Antidepressant reduces hospital stay for covid-19, study says

posted on 10/28/2021 06:00

Nurse assists a covid-19 patient at Santa Casa de Belo Horizonte: 1,497 volunteers participated in the research - (credit: Douglas Magno/AFP - 1/6/20)

Nurse assists a covid-19 patient at Santa Casa de Belo Horizonte: 1,497 volunteers participated in the research – (credit: Douglas Magno/AFP – 1/6/20)

An antidepressant can help in the recovery of patients with covid-19, concluded a Brazilian study, carried out in partnership with Canadian scientists. Experts noted in the study, with the participation of more than a thousand people, that the drug fluvoxamine, used to treat behavioral disorders, reduced the hospitalization time of patients infected with the virus Sars-CoV-2. The work, published in the latest issue of the specialized magazine The Lancet Global Health, presents a safer and cheaper therapy option for the treatment of the new coronavirus.

The TOGETHER pharmacological research partnership emerged in June 2020, a few months after the virus emerged, with the aim of evaluating the effectiveness of existing drugs in combating covid-19. “Our priority was to find a therapy that generated real gains for patients and that could be safely tested. For this, we had the help of partners from McMaster University, in Canada, who were carrying out similar studies and who had more advanced analysis tools to help us”, said to Correio Gilmar Reis, main author of the study and adjunct professor of the Department of Medicine of the Pontifical Catholic University of Minas Gerais (PUC-MG).

To study the use of fluvoxamine, researchers recruited Brazilian adults who tested positive for covid-19, were symptomatic, had not been vaccinated, and had at least one risk factor, such as diabetes or cardiovascular problems (comorbidities). During the analyses, a group of 741 participants received 100mg of fluvoxamine, twice a day, for 10 days. Another 756 volunteers took a placebo. All participants were followed for 28 days.

After treatment, the scientists observed that among the first group, which received the antidepressant drug, 79 people (10.6%) required an extended stay (for more than six hours) in an emergency setting or hospitalization, compared with 119 (15.7%) participants who received the placebo. The researchers praised the verified results.

Fewer deaths

“This represents a very important gain for us, especially after the situation we are experiencing here in Brazil, with overcrowded hospitals and patients who needed to return home still in serious condition, as they could not be treated in medical centers”, highlighted Reis. Although mortality was not a focus of the study, in a secondary analysis the researchers found that among patients who took the medication, only one death was recorded compared with 12 deaths in the placebo group.

The paper’s authors explained that fluvoxamine, a selective serotonin reuptake inhibitor (SSRI) currently used to treat mental health conditions such as depression and Obsessive Compulsive Disorder (OCD), yielded positive results due to its anti-inflammatory properties. “We had the suspicion that fluvoxamine could reduce the production of inflammatory molecules called cytokines, which can be triggered by the SarS-CoV-2 infection, as we saw, in previous studies, a potential in the use of this drug in combating other infections, like sepsis”, reported the researcher. “The drug helped to treat this inflammation, which was reflected in the reduced length of stay.”

For the study’s lead author, the results of the experiment are even more important when considering the cost of the drug used, which is much lower than the drugs currently available for the treatment of the new coronavirus. “One of the few really effective therapies for this disease are monoclonal antibodies, but they are extremely expensive and, therefore, it would be very difficult to include them in our Unified Health System (SUS)”, explained Gilmar Reis.

“Covid-19 still poses a risk to individuals in countries with limited resources and limited access to vaccination. Therefore, it is very important to take advantage of existing drugs that are widely available and have well-understood safety profiles,” said Edward Mills, a researcher at McMaster University and co-author of the study, in a press release.

promising horizon

An infectious disease specialist at Hospital Santa Lúcia, in Brasília, Werciley Junior also considered that the main highlight of the study is the possibility of using a cheaper drug to treat covid-19. “These are very encouraging results, seen in a well-done investigation and with a considerable number of participants. It is clear that we need more analysis to confirm this efficacy, but we have a promising horizon, of benefits obtained with a drug that is already used in the country and that can be accessed by everyone”, he highlighted.

“Monoclonal antibodies cost more than R$15,000 to treat a single patient. Therefore, we need to have alternatives, especially in less favored countries”, added the expert. Another point highlighted by Werciley Junior is the leading role of Brazilians in the area of ​​research during the pandemic. “It’s great to have valuable studies like this, coordinated in our country”, he praised.

Brazilian and Canadian scientists will continue the research. They intend to publish future studies with more results related to fluvoxamine, in addition to other drugs that are also being tested in partnership.

expert word

Necessary deepening

“Despite important findings from the TOGETHER trial, some issues related to the efficacy and safety of fluvoxamine for patients with covid-19 need to be further addressed. The definitive answer about the effects of this drug in relation to mortality, for example, still needs to be addressed. It is also necessary to determine whether fluvoxamine has an additive effect to other therapies, such as monoclonal antibodies and budesonide (anti-inflammatory), and what is the ideal therapeutic regimen for this drug. It remains unclear whether the TOGETHER trial results extend to other populations of outpatients with covid-19, including those without risk factors for disease progression, those who are fully vaccinated, and those infected with the delta strain or other variants. recent.” Otávio Berwanger, member of the Academic Research Organization at Hospital Israelita Albert Einstein, in São Paulo, in a commentary published in The Lancet Global Health.

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