Fluvoxamine Cuts Long COVID Fatigue in 399-Patient Trial
SkimNews Take
A cheap, widely available antidepressant showing benefit validates drug repurposing as the fastest route to evidence-based long COVID treatment, sidestepping the long timeline of novel therapeutics.
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- Fluvoxamine significantly reduced fatigue and improved quality of life in 399 Brazilian adults with long COVID in a randomized, placebo-controlled trial published in the Annals of Internal Medicine, making it one of the first medications to show meaningful benefits for the condition.
- Statistical analysis indicated a 99 percent probability that fluvoxamine was more effective than placebo, with participants also reporting quality-of-life gains across multiple measures in the REVIVE-TOGETHER trial.
- Metformin, the second drug tested, produced no meaningful improvement for patients with established long COVID fatigue — despite earlier research suggesting it could lower long COVID risk when taken during the initial infection.
- The trial used a Bayesian adaptive design that let researchers stop individual treatment groups early once evidence became clear, with investigators co-led from McMaster University, the University of British Columbia, Stanford, University of Pittsburgh, Duke, Georgetown, and several Brazilian institutions.
- Lead author Gilmar Reis of Cardresearch in Belo Horizonte called the design innovation "as important as the findings themselves," while corresponding author Jamie Forrest said the result is the "first strong evidence for a medication that helps reduce long COVID fatigue."
- Senior author Edward Mills of McMaster cautioned that fluvoxamine appears specifically promising for fatigue management, not a complete solution for long COVID — a condition estimated to affect about 65 million people worldwide with few proven therapies.
- The trial was funded by The Latona Foundation, with all 399 participants treated at clinical sites in Belo Horizonte and across the Brazilian state of Minas Gerais.
Why it matters: Patients with long COVID fatigue — a condition affecting an estimated 65 million people worldwide with almost no evidence-based drug options — may now have a low-cost, well-understood medication to try. Because fluvoxamine is already widely prescribed as an antidepressant, clinicians could deploy it immediately pending further research into which subgroups benefit most.
