在 26508 名 SARS-CoV-2 阳性退伍军人队列中，与较低死亡率相关的药物。
Medications Associated with Lower Mortality in a SARS-CoV-2 Positive Cohort of 26,508 Veterans.
机构信息
Division of Gastroenterology, Duke University, Durham, NC, USA.
Division of Gastroenterology, Durham VA Medical Center, Durham, NC, USA.
出版信息
J Gen Intern Med. 2022 Dec;37(16):4144-4152. doi: 10.1007/s11606-022-07701-3. Epub 2022 Jun 29.
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.
背景
许多严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）阳性患者服用的常用药物具有可能影响死亡率的特性。
目的
评估退伍军人事务部（VHA）中假定影响临床结局的常用药物是否与 SARS-CoV-2 阳性患者的死亡率相关。
设计
观察性全国队列分析。
参与者
连续 26508 名 SARS-CoV-2 阳性退伍军人（2020 年 3 月 1 日至 9 月 10 日检测的 399290 人中的 7%）构成研究队列。
主要措施
主要结局是从首次 SARS-CoV-2 检测阳性日期起 30 天的死亡率。在 SARS-CoV-2 阳性检测后 2 周内接受药物或药物对治疗的患者中，使用对数二项式标度或包含和不包含协变量的多项模型估计 30 天死亡率的相对风险（RR）。
主要结果
26508 名 SARS-CoV-2 阳性患者主要为男性（89%）和白人（59%），82%为超重/肥胖。与降低 30 天死亡率风险相关的药物包括：二甲双胍（aRR，0.33；95%CI，0.25-0.43）、秋水仙碱、血管紧张素转换酶抑制剂（ACEi）、血管紧张素 II 受体阻滞剂、他汀类药物、维生素 D、抗组胺药、α-受体阻滞剂、抗雄激素和非甾体抗炎药（aRR，0.69；95%CI，0.61-0.78）。同时使用药物对 30 天死亡率风险的影响显示，联合使用他汀类药物和二甲双胍的风险最低（aRR，0.21；95%CI，0.15-0.31），其次是 ACEi 和他汀类药物（aRR，0.25；95%CI，0.18-0.35），ACEi 和二甲双胍（aRR，0.26；95%CI，0.17-0.40），抗组胺药和 NSAIDs（aRR，0.41；95%CI，0.32-0.52），以及男性中，联合使用α-受体阻滞剂和抗雄激素药物（aRR，0.51；95%CI，0.42-0.64）。
结论
在这项大型全国队列研究中，SARS-CoV-2 阳性患者使用单独或联合使用二甲双胍和他汀类药物、ACEi 和他汀类药物（或二甲双胍）以及其他药物治疗与 30 天死亡率显著降低相关，并且可能可以安全地继续使用。临床试验可以评估它们的治疗效果。
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