15 ms·

Effect of early treatment with fluvoxamine on risk of hospitalization for Covid

40 points by AndrewBissell 5y ago

beebmam 5y ago
Hey this looks pretty awesome. More early treatment options for COVID-19 is going to save many lives!
- ericmay 5y ago
  Yep. Combined with vaccines we should be able to save more people!
  - s1artibartfast 5y ago
    Hopefully it will also help with mortality in the unvaccinated, which is driving >90% of US deaths
    - walterbell 5y ago
      Where the CDC definition of "unvaccinated" includes those who received a vaccine less than 14 days before an event.
      - s1artibartfast 5y ago
        I'm not sure how this relates to my post. Most of the unvaccinated deaths are people with no vaccine whatsoever. The number of people who were vaccinated less than 14 days that falls into this category is small.
        walterbell 5y ago
        It means the CDC recognizes that the vaccine is not effective for 14 days, so other known treatments (e.g. fluvoxamine) during that period can be helpful.
        s1artibartfast 5y ago
        IF you were just adding a reminder, the point is certainly true. Hopefully it helps the vaccinated, recently vaccinated, and truly unvaccinated.
londons_explore 5y ago
So... How was this not discovered 18 months ago? There are plenty of people taking fluvoxamine already, which acts as a natural experiment. After a few thousand hospitalizations, this effect size would have been obvious (ie. March 2020). At that point, a double-blind study could have been run, which (if done in a city with many infections) could have given results within weeks. What bit of health research dropped the ball on this?
- SketchySeaBeast 5y ago
  Wouldn't this sort of "obvious" link require tracking every patients entire history? Couldn't it be lost in other confounding factors? This seems like it would require a lot of good data and then strong analysis chops to pull that pattern out.
  - hdjjhhvvhga 5y ago
    But this is exactly where we should double our efforts, because the problem is technical: we do have lots of data to analyze already. The influence of anti-histamine drugs was relatively quickly discovered because everybody expected asthma patients would get worse and the opposite was happening, so this was an obvious thing to examine. But many more drugs may play a role and these are hiding in plain sight - I hope researchers try to organize around it and make more meaningful discoveries.
    - SketchySeaBeast 5y ago
      I'm not saying it wouldn't be a good idea if it was possible, but do we have enough sanitized, high quality, and complete medical data to pull that off? Given the number of potential interactions with all the different medications and conditions, could we actually pull out those links without a ton of confounding variables? Would it produce signal, or just noise?
      - hdjjhhvvhga 5y ago
        Given enormous resources spent on everything COVOD-related, from tests and vaccines to the costs of lockdowns and restrictions, I think we should at least try to analyze the data looking for the low-hanging fruit, then try to account for confounding factors, and if still interesting look at it closer. Not easy, but definitely possible for large hospitals - they do have enough data, they just need competent people to analyze them and make preliminary findings. On the other hand, we are probably most interested in patients who got infected but did not end up in a hospital. Were they taking any meds routinely? I don't think it's easy to gather this kind of data unless people share them voluntarily with an organization they trust.
hhw3h 5y ago
What's interesting is Steve Kirsch was touting this months ago alongside Robert Malone and Bret Weinstein. That content got banned from YouTube. Was more or less harm done by stifling this information? In the desire to drive official therapeutics and vaccines was this potentially not surfaced as fast as it could have been? I'm not sure. It's good food for thought though.
- SketchySeaBeast 5y ago
  Was it specifically because of this one claim, or because of his claims that hydroxychloroquine works and that COVID vaccines are toxic? I think you're doing a disservice by downplaying his history surrounding COVID.
- bhouston 5y ago
  I think the issue is how was it proven back then? There are a lot of people promoting ideas, some of which will eventually get clinical backing that they are correct. Prior to studies being done, how do we evaluate who is a quack and who is correct? There is a lot of harm promoting quack ideas during a pandemic. Based on reputation? Twitter followers? Their passion? I do not believe anyone censored research and scientific literature that was mainstream nor did they say they can not try to get your theories proven, rather they were basically saying do can not claim you have the truth if there is nothing solid backing you up. Basically skipping showing your work (e.g. peer review), and just saying you have the answer. I would argue that anyone who had a solution to Covid should rush to get it published in a reputable journal -- because that is how science works. You do not go and make YouTubes first promoting it as the cure first. Did Steven even have a role in this paper or are these professionals operating completely independently of him? So Steven didn't even bother to make this mainstream? Too much work?
  - bananapear 5y ago
    Aren't there many (>60) published studies showing varying positive effects of early treatment with Ivermectin though? (Despite a couple having been retracted for obvious fraud). YouTube's policy specifically bans mention of Ivermectin as a possible treatment. Combined with the safety profile and cost of Ivermectin, I'd have thought that it'd at least be worth a try in an emergency - the worst possible case being that it doesn't work (unless you have idiots taking horse-size doses). Compared with the quality of data surrounding remdesivir, molnupiravir etc, there seems to be a significant bias towards novelty (and therefore $$$). Similarly, it's been known for decades that vitamin D deficiency increases susceptibility to respiratory diseases, and most people in Europe/North America are deficient in winter. Why not hand it out? Worst case, it doesn't work.
didibus 5y ago
I'm not super familiar with how to interpret the statistics in the paper, am I correct in understanding that it showed a 5% reduction in hospitalizations? And it seems there was no significant effect on death? If someone knows how to read this, can you chime in?
- ahazred8ta 5y ago
