Current COVID Treatments Explained As Antidepressant Fluvoxamine Shows Promise in Study

A recent study in The Lancet detailed the potential of fluvoxamine, an anti-depressant, as a possible antiviral that could be used in the treatment of COVID.

The study, the first large randomized trial, according to The Lancet, for fluvoxamine that is currently used to treat severe depression and obsessive-compulsive disorder, reported that treatment with the drug in high-risk outpatients with early diagnosed COVID-19 seemed to reduce the need for continued hospitalization.

The researchers found a reduction in relative risk reduction of 32 percent, almost a third, in extended hospital stays or transfer to another facility, between their patients who received fluvoxamine, compared to those who didn't.

Independent pharmaceutical physician and visiting professor in pharmaceutical medicine at King's College London, Penny Ward, was not involved in the study. She said in a statement: "While promising, particularly as this product is inexpensive and could be made widely available, the impact on more severe outcomes remains uncertain."

She adds that given the level of protection against severe disease offered by vaccination, the potential additional benefit of fluvoxamine in alleviating breakthrough infection isn't clear because vaccinated patients were excluded from the trial.

Ward also points out that as high-risk groups were also not included in the trial that the patients studied may not be reflective of the wider population, especially for those at high risk of hospitalization/death from COVID.

Battling the COVID pandemic has become one of the medical profession's main concerns over the past two years, with the development of new vaccines at the forefront of innovation. But, alongside these preventative measures, researchers are also working on possible treatments for COVID like fluvoxamine.

Though for milder COVID cases, rest, fluids, and medicine to reduce fevers may be sufficient, more severe cases that require hospitalization are currently treated with supplemental oxygen, assisted ventilation, and other supportive measures, a recent report from Johns Hopkins said.

These supportive measures could include antiviral medications, which do not kill a virus but instead limit its ability to reproduce. Antivirals have been shown to be effective in the treatment of diseases like influenza shortening the duration of the illness and lessening complications in some people.

Because COVID is caused by a new virus, there is currently limited evidence regarding, which, if any, antivirals can be used in its treatment.

Microbiology expert Arturo Casadevall, M.D., Ph.D. and M.S, describes current COVID treatments that have been approved by the U.S. Food and Drugs Administration (FDA). He said: "Two drugs that have a role in treating severe COVID-19 infection are the anti-viral remdesivir, which recently received full FDA approval for treatment of hospitalized patients with COVID-19 and the corticosteroid dexamethasone."

What Is Remdesivir?

Remdesivir, originally developed to treat Ebola, was approved for use by the FDA in October 2020, after emergency use was in May 2020 following what appeared to be early positive trial results and intense media attention.

Yet, despite its approval by the FDA for the treatment of COVID, the effectiveness of remdesivir is still very much in question.

A study produced in August 2021 which looked at the effectiveness of remdesivir in the treatment of COVID concluded: "Based on the currently available evidence, we are moderately certain that remdesivir probably has little or no effect on all-cause mortality at up to day 28 in hospitalized adults with SARS-CoV-2 infection. We are uncertain about the effects of remdesivir on clinical improvement and worsening."

In a review of clinical trials of remdesivir, published in January 2021, however, the authors found that the antiviral did demonstrate some positive results in the treatment of COVID cases.

That research concluded: "Patients given remdesivir are more likely to demonstrate recovery and were associated with higher rates of hospital discharge, but not with a significant reduction in the mean time to clinical improvement or mortality."

Can Dexamethasone and Other Corticosteroids Treat COVID?

Dexamethasone isn't an antiviral, but a form of steroid called a corticosteroid. It is similar to a natural hormone produced by adrenal glands and is used in patients whose bodies cannot produce enough of the hormone.

The drug is used to relieve inflammation and in the treatment of a wide range of conditions including severe allergies, and asthma.

The World Health Organization (WHO) says that dexamethasone's anti-inflammatory and immunosuppressant effects have been shown to have benefits for critically ill COVID patients during a trial held in the United Kingdom.

On its website, the WHO says: "According to preliminary findings shared with WHO, for patients on ventilators, the treatment was shown to reduce mortality by about one third, and for patients requiring only oxygen, mortality was cut by about one fifth."

The WHO currently advises the use of dexamethasone and other corticosteroids to treat patients with severe and critical COVID infections, and advises against their use in mild and non-severe cases.

The options for the treatment of COVID are currently limited, but researchers continue trials with some other interventions delivering initially promising results.

The Johns Hopkins report points out that monoclonal antibodies— laboratory-engineered proteins that act like antibodies in the human immune system and fight disease —are currently being investigated as potential COVID treatments but results are varied.

Johns Hopkins infectious disease expert Paul Auwaerter added that in trials monoclonal antibody interventions have currently failed to show a benefit in reducing the mortality rates amongst COVID patients.

One drug that the FDA has withdrawn support for, with regards to the treatment of COVID, is the malaria drug, hydroxychloroquine.

The FDA revoked its authorization to use hydroxychloroquine to treat COVID-19, after a large, scientific study showed no benefit to patients treated with the drug.

Additionally, in July 2020, it warned of the drug's use outside hospital settings or clinical trials due to the risks the drug presents including its effect on the heart.

COVID Treatment
In a new a trial fluvoxamine showed some promise in reducing the hospital stays of patients with severe COVID. sittithat tangwitthayaphum/Getty