Effects of statins on clinical outcomes in hospitalized patients with COVID-19

Martins-Filho, Paulo Ricardo; Barreto-Filho, José Augusto Soares; Sousa, Antônio Carlos Sobral

doi:10.1016/j.ejim.2022.06.007

Cited by 6 publications

(6 citation statements)

References 9 publications

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“…Consistently, there is no clear evidence regarding the protective effects of in-hospital statin therapy (either continuation or introduction de novo) on the most severe forms of COVID-19. 13,14,[18][19][20][21]32,[45][46][47] Thus, as to whether statin-mediated protective effects in the context of COVID-19 may be time-…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, in the exploratory analyses of the present study, statin continuation during hospitalization was not associated with COVID‐19 outcomes. Consistently, there is no clear evidence regarding the protective effects of in‐hospital statin therapy (either continuation or introduction de novo) on the most severe forms of COVID‐19 13,14,18–21,32,45–47 . Thus, as to whether statin‐mediated protective effects in the context of COVID‐19 may be time‐dependent remains an open issue.…”

Section: Discussionmentioning

confidence: 99%

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The impact of statin therapy on in‐hospital prognosis and endothelial function of patients at high‐to‐very high cardiovascular risk admitted for COVID‐19

Bianconi

Mannarino

Cosentini

et al. 2023

Journal of Medical Virology

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Statins may protect against adverse outcomes from Coronavirus disease 2019 (COVID‐19) through their pleiotropic effects. Endothelial dysfunction seems to be implicated in the pathophysiology of COVID‐19, and can be attenuated by statins. This study assessed the role of preadmission statin therapy and its interaction with endothelial function, measured using flow‐mediated dilation (FMD) at hospital admission, in predicting in‐hospital outcomes among patients with COVID‐19 having high‐to‐very high cardiovascular (CV) risk. We conducted a retrospective cohort study of hospitalized patients with COVID‐19 having high‐to‐very high CV risk, including a subgroup of patients who underwent FMD assessment. Among 342 patients, 119 (35%) were treated with statins at study baseline. Preadmission statin therapy was independently associated with a 75% risk reduction of intensive care unit admission/in‐hospital death (adjusted hazard ratio 0.252, 95% confidence interval 0.122−0.521, p < 0.001). In the subgroup of patients with an FMD assessment (245 patients, 40% statin‐treated), preadmission statin therapy was independently associated with higher FMD values (β = 0.159, p = 0.013). However, preadmission statin therapy × FMD interaction was not associated with in‐hospital outcomes (F = 0.002, pinteraction = 0.960). Preadmission statin therapy is associated with better in‐hospital outcomes among patients with COVID‐19 having high‐to‐very high CV risk, independent of the endothelium‐protective effects of these drugs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The impact of statin therapy on in‐hospital prognosis and endothelial function of patients at high‐to‐very high cardiovascular risk admitted for COVID‐19

Bianconi

Mannarino

Cosentini

et al. 2023

Journal of Medical Virology

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“…Several drug repurposing strategies have been evaluated for the prevention and treatment of COVID-19. However, meta-analyses of clinical trials have shown that some of these promising drugs, including hydroxychloroquine [ 8 ], ivermectin [ 9 , 28 ], colchicine [ 29 ], and statins [ 30 ] have no clinical benefits against the disease. This systematic review and meta-analysis synthesized the evidence on the efficacy and safety of nitazoxanide as a potential treatment of patients with COVID-19 based on the results of blinded, placebo-controlled, RCTs.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of nitazoxanide in treating SARS-CoV-2 infection: a systematic review and meta-analysis of blinded, placebo-controlled, randomized clinical trials

Martins-Filho

Nascimento-Júnior

Barreto-Alves

et al. 2022

Eur J Clin Pharmacol

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Purpose Nitazoxanide is a broad-spectrum antiparasitic that has been tested for COVID-19 due to its anti-inflammatory effects and in vitro antiviral activity. This study synthesized the best evidence on the efficacy and safety of nitazoxanide in COVID-19. Methods Searches for studies were performed in peer-reviewed and grey-literature from January 1, 2020 to May 23, 2022. The following elements were used to define eligibility criteria: (1) Population: individuals with COVID-19; (2) Intervention: nitazoxanide; (3) Comparison: placebo; (4) Outcomes: primary outcome was death, and secondary outcomes were viral load, positive RT-PCR status, serum biomarkers of inflammation, composite measure of disease progression (ICU admission or invasive mechanical ventilation), and any adverse events; (5) Study type: blinded, placebo-controlled, randomized clinical trials (RCTs). Treatment effects were reported as relative risk (RR) for dichotomous variables and standardized mean difference (SMD) for continuous variables with 95% confidence intervals (CI). Results Five blinded, placebo-controlled RCTs were included and enrolled individuals with mild or moderate SARS-CoV-2 infection. We found no difference between nitazoxanide and placebo in reducing viral load (SMD = − 0.16; 95% CI − 0.38 to 0.05) and the frequency of positive RTP-PCR results (RR = 0.92; 95% CI 0.81 to 1.06). In addition, there was no decreased risk for disease progression (RR = 0.63; 95% CI 0.38 to 1.04) and death (RR = 0.81; 95% CI 0.36 to 1.78) among patients receiving nitazoxanide. Patients with COVID-19 treated with nitazoxanide had decreased levels of white blood cells (SMD = − 0.15; 95% − 0.29 to − 0.02), lactate dehydrogenase (LDH) (SMD − 0.32; 95% − 0.52 to − 0.13), and D-dimer (SMD − 0.49; 95% CI − 0.68 to − 0.31) compared to placebo, but the magnitude of effect was considered small to moderate. Conclusion This systematic review showed no evidence of clinical benefits of the use of nitazoxanide to treat patients with mild or moderate COVID-19. In addition, we found a reduction in WBC, LDH, and D-dimer levels among nitazoxanide-treated patients, but the effect size was considered small to moderate. Supplementary Information The online version contains supplementary material available at 10.1007/s00228-022-03380-5.

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“…A meta-analysis of five of the six RCTs of inpatient statin treatment has been published [ 206 ]. The relative risk of death was 0.90 (95% CI = 0.73–1.11; p value = 0.33).…”

Section: Inpatient Statin Treatmentmentioning

confidence: 99%

Treating COVID-19: Targeting the Host Response, Not the Virus

Fedson¹

2023

Life

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In low- and middle-income countries (LMICs), inexpensive generic drugs like statins, ACE inhibitors, and ARBs, especially if used in combination, might be the only practical way to save the lives of patients with severe COVID-19. These drugs will already be available in all countries on the first pandemic day. Because they target the host response to infection instead of the virus, they could be used to save lives during any pandemic. Observational studies show that inpatient statin treatment reduces 28–30-day mortality but randomized controlled trials have failed to show this benefit. Combination treatment has been tested for antivirals and dexamethasone but, with the exception of one observational study in Belgium, not for inexpensive generic drugs. Future pandemic research must include testing combination generic drug treatments that could be used in LMICs.

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Effects of statins on clinical outcomes in hospitalized patients with COVID-19

Cited by 6 publications

References 9 publications

The impact of statin therapy on in‐hospital prognosis and endothelial function of patients at high‐to‐very high cardiovascular risk admitted for COVID‐19

The impact of statin therapy on in‐hospital prognosis and endothelial function of patients at high‐to‐very high cardiovascular risk admitted for COVID‐19

Efficacy and safety of nitazoxanide in treating SARS-CoV-2 infection: a systematic review and meta-analysis of blinded, placebo-controlled, randomized clinical trials

Treating COVID-19: Targeting the Host Response, Not the Virus

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