  A reduction from 16% to 11%, in a group that was high risk due to age or medical conditions. So that's a 1/3rd reduction.
- s1artibartfast 5y ago
  It showed a 32% reduction in hospitalization and approx 31% reduction in deaths.
  - didibus 5y ago
    Why does it say: > We found a clinically important absolute risk reduction of 5·0%, and 32% RR reduction, on the primary outcome of hospitalisation Why is the absolute 5% and the RR 32%? What's the difference? Also why does it say: > There were no significant differences between fluvoxamine and placebo for viral clearance at day 7 (p=0·090) and hospitalisations due to COVID (p=0·10), all-cause hospitalisations (p=0·09), time to hospitalisation (p=0·11), number of days in hospital (p=0·06), mortality (p=0·24), time to death (p=0·49), number of days on mechanical ventilation (p=0·90), time to recovery (p=0·79) or the PROMIS Global Physical (p=0·55) or Mental Scale (p=0·32) And they say in the Interpretation section: > Treatment with fluvoxamine (100 mg twice daily for 10 days) among high-risk outpatients with early diagnosed COVID-19 reduced the need for hospitalisation defined as retention in a COVID-19 emergency setting or transfer to a tertiary hospital Why wouldn't they mention anything else but the reduction in hospitalization in their Interpretation section? Is it because all the other effects were not statistically significant to count?
    - arn 5y ago
      > Why is the absolute 5% and the RR 32%? What's the difference? Example: (20/100) 20% of patients die without treatment (10/100) 10% of patients die with treatment absolute = 10 percentage points difference (20->10) relative = percent decrease. 20 -> 10 50% difference
disabled 5y ago
I wouldn’t touch flovoxamine or any other antidepressent (or antipsychotic for that matter) with a 10 foot stick. If you want a good read about how the **y the US healthcare system is, this is a very worthwhile read. Ironically the author is the screenwriter of “Girl, Interrupted” and the story she writes is about how her son got screwed by the US healthcare system and is titled “Boy, Interrupted”. It also shows you how desperate people get for specialized care, and will shell out unfathomable amounts of money for “treatment” at sketchy places: https://www.madinamerica.com/2021/06/boy-interrupted-a-story-of-akathisia/ https://www.madinamerica.com/2021/06/boy-interrupted-a-story... K Ironically, the last straw for me, when it came to living in America was my diagnosis of akathisia (just like the linked story), which is 1000x worse than it sounds. I have severe depression and I had been taking my medications as prescribed. Because of my taking these medications, I developed severe akathisia. Literally, before all hell broke loose from the severe akathisia (of which I likely had to varying degrees for years) my highly respected neurologist in movement disorders immediately wrote a scathing report of my situation with the diagnosis. He also gave a ton of recommendations. He also wrote letters to all of my doctors. He did this all within an hour and took the situation extremely seriously. Unfortunately, even though he is technically a high powered doctor, the US healthcare system has taken a tremendous amount of power away from doctors in general. So a scathing write up in my medical record plus letters to all of my doctors (with recommendations) was all he could really do for me. I literally ended up in the ER 6 times in a week, with improper help. I kept on being discharged over and over again without any further help and even got in to trouble with the law multiple times. One time, after being drugged with Ativan (a benzodiazepine) and Ketamine (a general anesthetic) in the ER, from which I had been discharged. I had called my mother and she was going to pick me up from the hospital. She was well on her way for picking me up. Honestly, I thought I was just waiting outside on the sidewalk right next to the ER, for my mother, but something very wrong had happened. All of the sudden I see a cop car pull up about 30-40 feet away from me and they were headed my way to talk to me. Obviously the number one rule is to never talk to the police under any conditions. Traffic stops are a good time to practice Mm that, by the way. The best thing you can do is say “no comment, I need to talk to my lawyer first.” Anyways I was drugged up to the extreme so it was not like I was not talking and running my mouth to both of the cops observing the situation. Obviously I had caused some sort of public disturbance and somebody had called the cops on me and clearly I should have never been discharged from the hospital. Honestly, I have no idea how, when, or even where the public disturbance occurred (obviously this is public record but it is not healthy for me to investigate the situation further). Anyways, after the cops talked to me, they said that an “emergency detention order” was being issued and that I was going to be forced to get treatment at the **hole hospital which had improperly discharged me after being hella ativaned and ketamined up. Long story short, I had 3 interactions with the cops in 1 week. Prior to that I had only had 2 interactions with the police in my adult life (+14 years). Both were traffic stops, but neither were for moving traffic violations (burnt out headlight and expired registration during COVID-19). I was tremendously lucky that I was never charged with anything over that week from hell, and the cops managed to see that something was “off”. Anyways, like in the above link (excellent storytelling by the way so it is a worthwhile read), there are common denominators that I share with the writer’s son. I am a dual US|European Union (Croatian) citizen and I fled the US after the final hospital trip (from hell actually...it was the worst hospital trip of all time and I am hardcore chronically ill just in general) for Croatia exactly 21 days later (I had to obtain legal documents). Because of my training in electrical engineering, which I am profoundly fortunate to have, I do LORETA (technically sLORETA) neurofeedback training completely on my own to help heal my brain, just like the person in that story. Anyways, there is much more to the story that is better not put in writing. Just know that there is nothing that will bring me back to the USA.
Vrondi 5y ago
This is fascinating, but for people who already have a medical history of ITP, it might be a bad idea, as this drug has known anti-platelet activity. Good for "normal" people to avoid blood clots, but bad for ITP people who are trying to keep from losing platelets.

