This is a randomized, double-blind, placebo-controlled, adaptive two-stage design, human phase 2 study, with add-on treatment arrangement of fluvoxamine or placebo on top of standard of care (base therapy: the actual proposed therapy of moderate SARS-CoV-2 infected patients according to "Hungarian Coronavirus Handbook", including antiviral and immunmodulant therapy and reconvalescent plasma therapy in serious cases as indicated by the investigator).
Drug: Placebo
po placebo tablets
Drug: Fluvoxamine
po fluvoxamine tablets
Inclusion Criteria:
- Males and females 18-70 years of age at screening
- Hospitalized patients with confirmed SARS-CoV-2 by PCR or known contact of confirmed
case with syndrome consistent with coronavirus disease (COVID-19) with PCR pending
(positive PCR result should be available prior to randomisation).
- Moderate cases (each of the followings met): showing dyspnoea but not manifest
respiratory distress, respiratory rate 22-29 / min; oxygen saturation at rest > 93%;
with or without the need for oxygen supplementation; pneumonia on medical imaging with
pulmonary infiltrates occupying ≤ 50% of the lung-fields
- Subjects who are able to communicate with the Investigator and research staff, who
understand the study, are able to comply with all study procedures, and willing to
provide written informed consent prior to the screening examinations.
Exclusion Criteria:
- Mild COVID-19 at randomisation (each of the followings met): no dyspnoea, respiratory
rate < 22 / min, no need for oxygen supplementation, no pneumonia on medical imaging
- Severe COVID-19 at randomisation: respiratory distress - respiratory rate ≥
30/min, oxygen saturation at rest ≤ 93%, pulmonary infiltrates occupy > 50% of
the lung-fields
- Critical COVID-19 at randomisation: acute respiratory distress, requiring
mechanical ventilation, radiomorphology of ARDS, shock, including septic shock,
other organ dysfunction necessitating ICU admission
- High-risk patient for progression of COVID-19, as defined by having a calculated
pneumonia PORT-score of > 90
- Concomitant or previous administration of any experimental, non-established
COVID-19 therapy, either in off-label indication (of a registered medicinal
product) or as a non-registered drug candidate in a clinical trial setting or
compassionate use program (or equivalents thereof), EXCEPT therapies recommended
by the "Magyar Koronavírus Kézikönyv" (Hungarian Coronavirus Manual), and as
such, are considered as standard-of-care. Concomitant use of LMWHs can be
considered as emerging standard-of-care, and therefore their application is not
prohibited.
- Standard of care treatment planned with chloroquine or hydroxychloroquine.
- Any clinically significant abnormality identified during pre-study full physical
examination, vital signs, laboratory tests and ECG which is deemed by the
Investigator to be incompatible / inappropriate for study participation.
- Known hepatitis B, C, or HIV infection.
- A current or recent history of drug or substance abuse, including alcohol (> 14
units per week), within 3 months prior to screening (one unit of alcohol equals ½
pint [285 mL] of beer or lager, one glass [125 mL] of wine, or one shot [25 mL]
of spirits)
- Patients who regularly consume more than 4 cups daily of beverage containing
caffeine
- Current strong smoker as defined by smoking over 10 cigarettes a day, or its
equivalent
- Positive pregnancy test result for women with childbearing potential at screening
- Women who are pregnant or nursing, or who are planning to get pregnant within 3
months after the last dose of study drug
- A history of allergy, intolerance or sensitivity to fluvoxamine or any component
of the study drug formulation
- Closed-angle glaucoma
- Patients who are assessed as at risk for suicidal intent during screening by
psychiatric evaluation (including C-SSRS questionnaire). A score of 15 or higher
on the PHQ-9 depression scale at screening.
- Have undergone surgery or have donated blood within 12 weeks prior to the start
of the study
- A history of bleeding diathesis or other bleeding disorders
- Participated in any clinical trial involving an investigational drug or
investigational device within 1 month preceding study entry, or within 5 terminal
half-life of the investigational drug of this previous study
- A history of or present malignancy, with the exception of resected basal cell
carcinoma or squamous cell carcinoma of the skin, or resected cervical
intraepithelial neoplasia.
Prohibited concomitant medications:
- Co-administration of fluvoxamine with monoamine oxidase inhibitors (MAOI), including
methylene blue (intravenous dye) and linezolid (an antibiotic which is a reversible
non-selective MAOI)
- Co-administration of thioridazine, mesoridazine, pimozide, terfenadine, astemizole, or
cisapride with fluvoxamine; each of these drugs alone produces prolongation of the QTc
interval, which is associated with serious ventricular arrhythmias, such as torsade de
pointes-type arrhythmias and sudden death
- Co-administration of tizanidine and fluvoxamine
- Co-administration of fluvoxamine with ramelteon
- Co-administration of fluvoxamine with chloroquine or hydroxychloroquine
- Co-administration of morphine, or other opioids.
Dél-pesti Centrumkórház
Budapest, Hungary
Semmelweis Egyetem Pulmonológiai Klinika
Budapest, Hungary
Országos Korányi Pulmonológiai Intézet
Budapest, Hungary
Debreceni Egyetem Kenézy Gyula Kórház Infektológia
Debrecen, Hungary