Study Suggests COVID Survival Benefit from Common Drugs

While currently there are few specific treatments widely available for COVID-19, researchers from the Public Health Institute and the San Francisco Veterans Affairs Medical Center this week published an observational study in the British Medical Journal of VA medical record data from more than 9,500 patients with COVID-19 to assess the effectiveness of common medications, angiotensin receptor blockers (ARBs) and ACE inhibitors (ACE-I) and metformin (a drug often prescribed for treatment of diabetes), on mortality from COVID. The study found that 

• Discontinuation of ACE-I was associated with a 1.4 times greater risk of death. 
• Initiating or continuous use of ACE-I was associated with significant reduced risk of death (70% and 40% reduction in risk of death respectively).
• ARB and metformin associations were similar in direction and magnitude and also statistically significant.

The study, “Association of the patterns of use of medications with mortality of COVID-19 infection: a hospital-based observational study” was co-authored by Dr. Barbara Cohn of PHI’s Child Health and Development Studies. While recent trials have supported the safety of ACE-I and ARB treatment in patients with COVID-19, the study this week extends these findings to suggest a possible COVID-19 survival benefit for continuing or initiating ACE-I, ARB and metformin medications. 

The study hypothesized that mortality in patients with COVID-19 can be altered by drugs affecting the renin–angiotensin–aldosterone system and by other commonly used medications. Four patient groups were assessed over 60 day periods:

• Patients who did not use any of the medications.
• Patients who used a medication within 2 years before a positive COVID-19 test result but not within 60 days after.
• Patients with no medication use in 2 years prior to the diagnosis but who were administered a medication within the period of 60 days following a positive COVID test.
• Patients who took a medication in the period of 2 years prior to and during 60 days after a positive test.

The positive findings with the use of the medications were unchanged regardless of whether or not patients received mechanical ventilation. The authors note that the findings not only support continuation of ACE-I, ARB and metformin among hospitalised patients with COVID-19, but suggest a therapeutic benefit for all COVID patients.

Previous research published in Science last November from Dr. Cohn and the Veterans Affairs Medical Center and the University of Texas Health Science Center was the first to compare waning protection rates across all three vaccine types available to most Americans and to directly report death rates after breakthrough infection.