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0 0.5 1 1.5 2+ PASC, smell/taste 51% Improvement Relative Risk PASC, smell 44% PASC, taste 62% PASC, fatigue 52% primary PASC, headache 49% PASC, memory impairment 59% PASC, poor concentration -17% PASC, insomnia 8% PASC, aggression 74% PASC, depression 85% PASC, anxiety 37% PASC, myalgia 27% PASC, PCS 6% Fluvoxamine  Farahani et al.  EARLY TREATMENT  DB RCT  LONG COVID Does fluvoxamine reduce the risk of Long COVID (PASC)? Double-blind RCT 100 patients in Iran (March - June 2022) Lower PASC with fluvoxamine (not stat. sig., p=0.057) Farahani et al., BMC Infectious Diseases, Mar 2023 Favors fluvoxamine Favors control

Effect of fluvoxamine on preventing neuropsychiatric symptoms of post COVID syndrome in mild to moderate patients, a randomized placebo-controlled double-blind clinical trial

Farahani et al., BMC Infectious Diseases, doi:10.1186/s12879-023-08172-5
Mar 2023  
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27th treatment shown to reduce risk in November 2021
*, now known with p = 0.00011 from 20 studies, recognized in 3 countries.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
3,800+ studies for 60+ treatments.
RCT 100 mild/moderate COVID-19 outpatients in Iran, showing lower post COVID symptoms 12 weeks after infection, statistically significant only for fatigue with the small sample size. All symptoms may occur for non-COVID-19 reasons, smell/taste disorder may be the most likely to be related to COVID-19 infection. Fluvoxamine 100mg daily for 10 days.
risk of PASC, 50.8% lower, RR 0.49, p = 0.06, treatment 42, control 43, smell and taste disturbance combined.
risk of PASC, 44.2% lower, RR 0.56, p = 0.28, treatment 6 of 42 (14.3%), control 11 of 43 (25.6%), NNT 8.9, smell.
risk of PASC, 61.6% lower, RR 0.38, p = 0.20, treatment 3 of 42 (7.1%), control 8 of 43 (18.6%), NNT 8.7, taste.
risk of PASC, 51.5% lower, RR 0.48, p = 0.04, treatment 9 of 42 (21.4%), control 19 of 43 (44.2%), NNT 4.4, fatigue, primary outcome.
risk of PASC, 48.8% lower, RR 0.51, p = 0.48, treatment 3 of 42 (7.1%), control 6 of 43 (14.0%), NNT 15, headache.
risk of PASC, 59.0% lower, RR 0.41, p = 0.43, treatment 2 of 42 (4.8%), control 5 of 43 (11.6%), NNT 15, memory impairment.
risk of PASC, 17.0% higher, RR 1.17, p = 0.78, treatment 8 of 42 (19.0%), control 7 of 43 (16.3%), poor concentration.
risk of PASC, 7.9% lower, RR 0.92, p = 1.00, treatment 9 of 42 (21.4%), control 10 of 43 (23.3%), NNT 55, insomnia.
risk of PASC, 74.4% lower, RR 0.26, p = 0.36, treatment 1 of 42 (2.4%), control 4 of 43 (9.3%), NNT 14, aggression.
risk of PASC, 85.4% lower, RR 0.15, p = 0.06, treatment 1 of 42 (2.4%), control 7 of 43 (16.3%), NNT 7.2, depression.
risk of PASC, 37.0% lower, RR 0.63, p = 0.32, treatment 8 of 42 (19.0%), control 13 of 43 (30.2%), NNT 8.9, anxiety.
risk of PASC, 26.9% lower, RR 0.73, p = 0.76, treatment 5 of 42 (11.9%), control 7 of 43 (16.3%), NNT 23, myalgia.
risk of PASC, 6.4% lower, RR 0.94, p = 0.60, treatment 32 of 42 (76.2%), control 35 of 43 (81.4%), NNT 19, PCS.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Farahani et al., 31 Mar 2023, Double Blind Randomized Controlled Trial, placebo-controlled, Iran, peer-reviewed, mean age 38.5, 3 authors, study period March 2022 - June 2022. Contact:
This PaperFluvoxamineAll
Effect of fluvoxamine on preventing neuropsychiatric symptoms of post COVID syndrome in mild to moderate patients, a randomized placebo-controlled double-blind clinical trial
Ramin Hamidi Farahani, Ali Ajam, Alireza Ranjbar Naeini
BMC Infectious Diseases, doi:10.1186/s12879-023-08172-5
Background Shortly after the Coronavirus disease 2019 (COVID-19) pandemic, a considerable number of recovered patients reported persisting symptoms, especially neuropsychological manifestations, which were later named post-COVID syndrome (PCS). Immune dysregulation was suggested as one of the main mechanisms for PCS. Fluvoxamine, a selective serotonin reuptake inhibitor (SSRI) that is mostly used to treat depression, anxiety disorders, and obsessivecompulsive disorder, has been suggested as an anti-COVID drug due to its anti-inflammatory effects, mainly through the sigma-1 receptor. Therefore, we aimed to evaluate fluvoxamine's effect on PCS neuropsychiatric symptoms. Method In this double-blind randomized clinical trial, we included confirmed mild to moderate COVID-19 outpatients using polymerase chain reaction (PCR) by an infectious disease specialist. The presence of severe COVID-19 symptoms was evaluated by the infectious disease specialist and included dyspnea, SpO2 < 94% on room air, PaO2/ FiO2 < 300 mm Hg, a respiratory rate > 30 breaths/min, and lung infiltrates > 50%. Then we performed permuted block randomization and assigned patients 1:1 into two groups to either receive fluvoxamine 100 mg tablet or a placebo daily for 10 days. Eligible patients were evaluated after 12 weeks for the presence of fatigue, as the primary, and other PCS symptoms as secondary outcomes. Results We screened a total of 486 patients from March to June 2022. After 12 weeks, 42 patients receiving fluvoxamine and 43 patients receiving Placebo were evaluated for PCS. Patients had a mean age of 38.5 ± 14.1 and 48% of them were women. Fatigue was significantly lower in the fluvoxamine group (p-value 0.026). No significant differences were observed in other symptoms. Conclusion We concluded that taking fluvoxamine during active COVID-19 can reduce the chance of fatigue but the advantage of fluvoxamine was not observed for other symptoms. Further studies are necessary to confirm these preliminary results.
Authors' contributions A. Ajam contributed to interpreting the data, draft writing, and final editing. A. Ranjbar Naeini contributed to research design and final editing. R. Hamidi Farahani contributed to the research design and revised it critically. The author(s) read and approved the final manuscript. Funding All funding support was provided by the AJAUMS. Declarations Ethics approval and consent to participate Informed consent was obtained from all study participants. The protocol of this study is by the 2013 Helsinki declaration and was approved by the Ethics Committee of AJA University of Medical Sciences (AJAUMS), Ethics ID: IR.AJAUMS.REC.1400.302. This RCT was registered in the Iranian registry of clinical trials (IRCT), a primary registry in the WHO registry network (registration number: IRCT20220526054990N1) on 01/06/2022. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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