Association of fluvoxamine with mortality and symptom resolution among inpatients with COVID-19 in Uganda: a prospective interventional open-label cohort study

Bruce J Kirenga*, Levicatus Mugenyi, Marina Sánchez-Rico, Henry Kyobe, Winters Muttamba, Raymond Mugume, Eliya Mwesigwa, Ezra Kalimo, Vicky Nyombi, Ivan Segawa, Loryndah Olive Namakula, Rogers Sekibira, Wilberforce Kabweru, Rosemary Byanyima, Hellen Aanyu, Pauline Byakika-Kibwika, Henry G Mwebesa, Nicolas Hoertel, William Bazeyo

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)
4 Downloads (Pure)

Abstract

Prior research suggests that fluvoxamine, a selective serotonin reuptake inhibitor (SSRI) used for the treatment of obsessive-compulsive disorder and major depressive disorder, could be repurposed against COVID-19. We undertook a prospective interventional open-label cohort study to evaluate the efficacy and tolerability of fluvoxamine among inpatients with laboratory-confirmed COVID-19 in Uganda. The main outcome was all-cause mortality. Secondary outcomes were hospital discharge and complete symptom resolution. We included 316 patients, of whom 94 received fluvoxamine in addition to standard care [median age, 60 years (IQR = 37.0); women, 52.2%]. Fluvoxamine use was significantly associated with reduced mortality [AHR = 0.32; 95% CI = 0.19–0.53; p < 0.001, NNT = 4.46] and with increased complete symptom resolution [AOR = 2.56; 95% CI = 1.53–5.51; p < 0.001, NNT = 4.44]. Sensitivity analyses yielded similar results. These effects did not significantly differ by clinical characteristic, including vaccination status. Among the 161 survivors, fluvoxamine was not significantly associated with time to hospital discharge [AHR 0.81, 95% CI (0.54–1.23), p = 0.32]. There was a trend toward greater side effects with fluvoxamine (7.45% versus 3.15%; SMD = 0.21; χ2 = 3.46, p = 0.06), most of which were light or mild in severity and none of which were serious. One hundred mg of fluvoxamine prescribed twice daily for 10 days was well tolerated and significantly associated with reduced mortality and with increased complete symptom resolution, without a significant increase in time to hospital discharge, among inpatients with COVID-19. Large-scale randomized trials are urgently needed to confirm these findings, especially for low- and middle-income countries, where access to vaccines and approved treatments against COVID-19 is limited.
Original languageEnglish
Number of pages8
JournalMolecular Psychiatry
DOIs
Publication statusPublished - 3 Mar 2023

Fingerprint

Dive into the research topics of 'Association of fluvoxamine with mortality and symptom resolution among inpatients with COVID-19 in Uganda: a prospective interventional open-label cohort study'. Together they form a unique fingerprint.

Cite this