40 points by AndrewBissell 5y ago

beebmam 5y ago

Hey this looks pretty awesome. More early treatment options for COVID-19 is going to save many lives!

ericmay 5y ago
Yep. Combined with vaccines we should be able to save more people!
- s1artibartfast 5y ago
  Hopefully it will also help with mortality in the unvaccinated, which is driving >90% of US deaths
  - walterbell 5y ago
    Where the CDC definition of "unvaccinated" includes those who received a vaccine less than 14 days before an event.
    - s1artibartfast 5y ago
      I'm not sure how this relates to my post. Most of the unvaccinated deaths are people with no vaccine whatsoever. The number of people who were vaccinated less than 14 days that falls into this category is small.
      - walterbell 5y ago
        It means the CDC recognizes that the vaccine is not effective for 14 days, so other known treatments (e.g. fluvoxamine) during that period can be helpful.
        s1artibartfast 5y ago
        IF you were just adding a reminder, the point is certainly true. Hopefully it helps the vaccinated, recently vaccinated, and truly unvaccinated.

londons_explore 5y ago

So... How was this not discovered 18 months ago? There are plenty of people taking fluvoxamine already, which acts as a natural experiment. After a few thousand hospitalizations, this effect size would have been obvious (ie. March 2020). At that point, a double-blind study could have been run, which (if done in a city with many infections) could have given results within weeks. What bit of health research dropped the ball on this?

