Abstract
Fluvoxamine is a selective-serotonin reuptake inhibitor (SSRI),
well-tolerated and widely available, usually used in the management of
mental-health conditions. Fluvoxamine is also a sigma-1 agonist with
high affinity to this receptor and this pharmacodynamical effect has
been being portrayed as the main explanation in emerging evidence about
the potential of using fluvoxamine in COVID-19 patients. This systematic
review was conducted according to the PRISMA guidelines. The search was
run in MEDLINE, Web of Science, and CENTRAL from the Cochrane databases.
The study protocol was registered in PROSPERO (CRD42022302025). Our aim
was to assess the present evidence for therapeutic role of fluvoxamine
in COVID-19 patients, the review included studies which evaluate the
effect of fluvoxamine in COVID-19 patients. The main outcomes evaluated
in the review were: mortality, need for hospitalization (outpatients)
and clinical deterioration. The quality control of the selected articles
was made using Cochrane’s Risk of Bias tool for the randomized
controlled trials (RCTs) and the ROBINS-I criteria for non-randomized
studies. A total of 4 studies were included in the final qualitative
analysis of the review, 2 of which were RCTs, and the others were
open-label prospective cohorts. 3 studies assessed outpatient population
and 1 evaluated ICU population. Overall, the 4 studies included a total
of 1864 participants. In conclusion, 3 studies with outpatients showed
that fluvoxamine treatment can prevent clinical deterioration,
hospitalisation, or proxy-hospitalisation. The only study with patients
hospitalized in the ICU also demonstrated a therapeutic benefit reducing
overall mortality.