Illustration of Prozac, whose molecule is fluoxetine, which could be protective against Covid-19 according to some preliminary studies.
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Darron Cummings / AP / SIPA
Today, very few drugs have shown their effectiveness against Covid-19.
But hope comes from psychiatry: a French doctor published an observational study on February 4, revealing that patients on antidepressants have less severe forms.
Using data from AP-HP, this study shows that five antidepressants reduce the risk of intubation and death by 42% to 78%.
An unexpected lead that requires further proof thanks to large-scale clinical trials.
Hope from psychiatry.
Several indications show that certain antidepressants, in particular Prozac, would protect patients with severe forms of Covid-19.
An article published in
the journal of the
Nature
group
, Molecular Psychiatry, on February 4 reveals how this track of a curative treatment for the coronavirus has emerged in France.
Information that should attract attention as the search for treatments seems to be on the rise for several months and antidepressants are (unfortunately) widely used in France and more and more in these troubled times ...
Would Prozac be lifesaving in the fight against the pandemic?
At the origin of this surprising discovery, a French doctor, Nicolas Hoertel, who has several hats: psychiatrist-teacher-researcher at AP-HP, the University of Paris and Inserm.
Few psychiatric patients affected by Covid-19
The author of the article published in Molecular Psychiatry, was surprised to see, from the first wave, his psychiatric patients at Corentin Celton Hospital (AP-HP) little affected by the epidemic.
“In my department, we have 80 beds,” explains Nicolas Hoertel.
From the start of the epidemic until today, we have counted four patients suffering from severe Covid.
It is very weak.
And the number of patients with Covid-19 remains lower than the caregivers of the infected department.
This observation is confirmed by data from a hospital in New York and other psychiatric services in France.
"Simple coincidence?
Bias related to patient age?
"We know that patients hospitalized in a shrink often have other comorbidities, for example heart problems," argues the psychiatrist.
In addition, our psychiatric service receives many elderly people.
We did not understand ... But a hypothesis emerged: protection of certain psychotropic drugs vis-à-vis Covid-19.
»Track reinforced by the fact that antidepressants have anti-inflammatory properties.
"Patients with a psychiatric disorder often have a small inflammation in the blood, reduced by certain antidepressants," explains the researcher to
20 Minutes.
To be sure, a team of researchers, led by Nicolas Hoertel, is launching an observational study, that is to say one based on hospital data, on the feelings of patients.
Thanks to data from 36 AP-HP hospitals, they are accumulating information on 7,230 adult patients hospitalized for Covid-19 between January 24 and April 1, 2020. Among them, 345 patients (4.8%) were on antidepressants just before their hospitalization.
"Our surprise was to observe that these patients had a risk of more than 40% of intubation or death compared to other patients, when we take into account differences in age and comorbidity", summarizes Nicolas Hoertel .
"The effect was not the same depending on the molecules"
Second step: do all antidepressants produce this protection?
“With additional analyzes, we noticed that the effect was not the same depending on the molecules,” continues the doctor.
For five antidepressants - fluoxetine (Prozac), paroxetine, escitalopra, venlafaxine and mirtazapine - the risk reduction is between 42% and 78%.
For other antidepressants, however, there is no protective effect.
"
Preliminary results consolidated in July 2020. But at that time, it was impossible to explain this difference between these five molecules and the others… In November, a German professor of molecular biology provided an answer.
“Professor Erich Gulbins contacted me to tell me that these molecules had the in vitro property of preventing Sars-Cov-2 from entering cells,” continues Nicolas Hoertel.
He did an experiment on healthy volunteers who took an antidepressant tablet, he took nasal cells, put them in contact with the coronavirus and he observed that there was no infection.
When he repeated this experiment 24 hours later, the cells were infected, which corresponds to the exhaustion of the effect of the antidepressant.
"
Clinical trials to verify the hypothesis
Since then, other clues have accumulated to confirm that this hypothesis could be a real revolution in the search for a treatment against Covid-19.
In particular a clinical trial (drug versus placebo) carried out by Washington University in Saint Louis in the United States on another common antidepressant, fluvoxamine (Floxyfral), close to Prozac.
“On these preliminary data published in November, we discovered spectacular results: out of 80 patients receiving this antidepressant, none saw their condition worsen against six patients on placebo.
The final results of this randomized trial on several hundred patients are expected (impatiently) by the end of February.
“We are a pioneer on this issue and we are moving forward, enthuses the researcher.
It's a real hope!
I am not claiming that we have found a cure.
But there is a convergence of pre-clinical evidence, clinical trials, observational studies, which show a strong effectiveness of these treatments in preventing the worsening and curative treatment of Covid-1.
There are several ongoing randomized trials.
“Moreover, a clinical trial at AP-HP is being set up with several hundred hospitalized patients to test the effectiveness of fluoxetine (Prozac) to prevent intubation and death.
If this lead was successful, another positive aspect concerns its price.
Indeed, a box of 28 tablets of 20g of fluoxetine is sold for € 4.10 in France (roughly the same price as hydroxychloroquine… against more than 2,000 euros for remdesivir).
In addition, the fluoxetine production chains are concentrated in Europe, which could avoid the risk of shortages ... It remains to be seen whether all Covid patients would be ready to take an antidepressant, the risks of addiction and the side effects of which are known. .
"It would be for a short use: we expect 10 to 15 days, reassures the psychiatrist.
We have known about these molecules for decades.
And we know that they are very well tolerated in elderly subjects.
Adverse effects exist, but they are mild for the vast majority of patients.
"
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