SketchySeaBeast 5y ago
Wouldn't this sort of "obvious" link require tracking every patients entire history? Couldn't it be lost in other confounding factors? This seems like it would require a lot of good data and then strong analysis chops to pull that pattern out.
- hdjjhhvvhga 5y ago
  But this is exactly where we should double our efforts, because the problem is technical: we do have lots of data to analyze already. The influence of anti-histamine drugs was relatively quickly discovered because everybody expected asthma patients would get worse and the opposite was happening, so this was an obvious thing to examine. But many more drugs may play a role and these are hiding in plain sight - I hope researchers try to organize around it and make more meaningful discoveries.
  - SketchySeaBeast 5y ago
    I'm not saying it wouldn't be a good idea if it was possible, but do we have enough sanitized, high quality, and complete medical data to pull that off? Given the number of potential interactions with all the different medications and conditions, could we actually pull out those links without a ton of confounding variables? Would it produce signal, or just noise?
    - hdjjhhvvhga 5y ago
      Given enormous resources spent on everything COVOD-related, from tests and vaccines to the costs of lockdowns and restrictions, I think we should at least try to analyze the data looking for the low-hanging fruit, then try to account for confounding factors, and if still interesting look at it closer. Not easy, but definitely possible for large hospitals - they do have enough data, they just need competent people to analyze them and make preliminary findings. On the other hand, we are probably most interested in patients who got infected but did not end up in a hospital. Were they taking any meds routinely? I don't think it's easy to gather this kind of data unless people share them voluntarily with an organization they trust.

hhw3h 5y ago

What's interesting is Steve Kirsch was touting this months ago alongside Robert Malone and Bret Weinstein. That content got banned from YouTube. Was more or less harm done by stifling this information? In the desire to drive official therapeutics and vaccines was this potentially not surfaced as fast as it could have been? I'm not sure. It's good food for thought though.

SketchySeaBeast 5y ago
Was it specifically because of this one claim, or because of his claims that hydroxychloroquine works and that COVID vaccines are toxic? I think you're doing a disservice by downplaying his history surrounding COVID.
bhouston 5y ago
I think the issue is how was it proven back then? There are a lot of people promoting ideas, some of which will eventually get clinical backing that they are correct. Prior to studies being done, how do we evaluate who is a quack and who is correct? There is a lot of harm promoting quack ideas during a pandemic. Based on reputation? Twitter followers? Their passion? I do not believe anyone censored research and scientific literature that was mainstream nor did they say they can not try to get your theories proven, rather they were basically saying do can not claim you have the truth if there is nothing solid backing you up. Basically skipping showing your work (e.g. peer review), and just saying you have the answer. I would argue that anyone who had a solution to Covid should rush to get it published in a reputable journal -- because that is how science works. You do not go and make YouTubes first promoting it as the cure first. Did Steven even have a role in this paper or are these professionals operating completely independently of him? So Steven didn't even bother to make this mainstream? Too much work?
- bananapear 5y ago
  Aren't there many (>60) published studies showing varying positive effects of early treatment with Ivermectin though? (Despite a couple having been retracted for obvious fraud). YouTube's policy specifically bans mention of Ivermectin as a possible treatment. Combined with the safety profile and cost of Ivermectin, I'd have thought that it'd at least be worth a try in an emergency - the worst possible case being that it doesn't work (unless you have idiots taking horse-size doses). Compared with the quality of data surrounding remdesivir, molnupiravir etc, there seems to be a significant bias towards novelty (and therefore $$$). Similarly, it's been known for decades that vitamin D deficiency increases susceptibility to respiratory diseases, and most people in Europe/North America are deficient in winter. Why not hand it out? Worst case, it doesn't work.

didibus 5y ago

I'm not super familiar with how to interpret the statistics in the paper, am I correct in understanding that it showed a 5% reduction in hospitalizations? And it seems there was no significant effect on death? If someone knows how to read this, can you chime in?

ahazred8ta 5y ago
A reduction from 16% to 11%, in a group that was high risk due to age or medical conditions. So that's a 1/3rd reduction.
s1artibartfast 5y ago
It showed a 32% reduction in hospitalization and approx 31% reduction in deaths.
- didibus 5y ago
  Why does it say: > We found a clinically important absolute risk reduction of 5·0%, and 32% RR reduction, on the primary outcome of hospitalisation Why is the absolute 5% and the RR 32%? What's the difference? Also why does it say: > There were no significant differences between fluvoxamine and placebo for viral clearance at day 7 (p=0·090) and hospitalisations due to COVID (p=0·10), all-cause hospitalisations (p=0·09), time to hospitalisation (p=0·11), number of days in hospital (p=0·06), mortality (p=0·24), time to death (p=0·49), number of days on mechanical ventilation (p=0·90), time to recovery (p=0·79) or the PROMIS Global Physical (p=0·55) or Mental Scale (p=0·32) And they say in the Interpretation section: > Treatment with fluvoxamine (100 mg twice daily for 10 days) among high-risk outpatients with early diagnosed COVID-19 reduced the need for hospitalisation defined as retention in a COVID-19 emergency setting or transfer to a tertiary hospital Why wouldn't they mention anything else but the reduction in hospitalization in their Interpretation section? Is it because all the other effects were not statistically significant to count?
  - arn 5y ago
    > Why is the absolute 5% and the RR 32%? What's the difference? Example: (20/100) 20% of patients die without treatment (10/100) 10% of patients die with treatment absolute = 10 percentage points difference (20->10) relative = percent decrease. 20 -> 10 50% difference

