Fluvoxamine vs Paxlovid
Unsung Hero vs Media Darling
It’s an accepted tenet in medicine that treating infections early is associated with better outcomes—We don’t wait for a skin infection to become gangrenous to start antibiotics. With this precept in mind, I’ve been treating my Covid patients early since the pandemic began, with various outpatient prescription and non-prescription medications along with supplements—With very good results. These include accepted therapies such as monoclonal antibodies, as well as the drug that shall not be named, ivermectin—The subject of arguably one the most idiotic and unwarranted controversies in the history of medicine.
Long-Covid is not a rare event, and as counterintuitive as it may sound, even patients with mild cases of acute Covid are getting it. So in the pursuit of preventing both bad outcomes in the acute and long-term setting, when impressive data began accumulating on the efficacy of fluvoxamine for Covid, I was interested, especially after the 2nd randomized controlled study came out supporting its use.
Fluvoxamine—Censorship by Omission
When I first started using fluvoxamine, I’d mention it to Covid patients by saying something like “By now everyone has heard of the really impressive fluvoxamine trial data. You must have seen it on the news…”—But all I got back was the polite shaking of heads and an interested, “I haven’t heard of it. What’s that?” After this happened about a dozen times, I got that familiar sinking feeling that something is amiss. Our healthcare leaders and media were reacting to this life-saving news with deafening silence.
The data I was referring to is the TOGETHER trial published in The Lancet, which is the 2nd the randomized placebo-controlled trial demonstrating that fluvoxamine is effective against Covid. It was stopped early because fluvoxamine demonstrated “superiority,” to use their words:
“The trial was initiated on June 2, 2020, with the current protocol reporting randomisation to fluvoxamine from Jan 20 to Aug 5, 2021, when the trial arms were stopped for superiority.”
Fluvoxamine performed quite well in meeting its primary outcome:
“Our primary outcome was a composite endpoint of hospitalisation defined as either retention in a COVID-19 emergency setting or transfer to tertiary hospital due to COVID-19…”
It reduced the number of patients going to the hospital by two-thirds:
Per-protocol findings among patients who reported optimal adherence (greater than 80% for possible days) indicated a significant treatment effect (RR 0·34; 95% BCI 0·21–0·54 for the primary outcome…”
Secondary outcomes included a 91% reduction in mortality:
“There was one death in the fluvoxamine group and 12 in the placebo group for the per-protocol population (OR 0·09; 95% CI 0·01–0·47). We found no significant differences in number of treatment emergent adverse events among patients in the fluvoxamine and placebo groups.”
Stopping the trial early was based on parameters set up before it began—The benefits from the use of fluvoxamine exceeded the highest level of the range of anticipated outcomes requiring study completion. Above that range means that it almost certainly works, thus invalidating the need to complete the study. It would have been unethical to continue withholding it from Covid patients in the placebo group.
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