Higher-Dose Fluvoxamine and Time to Sustained Recovery in Outpatients With COVID-19
Thomas G. Stewart, Paulina A. Rebolledo, Ahmad Mourad, Christopher J. Lindsell, David R. Boulware, Matthew W. McCarthy, Florence Thicklin, Idania T. Garcia del Sol, Carolyn T. Bramante, Leslie Lenert, Stephen C. Lim, John Williamson, Orlando Quintero, Jake Scott, Tiffany Schwasinger‐Schmidt, Adit A. Ginde, Mario Castro, Dushyantha Jayaweera, Mark Sulkowski, Nina Gentile, Kathleen M. McTigue, G. Michael Felker, Allison DeLong, Rhonda Wilder, Russell L. Rothman, Sean P. Collins, Sarah E. Dunsmore, Stacey J. Adam, George J. Hanna, Elizabeth Shenkman, Adrian F. Hernandez, Susanna Naggie, Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV)-6 Study Group and Investigators, Ryan Fraser, Mark F. Ward, Jennifer Jackman, M. Patricia McAdams, Julia Vail, Kayla Korzekwinski, Martina Oyelakin, Julie Chopp, Desmon Randle, Samantha Dockery, Rodney H. Adkins, Mathew Crow, Erin Nowell, Kadie Wells, Alicia Herbert, Allegra Stone, Heather Heavlin, Linley Brown, Tina Harding, Amanda Harrington, Meaghan Beauchaine, Kelly Lindblom, Andrea Burns, David Aamodt, Jess Collins, Sheri Dixon, Yue Gao, John Graves, James Grindstaff, Frank E. Harrell, Jessica Lai, Vicky Liao, Itzel Lopez, Elizabeth Manis, Kalley Mankowski, Jessica Marlin, Alyssa Merkel, Sam Nwosu, Savannah Obregon, Dirk Orozco, Nelson Prato, Max Rohde, Jana Shirey-Rice, Krista Vermillion, Jacob Smith, Hsi‐nien Tan, Meghan Vance, Maria Weir, William Vincent, Raina Vincent, Ray Bianchi, Jen Premas, Diana Cordero-Loperena, E. M. Rivera, Madhu Gupta, Greg Karawan, Joseph Arena, Sonaly DeAlmeida, Soroush Ramin, Jaya Nataraj, Julien Dedier, Ana María Ramírez, Katherine Waite, Jason F. Okulicz, Joseph E Marcus, Alexis Southwell, Genice Jacques
Abstract
Importance: The effect of higher-dose fluvoxamine in reducing symptom duration among outpatients with mild to moderate COVID-19 remains uncertain. Objective: To assess the effectiveness of fluvoxamine, 100 mg twice daily, compared with placebo, for treating mild to moderate COVID-19. Design, Setting, and Participants: The ACTIV-6 platform randomized clinical trial aims to evaluate repurposed medications for mild to moderate COVID-19. Between August 25, 2022, and January 20, 2023, a total of 1175 participants were enrolled at 103 US sites for evaluating fluvoxamine; participants were 30 years or older with confirmed SARS-CoV-2 infection and at least 2 acute COVID-19 symptoms for 7 days or less. Interventions: Participants were randomized to receive fluvoxamine, 50 mg twice daily on day 1 followed by 100 mg twice daily for 12 additional days (n = 601), or placebo (n = 607). Main Outcomes and Measures: The primary outcome was time to sustained recovery (defined as at least 3 consecutive days without symptoms). Secondary outcomes included time to death; time to hospitalization or death; a composite of hospitalization, urgent care visit, emergency department visit, or death; COVID-19 clinical progression scale score; and difference in mean time unwell. Follow-up occurred through day 28. Results: Among 1208 participants who were randomized and received the study drug, the median (IQR) age was 50 (40-60) years, 65.8% were women, 45.5% identified as Hispanic/Latino, and 76.8% reported receiving at least 2 doses of a SARS-CoV-2 vaccine. Among 589 participants who received fluvoxamine and 586 who received placebo included in the primary analysis, differences in time to sustained recovery were not observed (adjusted hazard ratio [HR], 0.99 [95% credible interval, 0.89-1.09]; P for efficacy = .40]). Additionally, unadjusted median time to sustained recovery was 10 (95% CI, 10-11) days in both the intervention and placebo groups. No deaths were reported. Thirty-five participants reported health care use events (a priori defined as death, hospitalization, or emergency department/urgent care visit): 14 in the fluvoxamine group compared with 21 in the placebo group (HR, 0.69 [95% credible interval, 0.27-1.21]; P for efficacy = .86) There were 7 serious adverse events in 6 participants (2 with fluvoxamine and 4 with placebo) but no deaths. Conclusions and Relevance: Among outpatients with mild to moderate COVID-19, treatment with fluvoxamine does not reduce duration of COVID-19 symptoms. Trial Registration: ClinicalTrials.gov Identifier: NCT04885530.