Atorvastatin for reduction of 28-day mortality in severe and critical COVID-19 patients: a randomized controlled trial

Abstract

Background COVID-19 is an abnormal host response to the SARS-CoV-2 infection, which is associated with endothelial dysfunction and multi-organ failure. Atorvastatin has been proposed to reduce COVID-19 severity and mortality in chronic and de-novo users. Methods This randomized double-blind trial included 220 COVID-19 patients admitted to Mansoura University's isolation hospital in Egypt. One hundred and ten cases were given 40 mg of atorvastatin once daily for 28 days (group A), while 110 received a placebo (group B). All patients received treatment as per hospital protocol. The primary outcome is all-cause mortality at 28 days. We also tracked 6-month mortality, time to clinical improvement, the risk of invasive mechanical ventilation, acute kidney injury, potential adverse events, and hospital and intensive care length of stay. Results The 28-day all-cause mortality was 52/104 (50%) in group A vs. 54/103 (52.4%) in group B, odds ratio (OR) = 0.907 (0.526, 1.565), P = 0.727; adjusted OR = 0.773 (0.407, 1.47), P = 0.433. Six-month mortality occurred in 53/102 (52%) and 59/79 (60.8%) in group A vs. B, respectively, P = 0.208. Among hospital survivors in group A vs. group B, the median time to clinical improvement was 10 days (7–14) vs. 10 (7–15), P = 0.715; the duration of hospital stay was 10 days (7–14) vs. 10 (8–17), P = 0.378. Discontinuation was higher in group B (four vs. one), but statistically insignificant, P = 0.369. Conclusions In adults with severe or critical COVID-19, atorvastatin did not reduce the risk of 28-day or 6-month mortality and did not shorten the length of hospital stay or time to clinical improvement. Trial registration Clinical Trial Registry (NCT04952350) on July 1st, 2021. https://clinicaltrials.gov/ct2/show/NCT04952350

Effect of IL-6R blockade on plasma lipids and clinical outcomes among hospitalized patients with COVID-19 infection

“…It has been postulated that a protective effect of statins may result from their anti-inflammatory effects, possibly via decreasing lipid particle clearance of lipogenic viral particles whose clearance is slowed and half-life prolonged, and/or a direct inhibitory effect on SARS-CoV-2 infectivity ( 39 , 40 ). However, a meta-analysis of randomized controlled trials observed no benefit in adding statins to COVID-19 treatment ( 41 ), a finding further supported by recently published studies ( 42 , 43 ). In a small study, the use of proprotein convertase subtilisin/kexin type 9 inhibitors was shown to increase survival for 30 patients with COVID-19; however, additional larger studies are required to confirm this finding ( 44 ).…”