Abstract
The rapid spread of COVID-19 has become a health emergency causing an urgent need for drug treatments to control the outbreak, especially in more vulnerable individuals. This is reinforced by the fact that prophylactic vaccines and neutralizing monoclonal antibodies may not be fully effective against emerging variants. Despite all efforts made by the scientific community, efficient therapeutic options currently remain scarce, either in the initial, as well as in the advanced forms of the disease. From retrospective observational studies and prospective clinical trials, selective serotonin reuptake inhibitors (SSRIs), and other antidepressants with functional inhibition of acid sphingomyelinase (FIASMAs), have emerged as potential treatments of COVID-19. This has led to some prematurely optimistic points of view, promoting a large prescription of fluvoxamine in patients with COVID-19, that we think should be reasonably tempered.
Highlights
Many studies have proposed potential therapeutic approaches for treatment of COVID-19, especially for COVID-19 patients who are not hospitalized nor severely ill
We would like to point out three important methodological limitations of the current larger study by Reis (Reis et al, 2021) related to the primary endpoint, the absence of control in affectivity, and to the fluvoxamine dosing regimen that deserved discussion
The use of a composite criterion constitutes a strong limitation of this study
Summary
Many studies have proposed potential therapeutic approaches for treatment of COVID-19, especially for COVID-19 patients who are not hospitalized nor severely ill. A more powered retrospective observational study involving 3,401 patients with a medication order for a SSRI prescribed within a period ranging from 10 days before to 7 days after COVID-19 diagnosis, showed that SSRIs, and fluoxetine, have been associated with a reduced severity of COVID-19, as shown by a reduced relative risk of mortality (Oskotsky et al, 2021). Another retrospective study on 269 in hospitalized patients with pneumonia found a lower mortality rate in patients receiving fluoxetine (Németh et al, 2021). A meta-analysis has concluded that fluvoxamine has not shown significant efficacy in reducing either the mortality rates or mechanical ventilation while promising results in decreasing the likelihood for Frontiers in Pharmacology | www.frontiersin.org
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