This clinical trial aims to determine if fluvoxamine, a selective serotonin reuptake inhibitor with high affinity for the sigma-1 receptor, can be used in mild to moderate COVID-19 to prevent the progression to severe COVID-19. Fluvoxamine is an anti-depressant drug approved by the FDA for the treatment of obsessive-compulsive disorder and has a potential for immune modulation as a sigma-1 receptor agonist. The investigational use of fluvoxamine for the treatment of COVID-19 is approved by the South Korean Ministry of Food and Drug Safety. This study is performed fully-remotely at COVID-19 community treatment centers, temporary facilities in Seoul, Korea, to accommodate and monitor asymptomatic to moderately symptomatic case-patients who do not require hospital admission.
The investigators will randomize approximately 400 participants, age 18 and older, who have
laboratory-confirmed, mild to moderate COVID-19 and are admitted to community treatment
centers. All interactions for this study will be conducted remotely by videoconferencing,
mobile application, or phone.
Screening Phase: All patients admitted to community treatment centers receive self-monitoring
equipment, including an oxygen saturation monitor, blood pressure monitor, and thermometer.
All participants will first complete a pre-screen to see if they may be eligible for the
study. Once a participant is confirmed eligible and consented, the study team will deliver
study drugs to each participant room.
RCT Phase: Participants will be randomly assigned (1:1) to take either fluvoxamine or placebo
(ursodeoxycholate). This phase of the study will last until discharge from community
treatment centers (usually 10 days) and is single-blinded as the participants will not know
which treatment they receive. Participants will take up to 100 mg of fluvoxamine or placebo
by mouth twice a day for a daily total of 200 mg. Participants will continue this dose until
discharge from community treatment centers (for approximately 10 days). The dose may be
adjusted depending on tolerability. Participants will complete short 10 minute assessments
twice a day to report the results of self-monitoring (oxygen saturation, blood pressure, and
temperature), COVID-19 symptoms, and any adverse events using mobile application or phone.
Follow-up Phase: The study team will follow participants for approximately 30 days after the
end of the randomized phase (after discharge from community treatment centers) using phone.
Drug: Fluvoxamine
Up to 200 mg per day as tolerated until discharge from community treatment center or for approximately 10 days
Drug: Placebo
Up to 200 mg per day as tolerated until discharge from community treatment center or for approximately 10 days
Inclusion Criteria:
1. Men and women age 18 and older
2. Laboratory-confirmed SARS-CoV-2 patients who have mild to moderate symptoms related to
COVID-19 infection and are admitted to community treatment centers in Seoul, Korea
3. Has symptoms consistent with COVID-19 with onset ≤7 days of randomization
- Currently symptomatic with one or more of the following symptoms: fever, cough,
myalgia, shortness of breath, nausea, anorexia, diarrhea, vomiting, anosmia
(inability to smell), ageusia (inability to taste), sore throat, headache
4. Has laboratory-confirmed SARS-COV-2 infection (positive RT-PCR test) ≤ 3 days of
randomization
5. Able to provide informed consent
Exclusion Criteria:
1. Severe illness enough to require hospitalization or already meeting the study's
primary endpoint for clinical deterioration
2. Patients who cannot take oral medication
3. Pregnancy or breastfeeding
4. History of the psychiatric disorder including major depressive disorder
5. Patients who are taking or took selective serotonin reuptake inhibitors, serotonin and
noradrenaline reuptake inhibitor, or tricyclic anti-depressants within 2 weeks
6. Patients who are taking an anti-epileptic drug
7. Patients who are taking co-prescribed drugs (as below) which are contraindicated by
manufacturers due to drug-drug interaction
- Alosetron, tizanidine, theophylline, clozapine, olanzapine (drugs with a narrow
therapeutic index that are primarily metabolized by cytochrome P450 1A2)
- Donepezil, sertraline (sigma-1 receptor agonists)
- Warfarin (increased risk of bleeding)
- Phenytoin (rationale: fluvoxamine inhibits its metabolism)
- Clopidogrel (fluvoxamine inhibits its metabolism from pro-drug to active drug
which raises the risk of cardiovascular events)
- Monoamine oxidase inhibitors (linezolid, rasagiline, selegiline), triptans
(sumatriptan, naratriptan, almotriptan, frovatriptan, zolmitriptan, rizatriptan),
lithium, tramadol (rationale: to prevent the possible development of serotonin
syndrome)
- Alprazolam, diazepam (fluvoxamine modestly inhibits the metabolism of these
drugs): The patient could be enrolled in case of agreeing 25% dose reduction of
these medications.
8. Already enrolled in another COVID-19 medication trial
9. Medical comorbidities such as severe underlying lung disease (chronic obstructive
pulmonary disease on home oxygen, interstitial lung disease, pulmonary hypertension),
decompensated cirrhosis, chronic viral hepatitis, congestive heart failure (stage 3 or
4 per patient report and/or medical records), chronic kidney disease, or end-stage
renal disease requiring renal replacement therapy
10. Immunocompromised (solid organ transplant, bone-marrow transplant, acquired immune
deficiency syndrome, on biologics and/or high dose steroids [>20mg prednisone per
day])
11. Unable to provide informed consent (e.g., moderate-severe dementia diagnosis)
12. Unable to perform the study procedures (self-assessment of oxygen saturation, blood
pressure, and temperature using self-monitoring equipment)
Asan Medical Center
Seoul, Korea, Republic of
Yong Pil Chong, M.D., Ph.D., Principal Investigator
Asan Medical Center, Seoul, Korea