Natural Products for Neuroprotection and Anti-Ageing (Neur-Age Natura) Research Unit, Chulalongkorn University, Bangkok, 10330, Thailand.
Department of Clinical Chemistry, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand.
Sci Rep. 2024 Jun 12;14(1):13462. doi: 10.1038/s41598-024-64260-9.
There have been 774,075,242 cases of COVID-19 and 7,012,986 deaths worldwide as of January 2024. In the early stages of the pandemic, there was an urgent need to reduce the severity of the disease and prevent the need for hospitalization to avoid stress on healthcare systems worldwide. The repurposing of drugs to prevent clinical deterioration of COVID-19 patients was trialed in many studies using many different drugs. Fluvoxamine (an SSRI and sigma-1 receptor agonist) was initially identified to potentially provide beneficial effects in COVID-19-infected patients, preventing clinical deterioration and the need for hospitalization. Fourteen clinical studies have been carried out to date, with seven of those being randomized placebo-controlled studies. This systematic review and meta-analysis covers the literature from the outbreak of SARS-CoV-2 in late 2019 until January 2024. Search terms related to fluvoxamine, such as its trade names and chemical names, along with words related to COVID-19, such as SARS-CoV-2 and coronavirus, were used in literature databases including PubMed, Google Scholar, Scopus, and the ClinicalTrials.gov database from NIH, to identify the trials used in the subsequent analysis. Clinical deterioration and death data were extracted from these studies where available and used in the meta-analysis. A total of 7153 patients were studied across 14 studies (both open-label and double-blind placebo-controlled). 681 out of 3553 (19.17%) in the standard care group and 255 out of 3600 (7.08%) in the fluvoxamine-treated group experienced clinical deterioration. The estimated average log odds ratio was 1.087 (95% CI 0.200 to 1.973), which differed significantly from zero (z = 2.402, p = 0.016). The seven placebo-controlled studies resulted in a log odds ratio of 0.359 (95% CI 0.1111 to 0.5294), which differed significantly from zero (z = 3.103, p = 0.002). The results of this study identified fluvoxamine as effective in preventing clinical deterioration, and subgrouping analysis suggests that earlier treatment with a dose of 200 mg or above provides the best outcomes. We hope the outcomes of this study can help design future studies into respiratory viral infections and potentially improve clinical outcomes.
截至 2024 年 1 月，全球范围内已报告 COVID-19 病例 774075242 例，死亡 7012986 例。在大流行的早期阶段，迫切需要降低疾病的严重程度，防止需要住院治疗，以避免全球医疗系统的压力。许多研究尝试使用许多不同的药物将药物重新用于预防 COVID-19 患者的临床恶化。氟伏沙明（SSRIs 和 sigma-1 受体激动剂）最初被确定为可能对 COVID-19 感染患者提供有益作用，可预防临床恶化和住院治疗的需要。迄今为止，已经进行了 14 项临床研究，其中 7 项是随机安慰剂对照研究。这项系统评价和荟萃分析涵盖了自 2019 年底 SARS-CoV-2 爆发以来的文献，直至 2024 年 1 月。文献数据库（包括 PubMed、Google Scholar、Scopus 和 NIH 的 ClinicalTrials.gov 数据库）中使用了与氟伏沙明相关的检索词，如商品名和化学名，以及与 COVID-19 相关的词，如 SARS-CoV-2 和冠状病毒，以确定随后分析中使用的试验。在可用的情况下，从这些研究中提取了临床恶化和死亡数据，并在荟萃分析中使用了这些数据。共有 14 项研究（包括开放标签和双盲安慰剂对照）研究了 7153 名患者。在标准护理组中，3553 例中有 681 例（19.17%）和氟伏沙明治疗组中 3600 例中有 255 例（7.08%）出现临床恶化。估计平均对数优势比为 1.087（95%CI 0.200 至 1.973），与零显著不同（z=2.402，p=0.016）。这 7 项安慰剂对照研究得出的对数优势比为 0.359（95%CI 0.1111 至 0.5294），与零显著不同（z=3.103，p=0.002）。这项研究的结果表明氟伏沙明在预防临床恶化方面有效，亚组分析表明，使用 200mg 或更高剂量的早期治疗可提供最佳结果。我们希望这项研究的结果可以帮助设计未来关于呼吸道病毒感染的研究，并可能改善临床结果。
