School of Medicine

Finding a possible early treatment for COVID-19 in a 40-year-old antidepressant

Horses race at California's Golden Gate Fields (CBS-60 Minutes)

The race to find vaccines for COVID-19 has dominated the headlines, but there’s been less news about how to keep people with COVID out of the hospital. Tonight, we’re going to tell you a story about one possible treatment. It’s called fluvoxamine. The generic drug was developed 40 years ago as an antidepressant and has been primarily used to treat obsessive-compulsive disorder. Now, a small but ingenious clinical trial and a series of coincidences have led scientists to look closely at fluvoxamine as a possible tool to keep newly diagnosed COVID-19 patients from becoming severely ill. So how did a pill that costs 60 cents become a dark horse to treat COVID? We went to a place that knows all about long shots to find out.

Golden Gate Fields is in Berkeley, California. The stands have been empty since COVID hit last year, but the races go on. There are 1,200 thoroughbreds here – trained and cared for by more than 500 people. Last November, COVID went on a rampage in the barn area where many workers live.

Dr. David Seftel: We had four cases that were initially reported and because we have a community living back there, we decided to test everybody. And that’s when we saw the first round of testing reveal 200 positive individuals.

Sharyn Alfonsi: Wow. What was your reaction when you heard 200 positive cases right here?

Dr. David Seftel: Shock and dismay.

Dr. David Seftel has been the physician for employees and their families at Golden Gate Fields for 20 years.

He is originally from South Africa and is Harvard-educated.

Sharyn Alfonsi: Who was sick? Was it the jockeys, was it the guys who work in the stable, their families?

Dr. David Seftel: It was really across the entire spectrum. And what’s interesting about our community is that it really is a mirror image of the community that is most affected by COVID, predominantly Latino community, incredibly hardworking. They don’t have the luxury of working from home or working on Zoom. They have to be out there every single day.

But there are few early treatment options for COVID. The handful of drugs that have been approved are for high risk patients and must be delivered intravenously, often in a hospital.

Dr. David Seftel: When I looked at this community, I said I know the numbers, I know the stats. There are gonna be deaths and there’s gonna be disability unless I take action.

Sharyn Alfonsi: Is that what you were thinking as the numbers kind of rolled in?

Dr. David Seftel: This was a disaster in the making.

Dr. Seftel felt his only choice to keep his patients from getting sicker was to act on a tip he got just hours before. The doctor offered them the antidepressant fluvoxamine. To understand why, you have to go back to the starting gate of our story.

Eight months earlier in March, Dr. Angela Reiersen, a child psychiatrist at Washington University in St. Louis, was home sick with COVID symptoms. And thinking about old medical studies she’d read.

Sharyn Alfonsi: Most people when they’re home sick with COVID, they say, “Look, I just wanna sit on the couch, and ride this out.”

Dr. Angela Reiersen: Well, I didn’t wanna just sit there and be sick. I was really kind of driven to try to find answers.

Dr. Reiersen remembered a study published a year earlier by these researchers at the University of Virginia on mice. They found fluvoxamine stopped sepsis. Sepsis is a runaway immune response in which inflammation gets out of control, damages organs and can be deadly. It’s believed a similar phenomenon occurs in COVID patients.

Dr. Angela Reiersen: And I thought, well, I wonder if we could use fluvoxamine to treat COVID and prevent that clinical deterioration?

Sharyn Alfonsi: You thought, this is something that might be able to stop inflammation from going into overdrive?

Dr. Angela Reiersen: Right. Either stop the inflammation from going into overdrive or shut it down once it had started to prevent our own bodies from destroying ourselves basically. So, then I emailed Eric Lenze, and just kind of explained the whole rationale behind it in an email.

Dr. Eric Lenze is also a psychiatrist at Washington University. He specializes in finding new uses for drugs already approved by the Food and Drug Administration.

Sharyn Alfonsi: Did you have some skepticism at first?

Dr. Eric Lenze: Amazingly, I did not. Angela presented a very compelling and innovative case for this drug. And it turns out that there’s a lot of properties of– psychiatric drugs like… safety and ease of use… and the fact that they can get into the body quickly that makes ’em actually ideal for repurposing.

The doctors got $20,000 from Washington University last April to launch a small randomized clinical trial on fluvoxamine. But getting patients to try an antidepressant for COVID was hard.

Sharyn Alfonsi: How’d you sell it?

Dr. Eric Lenze: Yeah, and that was a real steep learning curve for us as well that we’re doing with this antidepressant drug that we usually use for obsessive-compulsive disorder. Imagine you’re a patient at home, sick with COVID and you get a phone call like that.

Patients who agreed didn’t have to leave their homes. Researchers would drop off a paper bag containing fluvoxamine pills to half of the COVID patients. The other half would get a placebo, with instructions to take the pills for 15 days.

Dr. Eric Lenze: Our team was acting like– couriers, or, if you will, delivery men, dropping it off at their house. And then we would work with them through the phone and the internet. By May we were kind of running on fumes, as far as– funding went. Fortunately it was at that point that I– read in the New York Times, of all places, about the COVID Early Treatment Fund.

Steve Kirsch is the founder of the group Lenze read about. Kirsch is a Silicon Valley entrepreneur who made a fortune developing the optical computer mouse. He put up a million dollars of his own money and then assembled a panel of scientists to decide which covid research he should fund.

Sharyn Alfonsi: Tell me about the first conversation you had with Dr. Lenze.

Steve Kirsch: You know, we were like, oh, we– we got a grant application. This is thrilling to us. And it’s for $67,000… and so it’s a very modest amount, so we ran it through the scientific advisory board and they said, you know, this is novel.

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