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0 0.5 1 1.5 2+ Death/intubation 42% Improvement Relative Risk Fluvoxamine for COVID-19  Hoertel et al.  Prophylaxis Is prophylaxis with fluvoxamine beneficial for COVID-19? Retrospective 2,846 patients in France Lower death/intubation with fluvoxamine (p=0.0000026) Hoertel et al., Clinical Pharmacology .., May 2021 Favors fluvoxamine Favors control

Association Between FIASMAs and Reduced Risk of Intubation or Death in Individuals Hospitalized for Severe COVID-19: An Observational Multicenter Study

Hoertel et al., Clinical Pharmacology & Therapeutics, doi:10.1002/cpt.2317
May 2021  
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26th treatment shown to reduce risk in November 2021
*, now known with p = 0.00014 from 21 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.
4,100+ studies for 60+ treatments.
Retrospective 2,846 severe COVID-19 patients in France, 277 taking a FIASMA medication, showing lower risk of intubation of death with FIASMA use.
risk of death/intubation, 42.0% lower, RR 0.58, p < 0.001, treatment 104 of 277 (37.5%), control 1,064 of 2,569 (41.4%), adjusted per study, IPW multivariable Cox regression.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Hoertel et al., 29 May 2021, retrospective, France, peer-reviewed, 78 authors.
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Association Between FIASMAs and Reduced Risk of Intubation or Death in Individuals Hospitalized for Severe COVID‐19: An Observational Multicenter Study
Nicolas Hoertel, Marina Sánchez‐rico, Erich Gulbins, Johannes Kornhuber, Alexander Carpinteiro, Eric J Lenze, Angela M Reiersen, Miriam Abellán, Pedro Muela, Raphaël Vernet, Carlos Blanco, Céline Cougoule, Nathanaël Beeker, Antoine Neuraz, Philip Gorwood, Jesús M Alvarado, Pierre Meneton, Frédéric Limosin, Pierre‐yves Ancel, Alain Bauchet, Nathanaël Beeker, Vincent Benoit, Mélodie Bernaux, Ali Bellamine, Romain Bey, Aurélie Bourmaud, Stéphane Breant, Anita Burgun, Fabrice Carrat, Charlotte Caucheteux, Julien Champ, Sylvie Cormont, Christel Daniel, Julien Dubiel, Catherine Ducloas, Loic Esteve, Marie Frank, Nicolas Garcelon, Alexandre Gramfort, Nicolas Griffon, Olivier Grisel, Martin Guilbaud, Claire Hassen‐khodja, François Hemery, Martin Hilka, Anne Sophie Jannot, Jerome Lambert, Richard Layese, Judith Leblanc, Léo Lebouter, Guillaume Lemaitre, Damien Leprovost, Ivan Lerner, Kankoe Levi Sallah, Aurélien Maire, Marie‐france Mamzer, Patricia Martel, Arthur Mensch, Thomas Moreau, Antoine Neuraz, Nina Orlova, Nicolas Paris, Bastien Rance, Hélène Ravera, Antoine Rozes, Elisa Salamanca, Arnaud Sandrin, Patricia Serre, Xavier Tannier, Jean‐marc Treluyer, Damien Van Gysel, Gaël Varoquaux, Jill Jen Vie, Maxime Wack, Perceval Wajsburt, Demian Wassermann, Eric Zapletal
Clinical Pharmacology & Therapeutics, doi:10.1002/cpt.2317
Several medications commonly used for a number of medical conditions share a property of functional inhibition of acid sphingomyelinase (ASM), or FIASMA. Preclinical and clinical evidence suggest that the ASM/ceramide system may be central to severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection. We examined the potential usefulness of FIASMA use among patients hospitalized for severe coronavirus disease 2019 (COVID-19) in an observational multicenter study conducted at Greater Paris University hospitals. Of 2,846 adult patients hospitalized for severe COVID-19, 277 (9.7%) were taking an FIASMA medication at the time of their hospital admission. The primary end point was a composite of intubation and/or death. We compared this end point between patients taking vs. not taking an FIASMA medication in time-to-event analyses adjusted for sociodemographic characteristics and medical comorbidities. The primary analysis was a Cox regression model with inverse probability weighting (IPW). Over a mean follow-up of 9.2 days (SD = 12.5), the primary end point occurred in 104 patients (37.5%) receiving an FIASMA medication, and 1,060 patients (41.4%) who did not. Despite being significantly and substantially associated with older age and greater medical severity, FIASMA medication use was significantly associated with reduced likelihood of intubation or death in both crude (hazard ratio (HR) = 0.71, 95% confidence interval (CI) = 0.58-0.87, P < 0.001) and primary IPW (HR = 0.58, 95%CI = 0.46-0.72, P < 0.001) analyses. This association remained significant in multiple sensitivity analyses and was not specific to one particular FIASMA class or medication. These results show the potential importance of the ASM/ceramide system in COVID-19 and support the continuation of FIASMA medications in these patients. Double-blind controlled randomized clinical trials of these medications for COVID-19 are needed.
SUPPORTING INFORMATION Supplementary information accompanies this paper on the Clinical Pharmacology & Therapeutics website ( ACKNOWLEDGMENTS The authors warmly thank the EDS APHP COVID consortium integrating the APHP Health Data Warehouse team as well as all the APHP staff and volunteers who contributed to the implementation of the EDS-COVID database and operating solutions for this database. FUNDING No funding was received for this work. CONFLICT OF INTEREST DISCLAIMER The information contained in this study is provided for research purpose and should not be used as a substitute or replacement for diagnosis or treatment recommendations or other clinical decisions or judgment. The views presented in this manuscript are those of the authors and should not be construed to represent the views of any of the sponsoring organizations, agencies, or the National Institute on Drug Abuse or any US Government Agency. APPENDIX 1 EDS APHP Covid consortium
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