Effect of ACE2 Expression Inhibiting Drugs on COVID-19 Disease Severity, Outcome and Length of Admission in Ethiopian Patients: A Causal Inference Using Marginal Structural Model with Inverse Probability Weight

Abstract

Background The role of drugs that inhibit ACE2 expression on COVID-19 disease severity, progression and outcome has been debatable with studies reporting contradictory findings. So far, there is no such study conducted in Africa. Having clarity on this issue is relevant as these drugs are the commonly prescribed medications for patients with co-morbid illnesses who are reported to be vulnerable to COVID-19 poor outcome. Therefore, the aim of this study was to assess the effect of acute or chronic ACEIs, ARBs and/or NSAIDs use on COVID-19 disease severity, outcome and length of admission among patients with COVID-19 admitted to the Millennium COVID-19 Care Center in Ethiopia. Methods A retrospective cohort study was conducted among 945 patients with COVID-19 who were on follow up from July 2nd to December 25th, 2020. Data was described using frequency tables and cross tabulations. To identify the effect of ACEIs, ARBs and/or NSAIDs use on COVID-19 disease severity, disease outcome and length of admission, Marginal Structural Model (MSM) with inverse probability weighting (IPW) approach was used. Results Among the 945 patients studied, 115 (12.2%) had a history of ACEIs, ARBs and/or NSAIDs use. At admission, the majority (39.6%) had mild disease and 272 (28.8%) had severe disease. Among the study participants, 900 (95.2%) were discharged improved and the rest 45 (4.8%) died. The median length of admission was 14.0 days (IQR, 13–16). Multinomial Logistic Regression, Log Binomial Regression and Negative Binomial Regression models were fitted to assess the effect of ACEIs, ARBs and/or NSAIDs use on disease severity, outcome and length of admission respectively. In all the three outcome models, ACEIs, ARBs and/or NSAIDs use didn’t show a statistically significant association with the outcomes. Conclusions Acute or chronic use of ACEIs, ARBs and/or NSAIDs showed no effect on COVID-19 disease severity, outcome and length of admission and therefore should not be withdrawn from patients who need these therapies.