The old drug fluvoxamine has a remarkable effect on the treatment of new crown

The Lancet magazine published phase III clinical results for the treatment of COVID-19 with an antidepressant antidepressant drug, fluvoxamine. The trial, called TOGETHER, screened 9803 severe covid-19 patients and was terminated prematurely due to its excellent efficacy. A total of 741 patients were treated with fluvoxamine and 756 were placebo at the time of termination, resulting in a hospitalization rate of 10.6 in the medication group (more than 6 hours in the emergency room or transfer) and 15.7% in the placebo group, reaching the first-level endpoint of the trial. One person died in the medication group and 12 people died on placebo.

Drug source analysis

Fluvoxamine is an old patented drug that is said to cost only $4 even after 10 days in a hospital. What is the spirit of an antidepressant serotonin inhibitor (SSRI) that goes far and wide to fight COVID-19? One theory is that fluvoxamine can inhibit platelets from binding to serotonin and slow down thrombosis, therefore reducing cardiotoxicity caused by COVID-19. Another theory is that fluvoxamine has an off-target activity that inhibits a protein called S1R and is anti-inflammatory, but these hypotheses are not supported by systematic, high-quality scientific data. Although black cats and white cats and catch rats are good cats, it does not matter what the effective mechanism of RCT proves, but the more bizarre the efficacy, the more stringent the evidence is required. SSRI antidepressants have been used by countless people for decades, and there are certainly many patients with autoimmune diseases who have used such drugs but have not reliably reported that such drugs can fight inflammation. It's just that it appeared at a time when the world needed the most anti-inflammatory drugs had to be a little suspicious.

But doubt is doubt, and fluvoxamine may really work. Previous uncontrolled trials have shown that this old drug does have the efficacy of controlling the new crown, and now there are two ongoing controlled trials in the United States. If fluvoxamine is conclusively shown to reduce hospitalization rates by 32%, it will be a major covid-19 weapon because it is cheap, easy to use and safer. This is partly due to the fact that the patent system allows manufacturers to make high profits during the patent period, so we have accumulated these drugs now, and these high-quality compounds are basically free to use after the patent expires. In contrast, Merck's recent covid-19 drug, molnupiravir, which is also an old compound but is still under patent protection, is estimated at $700 if it is listed, of course, this price is far lower than that of the new antibody drug.

Because the new crown is fierce and the pharmaceutical industry does not have enough time to systematically develop new drugs, the new use of old drugs has become a major battle strategy. Unfortunately, antivirals are not the focus of the modern pharmaceutical industry, so although in vitro screening of antiviral drugs is relatively easy, there are not many approved antiviral drugs available for screening. Only remdesivir, whose efficacy is now unclear, and mornaupiravir, which has controversial molexibuvir, which is controversial for merck, wins. Other IN VIX anti-virus drugs are mainly through the non-specific mechanism of inducing phospholipid deposition, and they are beaten back to the prototype in the clinic.

Severe COVID-19 complications are an immune disease, and there are far more marketed drugs that regulate the immune system than antiviral drugs, but in vitro screening of immune regulators and even animal experiments are much more complicated. Because of the tight timeline, clinical trials have become the only screening mode, and COVID-19 can be said to be the first clinical high-throughput screening (HTS) in history. This is different from the clinical trial and error of PD-1 drugs looking for different indications on a large scale, and HTS is the finding of active drugs from a large number of compounds. HTS generally requires that the screening system be cheap and simple because of the large amount, but the new crown is obviously an extreme case.