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Identification of drugs associated with reduced severity of COVID-19 - a case-control study in a large population

Ariel Israel1, Alejandro A Schäffer2, Assi Cicurel1,3

  • 1Division of Planning and Strategy, Clalit Health Services, Tel Aviv, Israel.

Elife
|July 27, 2021
PubMed

Insights

Certain cholesterol pathway medications like ubiquinone, ezetimibe, and rosuvastatin show promise in reducing COVID-19 hospitalization risk. Further research is needed to confirm these protective effects against severe coronavirus disease 2019.

Area of Science:

  • Epidemiology
  • Pharmacology
  • Public Health

Background:

  • Investigating existing medications for protective effects against severe coronavirus disease 2019 (COVID-19) is crucial due to limited accessibility of specific COVID-19 treatments.
  • A large population study was conducted within Clalit Health Services (CHS), Israel's largest healthcare provider, covering over 4.7 million members.

Purpose of the Study:

  • To identify medications acquired within the last month that decrease the risk of COVID-19 hospitalization.
  • To assess the association between medication use and reduced severity of COVID-19 outcomes.

Main Methods:

  • Two matched case-control cohorts were assembled, including adults aged 18-95 hospitalized for COVID-19 (cases).
  • Cohort 1: Five controls from the general population per case (n=6202). Cohort 2: Two non-hospitalized SARS-CoV-2 positive controls per case (n=6919).
  • Odds ratios (OR), 95% confidence intervals (CI), and p-values were calculated using Fisher's exact test, with false discovery rate adjustment for multiple testing.

Main Results:

  • Significantly reduced odds for COVID-19 hospitalization were associated with ubiquinone (OR=0.185), ezetimibe (OR=0.488), rosuvastatin (OR=0.673), flecainide (OR=0.301), and vitamin D (OR=0.869).
  • Notably, artificial tears, eye care products, and ophthalmologicals also showed a decreased risk of hospitalization.
  • Medications linked to the cholesterol synthesis pathway (ubiquinone, ezetimibe, rosuvastatin) demonstrated a protective effect.

Conclusions:

  • Ubiquinone, ezetimibe, and rosuvastatin, involved in cholesterol synthesis, were associated with lower COVID-19 hospitalization rates.
  • These findings suggest a potential protective role for these medications against severe COVID-19.
  • Further investigation in controlled, prospective studies is warranted to confirm these promising results.
Abstract

Keywords:
SARS-CoV-2disease severityepidemiologyglobal healthhumaninfectious diseasemicrobiologyretrospective study

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