By IDSE News Staff
The antidepressant drug fluvoxamine and gout drug colchicine are not recommended for patients with mild to moderate COVID-19 because there is insufficient evidence that they improve important outcomes for patients, and both drugs carry potential harms, according to a WHO Guideline Development Group (GDG) panel of international experts (BMJ 2022;377:o1005 https://doi.org/10.1136/bmj.o1005).
No recommendation was made for either drug in patients with severe or critical illness, given limited or no data.
Fluvoxamine and colchicine are commonly used, inexpensive drugs that have received considerable interest as potential COVID-19 treatments during the pandemic.
However, the World Health Organization recommendations against their use reflect ongoing uncertainty about how the drugs produce an effect in the body, and evidence of little or no effect on survival and other important measures, such as risk for hospital admission and need for mechanical ventilation.
Reliable data on COVID-19–related serious harms associated with these drugs also are lacking.
The WHO’s advice against the use of fluvoxamine except in clinical trials was informed by data from three randomized controlled trials (RCTs) involving more than 2,000 patients, and their strong advice against colchicine was based on data from seven RCTs involving 16,484 patients.
The panel of international experts, including four patients who have had COVID-19, noted that none of the included studies enrolled children, so the applicability of these recommendations to children is uncertain. However, they did not see a reason why children with COVID-19 would respond any differently to treatment with fluvoxamine or colchicine.
Previously, WHO made a strong recommendation for use of nirmatrelvir and ritonavir, and conditional recommendations for sotrovimab, remdesivir and molnupiravir for high-risk patients with mild to moderate disease.
For patients with severe COVID-19, WHO strongly recommends corticosteroids, with the addition of interleukin-6 receptor blockers or baricitinib, but advises against the use of convalescent plasma, ivermectin and hydroxychloroquine in patients with COVID-19, regardless of disease severity.
