סקירה של יכולתו של פלובוקסמין למנוע אשפוז בחולי COVID-19

ממצאים עיקריים

סקירה ומטה-אנליזה זו בחנה את הראיות הקיימות לשימוש בפלובוקסמין לטיפול מוקדם ב-COVID-19 על מנת להפחית את שיעור האשפוזים.

נותחו נתונים משלושה ניסויים שכללו סך של 2,196 חולים. כל החולים לא היו מחוסנים, נמצאו חיוביים ל-COVID-19 (לפני דלתא או אומיקרון) וטופלו בבית עם פלובוקסמין או פלצבו.

התוצאות מצביעות על כך שטיפול ביתי מוקדם עם פלובוקסמין קשור בסיכון מופחת לאשפוז.

בהתבסס על ממצא זה, יחד עם פרופיל הבטיחות של התרופה, ניתן להמליץ ​​בבטחה על טיפול בפלובוקסמין לחולי COVID-19.

JAMA Network Open

Publication Date: אפריל 6, 2022
Peer Reviewed: Yes
Publication Type: Review/Commentary/Letter
DOI: https://www.doi.org/10.1001/jamanetworkopen.2022.6269

Fluvoxamine for Outpatient Management of COVID-19 to Prevent Hospitalization: A Systematic Review and Meta-analysis

Todd C. Lee, Simone Vigod, Émilie Bortolussi-Courval, Ryan Hanula, David R. Boulware, Eric J. Lenze, Angela M. Reiersen, Emily G. McDonald

Abstract

Importance:
Widely available and affordable options for the outpatient management of COVID-19 are needed, particularly for therapies that prevent hospitalization.

Objective:
To perform a meta-analysis of the available randomized clinical trial evidence for fluvoxamine in the outpatient management of COVID-19.

Data Sources:
World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov.

Study Selection:
Studies with completed outpatient trials with available results that compared fluvoxamine with placebo were included.

Data Extraction and Synthesis:
The PRISMA 2020 guidelines were followed and study details in terms of inclusion criteria, trial demographics, and the prespecified outcome of all-cause hospitalization were extracted. Risk of bias was assessed by the Cochrane Risk of Bias 2 tool and a bayesian random effects meta-analysis with different estimates of prior probability was conducted: a weakly neutral prior (50% chance of efficacy with 95% CI for risk ratio [RR] between 0.5 and 2.0) and a moderately optimistic prior (85% chance of efficacy). A frequentist random-effects meta-analysis was conducted as a senstivity analysis, and the results were contextualized by estimating the probability of any association (RR ≤ 1) and moderate association (RR ≤ 0.9) with reduced hospitalization.

Main Outcomes and Measures:
All-cause hospitalization.

Results:
This systematic review and meta-analysis of 3 randomized clinical trials and included 2196 participants. The RRs for hospitalization were 0.78 (95% CI, 0.58-1.08) for the bayesian weakly neutral prior, 0.73 (95% CI, 0.53-1.01) for the bayesian moderately optimistic prior, and 0.75 (95% CI, 0.58-0.97) for the frequentist analysis. Depending on the scenario, the probability of any association with reduced hospitalization ranged from 94.1% to 98.6%, and the probability of moderate association ranged from 81.6% to 91.8%.

Conclusions and Relevance:
In this systematic review and meta-analysis of data from 3 trials, under a variety of assumptions, fluvoxamine showed a high probability of being associated with reduced hospitalization in outpatients with COVID-19. Ongoing randomized trials are important to evaluate alternative doses, explore the effectiveness in vaccinated patients, and provide further refinement to these estimates. Meanwhile, fluvoxamine could be recommended as a management option, particularly in resource-limited settings or for individuals without access to SARS-CoV-2 monoclonal antibody therapy or direct antivirals.