Therapeutics Update

Stephen B. -

a helpful (tho imperfect) tool for evaluating high risk for progression in patients being discharged that is likely much more objective and repeatable than a physician's covid Gestalt

Brian D., Dr -

I listened to the COVID-19 Update broadcast on January 18. I wanted to express my appreciation for everyone's efforts as I found it very useful.

I am, however, confused by a few of the comments on the Therapeutics segment. Sean Nordt said, "The data for fluvoxamine and inhaled budesonide is weak." I am not sure that this is fair and equitable assessment. Please see articles below, including EM:RAP EMA segment on budesonide in December 2021 issue.

EMA Decemeber, 2021: Inhaled budesonide for COVID-19 in people at high risk of complications in the community in the UK


In Canada, Paxlovid is still not available — at least where I practice — and Molnupiravir is not approved by Health Canada (our national regulatory body). Sotrovimab is said to cost $2100 USD (though this would not come out of the patient's pocket), and has strictly enforced prescribing criteria. I would appreciate a deeper dive into fluvoxamine and budesonide, two significantly less expensive options.

Brian Deady, MD
Emergency Department
Royal Columbian Hospital
New Westminster, BC, Canada

Sean N. -

Hi Brian,

Thank you for your comments!

We do not believe the data currently available supports a recommendation for the routine use of fluvoxamine or inhaled corticosteroids in treating COVID, although we do believe that the use of inhaled corticosteroids in those patients with COPD and/or asthma is supported.

We try to strike a careful balance in our Live segments to be complete while not focusing too much on therapies with limited data. The TOGETHER trial in Lancet Global Health was inconclusive on the individual rates of hospitalization and mortality and the contribution of concomitant therapies. The Lancet Respiratory Medicine STOIC study was an open-label study and the main outcome was patient self-reporting of clinical improvement.

As more data comes available, we will continue to review and evaluate.

Thanks again and thank you for what you do!
Sean and Stuart

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