Let’s talk: anti-depressant Fluvoxamine may help with COVID. New paper out. Here’s why you should get vaccinated, should maybe consider FLV if you’re high risk, why you should STILL GET VACCINATED, and why it’s important to read the paper and not just the infographic: 🧵👇 pic.twitter.com/L8TGeyaiTv

— Graham Walker, MD (@grahamwalker) August 24, 2021

I know you’re all here for the results, but I’ll only give them to you if you promise to read this whole thread. You ARE WRONG if you just conclude “Fluvoxamine works for COVID!” so keep reading.

👉FLV reduced hospitalizations by 4.3% compared to placebo. That’s not bad, TBH.

— Graham Walker, MD (@grahamwalker) August 24, 2021

It’s a pretty good study. They take unvaxx’d recently COVID+ adults w COVID symptoms w risk factors for getting seriously sick and gave them either placebo or FLV and watched what happened.

It was also a blinded, randomized, and large (1472 people) which all help strengthen it. pic.twitter.com/L4FNWCSHC7

— Graham Walker, MD (@grahamwalker) August 24, 2021

Regeneron, again via @REBEL__EM, a really fantastic evidence review site, in the RECOVERY Trial. Essentially, if you were “seronegative” (meaning your body doesn’t have antibodies against COVID already), Regeneron reduced your risk of death by 6%.https://t.co/qr57IuWHpC

— Graham Walker, MD (@grahamwalker) August 24, 2021

I should mention a number of concerns and caveats:
* GET VACCINATED. Think of vaccination as “long-acting fluvoxamine” if you want. Vaccination is very safe and very effective.
* FLV has a black box warning for increasing suicidality in young people. https://t.co/WGt6bvIshf

— Graham Walker, MD (@grahamwalker) August 24, 2021

So there’s a chance if Delta is making more previously healthy people sicker that FLV is actually MORE effective than in this trial. But if it’s making younger people sicker, there’s a chance of more side effects (suicidality) in younger people, too.

— Graham Walker, MD (@grahamwalker) August 24, 2021

Also, generally in medicine we kinda like our medicines to make sense on a biochemical level. Like, *why* would an anti-depressant help with COVID? (There’s some data that FLV might have anti-viral or anti-inflammatory properties, we… think.)

— Graham Walker, MD (@grahamwalker) August 24, 2021

Finally, we never like it when a trial is stopped early — either for harm or benefit. (This trial was stopped early for benefit.)

— Graham Walker, MD (@grahamwalker) August 24, 2021

Want to hear opinions from @jeremyfaust @Bob_Wachter @GidMK @EMSwami @srrezaie @EricTopol @boulware_dr @gorskon @farid__jalali @angie_rasmussen @nickmmark @AlastairMcA30 as well. Especially how vaccination impacts FLV (I think vaccine>>>FLV) and how Delta impacts this study.

— Graham Walker, MD (@grahamwalker) August 24, 2021

Update: @emlitofnote might be right here (as always). I was thrown off by the text, but it looks as if FLV may be mostly reducing 6 hour ED visits, which is not that clinically relevant.

What’s the right etiquette here, delete the thread and make a new one? https://t.co/sI3QnEi8Ca

— Graham Walker, MD (@grahamwalker) August 24, 2021

The slides are here: https://t.co/YghTd4jHTn

The preprint should be coming out soon, but as of yet can only assess the trial based on the protocol from other results published from this trial (it's pretty solid)

— Health Nerd (@GidMK) August 12, 2021

Worth waiting for the study to be published for any certainty, but at this point I'd say there's still a plausible minor benefit for ivermectin (on the order of 10% benefit) but any enormous benefits have been largely excluded by the data to date

— Health Nerd (@GidMK) August 12, 2021

TOGETHER is the largest, most well-conducted ivermectin study to date, and it was in low-risk outpatients

Which means the two main arguments from the ivermectin proponents simply no longer make any sense at all

— Health Nerd (@GidMK) August 12, 2021

One more point – there DOES appear to be a benefit in these slides from fluvoxamine for hospitalization/ED. I don't know enough about the literature on fluvoxamine to comment, but this looks very encouraging in isolation pic.twitter.com/X7Z1RjEZhL

— Health Nerd (@GidMK) August 12, 2021

I wrote about this all in a new piece
https://t.co/sb1ILcI8Nr

— Health Nerd (@GidMK) August 12, 2021

The largest randomised control clinical trial on Ivermectin and COVID-19 (the TOGETHER trial with 2100 participants) found that Ivermectin had NO significant effect on preventing hospitalisation in COVID-19 positive patients.

— IG: dr.setshwaelo✨ (@melosets) August 12, 2021

*have

— IG: dr.setshwaelo✨ (@melosets) August 12, 2021

Preliminary (not published, not peer-reviewed, so view with caution) results from the large TOGETHER trial (1300 people).
Ivermectin had no effect on mortality or hospitalization in those with mild Covid-19 disease.
It’s looking worse and worse for ivm.https://t.co/7INATj41Iy pic.twitter.com/MfukG6WgWs

— Alastair McAlpine, MD (@AlastairMcA30) August 12, 2021

Biznews, Nadya Swart, and Dr EV Rapiti are all incorrect.
The best data we have does NOT support the use of ivermectin for Covid-19.
Large TOGETHER trial about to be published also shows no benefit.https://t.co/kuH1EL50MH pic.twitter.com/V0HOgjpXXX

— Alastair McAlpine, MD (@AlastairMcA30) August 12, 2021

This is Biznews continuously pushing misinformation in service of a bizarre narrative that does not hold up under scrutiny.

Don’t fall for it.

— Alastair McAlpine, MD (@AlastairMcA30) August 12, 2021