Kim Jean, Miyazaki Kyle, Shah Parthav, Kozai Landon, Kewcharoen Jakrin
Department of Internal Medicine, University of Hawaii, Honolulu, HI 96813, USA.
Division of Cardiovascular Medicine, Loma Linda University Health, Loma Linda, CA 92354, USA.
Healthcare (Basel). 2022 Mar 30;10(4):645. doi: 10.3390/healthcare10040645.
Since the onset of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, various potential targeted therapies for SARS-CoV-2 infection have been proposed. The protective effects of mineralocorticoid receptor antagonists (MRA) against tissue fibrosis, pulmonary and systemic vasoconstriction, and inflammation have been implicated in potentially attenuating the severity of SARS-CoV-2 infection by inhibiting the deleterious effects of aldosterone. Furthermore, spironolactone, a type of MRA, has been suggested to have a beneficial effect on SARS-CoV-2 outcomes through its dual action as an MRA and antiandrogen, resulting in reduced transmembrane protease receptor serine type 2 (TMPRSS2)-related viral entry to host cells. In this study, we sought to investigate the association between MRA antagonist therapy and mortality in SARS-CoV-2 patients via systematic review and meta-analysis. The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE and EMBASE databases were searched for studies that reported the incidence of mortality in patients on MRA with SARS-CoV-2 infection. Pooled odds ratio (OR) and 95% confidence interval (CI) of the outcome were obtained using the random-effects model. Five studies with a total of 1,388,178 subjects (80,903 subjects receiving MRA therapy) met the inclusion criteria. We included studies with all types of MRA therapy including spironolactone and canrenone and found no association between MRA therapy and mortality in SARS-CoV-2 infection (OR = 0.387, 95% CI: 0.134-1.117, = 0.079).
自严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行开始以来，已提出了多种针对SARS-CoV-2感染的潜在靶向治疗方法。盐皮质激素受体拮抗剂（MRA）对组织纤维化、肺和全身血管收缩以及炎症的保护作用，被认为可能通过抑制醛固酮的有害作用来减轻SARS-CoV-2感染的严重程度。此外，螺内酯作为一种MRA，已被认为通过其作为MRA和抗雄激素的双重作用对SARS-CoV-2感染的预后具有有益影响，从而减少跨膜蛋白酶丝氨酸2型（TMPRSS2）相关的病毒进入宿主细胞。在本研究中，我们试图通过系统评价和荟萃分析来研究MRA拮抗剂治疗与SARS-CoV-2感染患者死亡率之间的关联。系统评价按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行。在MEDLINE和EMBASE数据库中检索报告了接受MRA治疗的SARS-CoV-2感染患者死亡率的研究。使用随机效应模型获得该结局的合并比值比（OR）和95%置信区间（CI）。五项研究共纳入1,388,178名受试者（80,903名接受MRA治疗的受试者）符合纳入标准。我们纳入了包括螺内酯和坎利酮在内的所有类型MRA治疗的研究，发现MRA治疗与SARS-CoV-2感染患者的死亡率之间无关联（OR = 0.387，95% CI：0.134 - 1.117， = 0.079）。
