most trials for Covid-19 treatment are not suspended yet. In large-scale clinical trials, these drugs either produce no results or show a little bit of effect. However, most of the few active medicines are expensive, so they are not easily accessible for everyone.
The FDA has permitted emergency approval to several Covid-19 treatments. Unfortunately, in many of them, there is limited evidence and more negligible effects. But they hoped that repurposing of antiviral drugs could be effective for the treatment. For this hope, they routinely administered many of them, and at least one showed to decrease the length of hospital stay for the patients. But, unfortunately, some studies did not show any effect on mortality.
Current Covid-19 treatment options
There are two types of Covid-19 treatments. The first treatment option is for a severe infection and is often administered to the hospitalized patients at risk of death. The second option helps stop the onset of illness that potentially reduces the chances of being hospitalized a Covid-19 patient at all.
1. Convalescent plasma is a treatment option telling the same story. In this technique, they transfuse blood proteins from the recovered Covid-19 patients into the infected person. But, unfortunately, this treatment also mostly looks ineffective after continuous research over a year because there are still many things that we do not know yet.
2. Besides, hydroxychloroquine is an antimalarial drug, which President Trump enthusiastically recommended last year. But, unfortunately, it has proved to have no computable effects against coronavirus.
3. In contrast, health regulators have approved few advanced treatment options, such as monoclonal antibodies. In these types of drugs, proteins mimic the immune system’s response to disease. But FDA approved this treatment option only for those Covid-19 patients who have severe illness and a higher risk of death. Additionally, a doctor must deliver it via four injections or infused intravenously that costs are very high. The bad thing is that monoclonal antibodies can effectively work at the pre-hospitalization stage. However, it is strategically challenging to administer such an expensive treatment for people with mild symptoms and just tested positive for Covid-19.
4. Corticosteroids are effective anti-inflammatory drugs. Past studies have shown that administering dexamethasone (one of the cheap steroids) as an infusion or a pill in the hospitalized Covid-19 patients reduces the risk of death. But unfortunately, this drug has an adverse effect. It constrains the patients’ immune system, so not currently recommending the covid-19 treatment.
Fluoxetine showed promising results for Covid-19 treatment
However, scientists are still looking for new, outpatient, and cheap Covid-19 treatments that do not need clinicians to administer the drug in a medical setting and reduce the risk of hospitalization in the first dose.
For this purpose, researchers from McMaster University have tested eight different Covid-19 treatments in a randomized, extensive clinical trial. This trial lasted over the past six months against a control group. The study involved thousands of patients in finding out what these treatments work.
During this effort, one drug called fluoxetine came into the light that fulfills the entire above requirement. In addition, this antidepressant drug has already been approved by the Food and Drug Administration. Furthermore, it is also more economical to produce generic medicine.
Fluvoxamine could control the hospital admission due to Covid-19 infection
The new findings from the current large-scale study support some of the promising results obtained last year in some small-scale trials. In these small-scale studies, the researchers found that fluoxetine was highly effective in controlling hospital admissions of Covid-19 patients. However, sometimes small-scale trials can lead to fake good results, so the researchers restrained these findings due to too many warnings.
The current study is named as TOGETHER study. It involved more than 3,000 participants, including 800 patients in the fluvoxamine group. The study supports all the promising results obtained from the past reflections on covid-19 treatment.
When they administered fluoxetine to Covid-19 patients who tested positive a few days ago, they found that about 31% of patients were less likely to be admitted to the hospital and went on a ventilator. However, the study did not conclude the results. The error bars were too wide due to the rare deaths when they figured out how fluoxetine could reduce death.
How does fluvoxamine help in the Covid-19 treatment?
Angela Reiersen is a psychiatrist studying a unique genetic disorder called Wolfram syndrome at Washington University in St. Louis. Years ago, when the novel coronavirus did not infect the first patient, Reiersen found that fluvoxamine binds to an extracellular receptor in the cells responsible for regulating cellular stress responses in her patients with this genetic disorder. Because of these responses, cells produce cytokines that tell our body that something is wrong and causing inflammation.
At that time, the Covid-19 pandemic hit. Some scientists believed that Covid-19 infection causes damage to the lung cells resulting in the release of cytokines. In turn, it results in inflammation in the lungs. Consequently, it causes difficulty breathing and lasting tissue damages. Thus, at the start of the pandemic, Reiersen offers a wild idea that fluvoxamine might help in the Covid-19 treatment.
The current study confirms the promising finding of past small-scale studies
Among all the previous small-scale studies, the study at Washington University was promising to confirm the current findings. Eric Lenze, a clinical researcher at the Washington University School of Medicine in St. Louis. When Reiersen offered a wild idea about the fluvoxamine that could help in Covid-19 treatment, she agreed to test it with a randomized, short controlled trial. Lenze, along with the team and Reiersen, started that trial by April 10.
They recruited and treated Covid-19 patients throughout the whole spring and summer. They found results of the 152 participants by the fall. Half participants belonged to the placebo group that was receiving a sugar pill instead of an active drug. Similarly, half of the participants belonged to the fluvoxamine group. Among all the placebo group participants, six patients had met the threshold of that study for respiratory difficulties. On the other hand, in the fluvoxamine group, none of them had any respiratory complications. That study was published in the Journal of the American Medical Association.
Furthermore, another passed trial confirmed the evidence when they gave fluvoxamine to the 65 infected patients in California. Among all of them, about 48 patients declined to take it. Among the patients who took it, none of them went to the hospital. On the other hand, six patients who refused to take it needed to be hospitalized.
What makes this Covid-19 treatment interesting?
Since fluvoxamine is a cheap and FDA-approved drug for obsessive-compulsive disorder (OCD), doctors can easily prescribe an off-label pill for Covid-19. It means it does not need to be given by a medical professional or in a hospital.
It makes this study a potentially big deal in the future. However, it has just been released, and clinicians are still looking at this drug to decide whether they prescribe fluvoxamine or not. Moreover, future studies could also check this finding.
Furthermore, it was a large and well-designed study. Scientists think that it confirms several past small-scale studies. Thus, the current and past small-scale studies on the Covid-19 treatment are pointing towards the same direction.
Despite all these efforts, the researchers still need more studies to determine the death rate and know how fluvoxamine influences Covid-19 patients. Nevertheless, the way researchers go head over heels for the drugs as a possible Covid-19 treatment option is a valuable story in itself about the scientific process and the hidden and often anonymous works. In conclusion, the outcomes of this trial might provide a new Covid-19 treatment option in the future. Hopefully, it would help humanity fight against this pandemic.
Most of the studies involved in the Covid-19 treatments that have been included in the trials are not over. A new and large study suggests that fluoxetine, a cheap antidepressant drug, may act differently. Although, until now, several drugs have been introduced for the Covid-19 treatment, no one is effective now. In this study, researchers used extensive data and found fluoxetine as a promising drug that can reduce the risk of hospitalized Covid-19 patients. Additionally, it does not require any clinical professional to administer the medication, unlike the monoclonal antibodies. Besides, it is inexpensive enough to produce as a generic medicine around the world.
However, researchers need further studies because a short-scale trial is not enough to tell the whole story. For this purpose, Lenze and Reiersen have started recruiting for a larger-scale trial. They are looking for more evidence for fluvoxamine. They tried to find whether fluvoxamine could be a primary Covid-19 treatment in the future. At the same time, they also hope that the findings from this trial might provide a new Covid-19 treatment option. And it would help people fight against this infection in the future.