Evaluating fluvoxamine for the outpatient treatment of COVID‐19: A systematic review and meta‐analysis

Author:

Deng Jiawen12ORCID,Moskalyk Myron3ORCID,Zuo Qi Kang4ORCID,Garcia Cristian1ORCID,Abbas Umaima5ORCID,Ramaraju Harikrishnaa Ba6ORCID,Rayner Daniel7ORCID,Park Ye‐Jean12ORCID,Heybati Kiyan8ORCID,Zhou Fangwen9ORCID,Lohit Simran1ORCID

Affiliation:

1. Temerty Faculty of Medicine University of Toronto Toronto Ontario Canada

2. Li Ka Shing Knowledge Institute St. Michael's Hospital Toronto Ontario Canada

3. Biostatistics Division Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada

4. UBC Faculty of Medicine University of British Columbia Vancouver British Columbia Canada

5. Schulich School of Medicine & Dentistry (Windsor) Western University Windsor Ontario Canada

6. VCU School of Medicine Virginia Commonwealth University Richmond Virginia USA

7. Department of Health Research Methods, Evidence, and Impact Faculty of Health Sciences McMaster University Hamilton Ontario Canada

8. Mayo Clinic Alix School of Medicine (Jacksonville) Mayo Clinic Jacksonville Florida USA

9. Faculty of Health Sciences McMaster University Hamilton Ontario Canada

Abstract

AbstractThis systematic review and meta‐analysis of randomised controlled trials (RCTs) aimed to evaluate the efficacy, safety, and tolerability of fluvoxamine for the outpatient management of COVID‐19. We conducted this review in accordance with the PRISMA 2020 guidelines. Literature searches were conducted in MEDLINE, EMBASE, International Pharmaceutical Abstracts, CINAHL, Web of Science, and CENTRAL up to 14 September 2023. Outcomes included incidence of hospitalisation, healthcare utilization (emergency room visits and/or hospitalisation), mortality, supplemental oxygen and mechanical ventilation requirements, serious adverse events (SAEs) and non‐adherence. Fluvoxamine 100 mg twice a day was associated with reductions in the risk of hospitalisation (risk ratio [RR] 0.75, 95% confidence interval [CI] 0.58–0.97; I 2 = 0%) and reductions in the risk of healthcare utilization (RR 0.68, 95% CI 0.53–0.86; I 2 = 0%). While no increased SAEs were observed, fluvoxamine 100 mg twice a day was associated with higher treatment non‐adherence compared to placebo (RR 1.61, 95% CI 1.22–2.14; I 2 = 53%). In subgroup analyses, fluvoxamine reduced healthcare utilization in outpatients with BMI ≥30 kg/m2, but not in those with lower BMIs. While fluvoxamine offers potential benefits in reducing healthcare utilization, its efficacy may be most pronounced in high‐risk patient populations. The observed non‐adherence rates highlight the need for better patient education and counselling. Future investigations should reassess trial endpoints to include outcomes relating to post‐COVID sequelaes. Registration: This review was prospectively registered on PROSPERO (CRD42023463829).

Publisher

Wiley

Subject

Infectious Diseases,Virology

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