WHO Guideline Advises Against Fluvoxamine, Colchicine for COVID-19

FRIDAY, July 15, 2022 — Fluvoxamine and colchicine are not recommended for nonsevere COVID-19, according to the 11th version of the World Health Organization living guideline on drugs for COVID-19 published online July 13 in The BMJ.

Arnav Agarwal, M.D., from McMaster University in Hamilton, Ontario, Canada, and colleagues developed the 11th version of the living guideline to examine the role of drugs in the treatment of COVID-19, specifically focusing on recommendations for fluvoxamine and colchicine for nonsevere COVID-19. The recommendation for fluvoxamine was informed by data from three randomized controlled trials (RCTs) with 2,196 patients, and the recommendation relating to colchicine was based on data from seven RCTs involving 16,484 patients.

The researchers recommend against use of fluvoxamine, except in the context of a clinical trial involving patients with nonsevere illness. For colchicine, a strong recommendation is made against its use in patients with nonsevere illness. For patients with severe or critical illness, no recommendations were made for either drug. The recommendations against fluvoxamine and colchicine reflect the lack of a clear mechanism of action; evidence of little or no effect on the risks for hospital admission, mechanical ventilation, and mortality; and the absence of reliable data on serious adverse events and harms related to COVID-19. Considerations included known serious pharmacological interactions and large proportions of drug discontinuations for fluvoxamine and known risks for drug interactions and the narrow therapeutic window for colchicine.

“This eleventh version of the WHO living guideline addresses the use of fluvoxamine and colchicine in nonsevere COVID-19,” the authors write. “These drugs are less costly and more readily available than other therapeutic alternatives and have therefore received considerable interest during the pandemic.”

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