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0 0.5 1 1.5 2+ Mortality 28% Improvement Relative Risk Mortality, 100mg 29% Hospitalization 21% Hospitalization, 100mg 20% Hospitalization, 50mg 2% c19early.org/f Deng et al. Fluvoxamine for COVID-19 META ANALYSIS Favors fluvoxamine Favors control
Efficacy and safety of selective serotonin reuptake inhibitors in COVID-19 management: A systematic review and meta-analysis
Deng et al., Clinical Microbiology and Infection, doi:10.1016/j.cmi.2023.01.010
Deng et al., Efficacy and safety of selective serotonin reuptake inhibitors in COVID-19 management: A systematic review and.., Clinical Microbiology and Infection, doi:10.1016/j.cmi.2023.01.010
Jan 2023   Source   PDF  
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Meta analysis of 6 fluvoxamine RCTs showing fluvoxamine associated with lower mortality and hospitalization. 100mg bid showed lower mortality and hospitalization, but 50mg bid did not.
Authors use the Hartung-Knapp adjustment and they include trials reporting zero events in both arms - 5 of 6 trials for mortality. This narrows the confidence interval from the Together Trial so that it becomes significant, but this is not logical - zero mortality in both arms does not provide information on the mortality benefit of fluvoxamine.
Bias evaluation is not accurate. For example, authors rate the Together Trial as low risk of bias except for some concerns for deviations from the intended interventions. However, this trial not only shows a very high theoretical risk of bias, but also has very high actual bias, randomization failure, blinding failure, and reports conflicting data that is impossible to be correct [Reis].
Currently there are 13 fluvoxamine studies and meta analysis shows:
OutcomeImprovement
Mortality37% lower [-1‑60%]
Ventilation22% lower [-28‑53%]
Hospitalization28% lower [-3‑49%]
Cases28% fewer [18‑37%]
risk of death, 28.0% lower, RR 0.72, p < 0.001.
risk of death, 29.0% lower, RR 0.71, p = 0.004, 100mg bid.
risk of hospitalization, 21.0% lower, RR 0.79, p = 0.03.
risk of hospitalization, 20.0% lower, RR 0.80, p = 0.007, 100mg bid.
risk of hospitalization, 2.0% lower, RR 0.98, p = 0.99, 50mg bid.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Deng et al., 14 Jan 2023, peer-reviewed, 10 authors.
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