Elkin Peter L, Resendez Skyler, Mullin Sarah, Troen Bruce R, Mammen Manoj J, Chang Shirley, Franklin Gillian, McCray Wilmon, Brown Steven H
Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Department of Veterans Affairs, VA Western New York Healthcare System and WNY, VA Research Service, Buffalo, NY, USA.
J Clin Transl Sci. 2022 May 16;6(1):e74. doi: 10.1017/cts.2022.401. eCollection 2022.
COVID-19 is a major health threat around the world causing hundreds of millions of infections and millions of deaths. There is a pressing global need for effective therapies. We hypothesized that leukotriene inhibitors (LTIs), that have been shown to lower IL6 and IL8 levels, may have a protective effect in patients with COVID-19.
In this retrospective controlled cohort study, we compared death rates in COVID-19 patients who were taking a LTI with those who were not taking an LTI. We used the Department of Veterans Affairs (VA) Corporate Data Warehouse (CDW) to create a cohort of COVID-19-positive patients and tracked their use of LTIs between November 1, 2019 and November 11, 2021.
Of the 1,677,595 cohort of patients tested for COVID-19, 189,195 patients tested positive for COVID-19. Forty thousand seven hundred one were admitted. 38,184 had an oxygen requirement and 1214 were taking an LTI. The use of dexamethasone plus a LTI in hospital showed a survival advantage of 13.5% (CI: 0.23%-26.7%; p < 0.01) in patients presenting with a minimal OSat of 50% or less. For patients with an OSat of <60 and <50% if they were on LTIs as outpatients, continuing the LTI led to a 14.4% and 22.25 survival advantage if they were continued on the medication as inpatients.
When combined dexamethasone and LTIs provided a mortality benefit in COVID-19 patients presenting with an O saturations <50%. The LTI cohort had lower markers of inflammation and cytokine storm.
新型冠状病毒肺炎（COVID-19）是全球主要的健康威胁，导致数亿人感染和数百万人死亡。全球迫切需要有效的治疗方法。我们假设，已被证明可降低白细胞介素6（IL6）和白细胞介素8（IL8）水平的白三烯抑制剂（LTI）可能对COVID-19患者具有保护作用。
在这项回顾性对照队列研究中，我们比较了服用LTI的COVID-19患者与未服用LTI的患者的死亡率。我们使用美国退伍军人事务部（VA）企业数据仓库（CDW）创建了一组COVID-19阳性患者队列，并追踪了他们在2019年11月1日至2021年11月11日期间LTI的使用情况。
在1,677,595名接受COVID-19检测的患者队列中，189,195名患者COVID-19检测呈阳性。47,001人入院。38,184人需要吸氧，1214人正在服用LTI。在入院时氧饱和度（OSat）最低为50%或更低的患者中，在医院使用地塞米松加LTI显示出13.5%的生存优势（置信区间：0.23%-26.7%；p<0.01）。对于门诊使用LTI且OSat<60%和<50%的患者，如果他们住院时继续使用LTI，则继续用药会带来14.4%和22.25%的生存优势。
当联合使用地塞米松和LTI时，对OSat<50%的COVID-19患者有降低死亡率的益处。LTI队列的炎症和细胞因子风暴标志物较低。
