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Observational Study
. 2022 Dec;37(16):4144-4152.
doi: 10.1007/s11606-022-07701-3. Epub 2022 Jun 29.

Medications Associated with Lower Mortality in a SARS-CoV-2 Positive Cohort of 26,508 Veterans

Christine M Hunt  1   2   3 , Jimmy T Efird  4   5 , Thomas S Redding 4th  3 , Andrew D Thompson Jr  3 , Ashlyn M Press  3 , Christina D Williams  3   6   7 , Christopher J Hostler  8   9 , Ayako Suzuki  10   11
Affiliations
Observational Study

Medications Associated with Lower Mortality in a SARS-CoV-2 Positive Cohort of 26,508 Veterans

Christine M Hunt et al. J Gen Intern Med. 2022 Dec.

Abstract

Background: Many severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) positive patients take commonly prescribed medications with properties which may affect mortality.

Objective: Assess if common medications postulated to affect clinical outcomes are associated with mortality in SARS-CoV-2 positive patients in the Veterans Health Administration (VHA).

Design: Observational national cohort analysis.

Participants: Consecutive 26,508 SARS-CoV-2 positive Veterans (7% of 399,290 tested from March 1 to September 10, 2020) constitute the study cohort.

Main measures: The primary outcome was 30-day mortality from the first positive SARS-CoV-2 test date. In patients receiving medications or drug pairs within 2 weeks post-SARS-CoV-2 positive test, 30-day mortality was estimated as relative risk (RR) on the log-binomial scale or using multinomial models with and without adjusting for covariates.

Key results: The 26,508 SARS-CoV-2 positive patients were predominantly male (89%) and White (59%), and 82% were overweight/obese. Medications associated with decreased 30-day mortality risk included the following: metformin (aRR, 0.33; 95% CI, 0.25-0.43), colchicine, angiotensin-converting-enzyme inhibitors (ACEi), angiotensin II receptor blockers, statins, vitamin D, antihistamines, alpha-blockers, anti-androgens, and nonsteroidal anti-inflammatory drugs (aRR, 0.69; 95% CI, 0.61-0.78). The effect of co-prescribed medications on 30-day mortality risk revealed the lowest risk for combined statins and metformin (aRR, 0.21; 95% CI, 0.15-0.31), followed by ACEi and statins (aRR, 0.25; 95% CI, 0.18-0.35), ACEi and metformin (aRR, 0.26; 95% CI, 0.17-0.40), antihistamines and NSAIDs (aRR, 0.41; 95% CI, 0.32-0.52), and in men, combined alpha-blockers and anti-androgens (aRR, 0.51; 95% CI, 0.42-0.64).

Conclusions: In this large national cohort, treatment of SARS-CoV-2 positive patients with individual or co-prescribed metformin and statins, ACEi and statins (or metformin) and other medications was associated with a markedly decreased 30-day mortality and can likely be continued safely. Clinical trials may assess their therapeutic benefit.

Keywords: angiotensin-converting enzyme inhibitor; drug safety; metformin; mortality; severe acute respiratory syndrome coronavirus-2; statins.

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Conflict of interest statement

Dr. Hunt is a consultant to Akebia Therapeutics, Inc. Dr. Hostler is co-owner of Infection Control Education for Major Sports, LLC, and consultant for OneBeacon Insurance and Prime Education, LLC.

Comment in

  • Statin Therapy in COVID-19: Inhibition of NETosis.
    Kow CS, Ramachandram DS, Hasan SS. Kow CS, et al. J Gen Intern Med. 2023 Mar;38(4):1077. doi: 10.1007/s11606-022-07964-w. Epub 2022 Nov 22. J Gen Intern Med. 2023. PMID: 36414801 Free PMC article. No abstract available.

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