The majority of COVID-19 cases are only mildly or moderately symptomatic, but in some patients excessive inflammatory response becomes the dominant factor of disease progression to the advanced stage, with high mortality. Treatment with anti-inflammatory drugs either does not prevent disease progression (non-steroidal anti-inflammatory drugs [NSAIDs], colchicine), or is recommended only at the advanced disease stage (dexamethasone). Fluvoxamine and amantadine are drugs used to treat neurological and psychiatric diseases. Fluvoxamine is a selective serotonin uptake inhibitor, whereas amantadine is an old antiviral variably influencing brain neurotransmitter systems, and repurposed to Parkinson’s disease. Both drugs are agonists of sigma-1 receptors located in the endoplasmic reticulum, which effect seems responsible for their anti-inflammatory activity. Moreover, amantadine was found to dampen the expression of cathepsin-L, a lysosomal enzyme implicated in SARS-CoV-2 virus entry to target cells. In two small controlled clinical trials, early treatment of SARS-CoV-2-infected persons with fluvoxamine fully prevented COVID-19 symptoms. Anecdotal evidence shows that amantadine may be similarly effective. Both drugs are easily available, inexpensive and have favorable safety profiles. Clinical trials evaluating their efficacy as much-needed post-exposure prophylaxis and early treatment of COVID-19 are ongoing.

中文翻译：

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显示抗炎活性的中枢神经系统药物是否适合 COVID-19 的早期治疗？

大多数 COVID-19 病例只有轻度或中度症状，但在某些患者中，过度的炎症反应成为疾病进展至晚期的主导因素，死亡率很高。抗炎药治疗要么不能阻止疾病进展（非甾体抗炎药 [NSAID]、秋水仙碱），要么仅在疾病晚期推荐（地塞米松）。氟伏沙明和金刚烷胺是用于治疗神经和精神疾病的药物。氟伏沙明是一种选择性血清素摄取抑制剂，而金刚烷胺是一种古老的抗病毒药物，对脑神经递质系统有不同的影响，并被重新用于治疗帕金森病。这两种药物都是位于内质网中的 sigma-1 受体的激动剂，这种效果似乎是它们抗炎活性的原因。此外，发现金刚烷胺会抑制组织蛋白酶-L 的表达，组织蛋白酶-L 是一种溶酶体酶，与 SARS-CoV-2 病毒进入靶细胞有关。在两项小型对照临床试验中，使用氟伏沙明对 SARS-CoV-2 感染者进行早期治疗可以完全预防 COVID-19 症状。轶事证据表明，金刚烷胺可能同样有效。这两种药物都易于获得、价格低廉且具有良好的安全性。由于急需的暴露后预防和 COVID-19 早期治疗的有效性，临床试验正在进行中。使用氟伏沙明对 SARS-CoV-2 感染者进行早期治疗可完全预防 COVID-19 症状。轶事证据表明，金刚烷胺可能同样有效。这两种药物都易于获得、价格低廉且具有良好的安全性。由于急需的暴露后预防和 COVID-19 早期治疗的有效性，临床试验正在进行中。使用氟伏沙明对 SARS-CoV-2 感染者进行早期治疗可完全预防 COVID-19 症状。轶事证据表明，金刚烷胺可能同样有效。这两种药物都易于获得、价格低廉且具有良好的安全性。由于急需的暴露后预防和 COVID-19 早期治疗的有效性，临床试验正在进行中。