A cheap antidepressant lowers the risk of Covid hospitalization, a large study finds.


Fluvoxamine for outpatients with COVID-19: where do we stand?

”…Fluvoxamine is a selective serotonin reuptake inhibitor commonly indicated for the management of depression, obsessive-compulsive disorders, and other mental-health conditions. Owing to potential anti-inflammatory effects observed in initial experimental non-clinical studies,3 fluvoxamine has been proposed as a potential therapy for COVID-19…In trial results published in 2020, 152 outpatients with mild COVID-19 were randomly assigned to receive 100 mg fluvoxamine three times daily or matching placebo for 15 days.5 The primary outcome was clinical deterioration, defined as shortness of breath or hospitalisation for shortness of breath or pneumonia, and oxygen saturation less than 92% on room air or need for supplemental oxygen to achieve oxygen saturation of 92% or greater. Within 15 days, none of the participants who received fluvoxamine and 8·3% of those who received placebo reached the primary endpoint (absolute risk difference 8·7%; 95% CI 1·8%–16·5%; p=0·009). Despite the promising results, limitations such as low statistical power and missing data for the primary outcome precluded definitive conclusions about the efficacy of fluvoxamine for the treatment of COVID-19….[RECENTLY] TOGETHER, a randomised, adaptive, platform, placebo-controlled trial.6 A total of 1497 participants were randomly allocated to fluvoxamine, 100 mg twice daily, or matching placebo. All included participants had a positive test for SARS-CoV-2 and known risk factors for disease progression (including age ≥50 years, diabetes, hypertension, obesity, smoking, conditions associated with immunosuppression, unvaccinated status, or comorbidities such cancer, cardiovascular, pulmonary, and kidney disorders). Enrolment occurred in 11 cities in Brazil. The primary endpoint was a composite of COVID-19 emergency setting retention for greater than 6 h or hospitalisation (defined as either retention in a COVID-19 emergency setting or transfer to tertiary hospital) from COVID-19 up to 28 days. Using a Bayesian analytical approach, the authors found that the proportion of patients reaching the primary endpoint was lower for the fluvoxamine group compared with placebo (11% vs 16%; relative risk: 0·68; 95% Bayesian credible interval 0·52–0·88), with a probability of superiority of 99·8%….Despite the important findings from the TOGETHER trial, some questions related to the efficacy and safety of fluvoxamine for patients with COVID-19 remain open. The definitive answer regarding the effects of fluvoxamine on individual outcomes such as mortality and hospitalisations still need addressing. In addition, it remains to be established whether fluvoxamine has an additive effect to other therapies such as monoclonal antibodies7 and budesonide,8 and what is the optimal fluvoxamine therapeutic scheme. Finally, it is still unclear whether the results from the TOGETHER trial extend to other outpatient populations with COVID-19, including those without risk factors for disease progression, those who are fully vaccinated, and those infected with the delta variant or other variants.


 FROM THE NYT  A 10-day course of the drug costs about $4.



Car mechanics tell you the truth. You never have to drive to another gas station restroom because this one is just too icky. You don’t have to stop and think of which way to turn a nut on a bolt. Wrinkles add character. Wedding dress — $5,000 Tux rental — $100. People never stare at your chest when you’re talking to them.

 New shoes normally don’t cut, blister, or mangle your feet. One mood all the time. Phone conversations are over in 30 seconds flat. You know stuff about tanks. A five-day vacation requires only one suitcase. You can open all your own jars.

You get extra credit for the slightest act of thoughtfulness. If someone forgets to invite you, he or she can still be your friend. Your underwear is $8.95 for a three-pack. Two pairs of shoes are more than enough. You almost never have strap problems in public. You are unable to see wrinkles in your clothes.


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