Oral Fluvoxamine With Inhaled Budesonide for Treatment of Early-Onset COVID-19 : A Randomized Platform Trial.
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Reis Gilmar, Dos Santos Moreira Silva Eduardo Augusto, Medeiros Silva Daniela Carla, Thabane Lehana, de Souza Campos Vitoria Helena, Ferreira Thiago Santiago, Quirino Dos Santos Castilho Vitor, Ribeiro Nogueira Ana Maria, Figueiredo Guimaraes Almeida Ana Paula, Cançado Monteiro Savassi Leonardo, de Figueiredo Neto Adhemar Dias, Bitarães Carina, Cruz Milagres Aline, Diniz Callegari Eduardo, Campos Simplicio Maria Izabel, Barra Ribeiro Luciene, Oliveira Rosemary, Harari Ofir, Wilson Lindsay A, Forrest Jamie I, Ruton Hinda, Sprague Sheila, McKay Paula, Guo Christina M, Guyatt Gordon H, Rayner Craig R, Boulware David R, Ezer Nicole, Lee Todd C, McDonald Emily Gibson, Bafadhel Mona, Butler Christopher, Rodrigues Silva Josue, Dybul Mark, Mills Edward J, TOGETHER Investigators
Аннотация
OBJECTIVE: To determine whether the combination of fluvoxamine and inhaled budesonide would increase treatment effects in a highly vaccinated population.
DESIGN: Randomized, placebo-controlled, adaptive platform trial. (ClinicalTrials.gov: NCT04727424).
SETTING: 12 clinical sites in Brazil.
PARTICIPANTS: Symptomatic adults with confirmed SARS-CoV-2 infection and a known risk factor for progression to severe disease.
INTERVENTION: Patients were randomly assigned to either fluvoxamine (100 mg twice daily for 10 days) plus inhaled budesonide (800 mcg twice daily for 10 days) or matching placebos.
MEASUREMENTS: The primary outcome was a composite of emergency setting retention for COVID-19 for more than 6 hours, hospitalization, and/or suspected complications due to clinical progression of COVID-19 within 28 days of randomization. Secondary outcomes included health care attendance (defined as hospitalization for any cause or emergency department visit lasting >6 hours), time to hospitalization, mortality, patient-reported outcomes, and adverse drug reactions.
RESULTS: Randomization occurred from 15 January to 6 July 2022. A total of 738 participants were allocated to oral fluvoxamine plus inhaled budesonide, and 738 received placebo. The proportion of patients observed in an emergency setting for COVID-19 for more than 6 hours or hospitalized due to COVID-19 was lower in the treatment group than the placebo group (1.8% [95% credible interval {CrI}, 1.1% to 3.0%] vs. 3.7% [95% CrI, 2.5% to 5.3%]; relative risk, 0.50 [95% CrI, 0.25 to 0.92]), with a probability of superiority of 98.7%. No relative effects were found between groups for any of the secondary outcomes. More adverse events occurred in the intervention group than the placebo group, but no important differences between the groups were detected.
LIMITATION: Low event rate overall, consistent with contemporary trials in vaccinated populations.
CONCLUSION: Treatment with oral fluvoxamine plus inhaled budesonide among high-risk outpatients with early COVID-19 reduced the incidence of severe disease requiring advanced care.
PRIMARY FUNDING SOURCE: Latona Foundation, FastGrants, and Rainwater Charitable Foundation.