disabled 5y ago

I wouldn’t touch flovoxamine or any other antidepressent (or antipsychotic for that matter) with a 10 foot stick. If you want a good read about how the **y the US healthcare system is, this is a very worthwhile read. Ironically the author is the screenwriter of “Girl, Interrupted” and the story she writes is about how her son got screwed by the US healthcare system and is titled “Boy, Interrupted”. It also shows you how desperate people get for specialized care, and will shell out unfathomable amounts of money for “treatment” at sketchy places: https://www.madinamerica.com/2021/06/boy-interrupted-a-story-of-akathisia/ https://www.madinamerica.com/2021/06/boy-interrupted-a-story... K Ironically, the last straw for me, when it came to living in America was my diagnosis of akathisia (just like the linked story), which is 1000x worse than it sounds. I have severe depression and I had been taking my medications as prescribed. Because of my taking these medications, I developed severe akathisia. Literally, before all hell broke loose from the severe akathisia (of which I likely had to varying degrees for years) my highly respected neurologist in movement disorders immediately wrote a scathing report of my situation with the diagnosis. He also gave a ton of recommendations. He also wrote letters to all of my doctors. He did this all within an hour and took the situation extremely seriously. Unfortunately, even though he is technically a high powered doctor, the US healthcare system has taken a tremendous amount of power away from doctors in general. So a scathing write up in my medical record plus letters to all of my doctors (with recommendations) was all he could really do for me. I literally ended up in the ER 6 times in a week, with improper help. I kept on being discharged over and over again without any further help and even got in to trouble with the law multiple times. One time, after being drugged with Ativan (a benzodiazepine) and Ketamine (a general anesthetic) in the ER, from which I had been discharged. I had called my mother and she was going to pick me up from the hospital. She was well on her way for picking me up. Honestly, I thought I was just waiting outside on the sidewalk right next to the ER, for my mother, but something very wrong had happened. All of the sudden I see a cop car pull up about 30-40 feet away from me and they were headed my way to talk to me. Obviously the number one rule is to never talk to the police under any conditions. Traffic stops are a good time to practice Mm that, by the way. The best thing you can do is say “no comment, I need to talk to my lawyer first.” Anyways I was drugged up to the extreme so it was not like I was not talking and running my mouth to both of the cops observing the situation. Obviously I had caused some sort of public disturbance and somebody had called the cops on me and clearly I should have never been discharged from the hospital. Honestly, I have no idea how, when, or even where the public disturbance occurred (obviously this is public record but it is not healthy for me to investigate the situation further). Anyways, after the cops talked to me, they said that an “emergency detention order” was being issued and that I was going to be forced to get treatment at the **hole hospital which had improperly discharged me after being hella ativaned and ketamined up. Long story short, I had 3 interactions with the cops in 1 week. Prior to that I had only had 2 interactions with the police in my adult life (+14 years). Both were traffic stops, but neither were for moving traffic violations (burnt out headlight and expired registration during COVID-19). I was tremendously lucky that I was never charged with anything over that week from hell, and the cops managed to see that something was “off”. Anyways, like in the above link (excellent storytelling by the way so it is a worthwhile read), there are common denominators that I share with the writer’s son. I am a dual US|European Union (Croatian) citizen and I fled the US after the final hospital trip (from hell actually...it was the worst hospital trip of all time and I am hardcore chronically ill just in general) for Croatia exactly 21 days later (I had to obtain legal documents). Because of my training in electrical engineering, which I am profoundly fortunate to have, I do LORETA (technically sLORETA) neurofeedback training completely on my own to help heal my brain, just like the person in that story. Anyways, there is much more to the story that is better not put in writing. Just know that there is nothing that will bring me back to the USA.

Vrondi 5y ago

This is fascinating, but for people who already have a medical history of ITP, it might be a bad idea, as this drug has known anti-platelet activity. Good for "normal" people to avoid blood clots, but bad for ITP people who are trying to keep from losing platelets.