Effect of common maintenance drugs on the risk and severity of COVID-19 in elderly patients

Abstract

Background Maintenance drugs are used to treat chronic conditions. Several classes of maintenance drugs have attracted attention because of their potential to affect susceptibility to and severity of COVID-19. Methods Using claims data on 20% random sample of Part D Medicare enrollees from April to December 2020, we identified patients diagnosed with COVID-19. Using a nested case-control design, non-COVID-19 controls were identified by 1:5 matching on age, race, sex, dual-eligibility status, and geographical region. We identified usage of angiotensin-converting enzyme inhibitors (ACEI), angiotensin-receptor blockers (ARB), statins, warfarin, direct factor Xa inhibitors, P2Y12 inhibitors, famotidine and hydroxychloroquine based on Medicare prescription claims data. Using extended Cox regression models with time-varying propensity score adjustment we examined the independent effect of each study drug on contracting COVID-19. For severity of COVID-19, we performed extended Cox regressions on all COVID-19 patients, using COVID-19-related hospitalization and all-cause mortality as outcomes. Covariates included gender, age, race, geographic region, low-income indicator, and co-morbidities. To compensate for indication bias related to the use of hydroxychloroquine for the prophylaxis or treatment of COVID-19, we censored patients who only started on hydroxychloroquine in 2020. Results Up to December 2020, our sample contained 374,229 Medicare patients over 65 who were diagnosed with COVID-19. Among the COVID-19 patients, 278,912 (74.6%) were on at least one study drug. The three most common study drugs among COVID-19 patients were statins 187,374 (50.1%), ACEI 97,843 (26.2%) and ARB 83,290 (22.3%). For all three outcomes (diagnosis, hospitalization and death), current users of ACEI, ARB, statins, warfarin, direct factor Xa inhibitors and P2Y12 inhibitors were associated with reduced risks, compared to never users. Famotidine did not show consistent significant effects. Hydroxychloroquine did not show significant effects after censoring of recent starters. Conclusion Maintenance use of ACEI, ARB, warfarin, statins, direct factor Xa inhibitors and P2Y12 inhibitors was associated with reduction in risk of acquiring COVID-19 and dying from it.

Association of Cardiovascular Medications With Adverse Outcomes in a Matched Analysis of a National Cohort of Patients With COVID-19

“…Overall, our observation that the outpatient use of statins, ACEI/ARBs and anticoagulants were protective against adverse outcomes in patients diagnosed with COVID-19 is consistent with a review conducted by Alves et al 52 and previous studies that assessed premorbid use of these classes of cardiovascular medications. 53 , 54 , 55 , 56 , 57 It is important to note, that ours is, to our knowledge, the largest matched, national comparative analysis of cardiovascular medications and COVID-19 outcomes thus far.…”

Long COVID in Elderly Patients: An Epidemiologic Exploration Using a Medicare Cohort

“…Not all COVID-19 diagnoses are captured in Medicare claims data. Our previous study showed that up to one-third of COVID-19 cases could be missed [54]. Medicare claims-based data may miss services or treatment paid for by private insurance or other means.…”

Prevalence and characteristics of long COVID in elderly patients: An observational cohort study of over 2 million adults in the US

“…Not all COVID-19 diagnoses are captured in Medicare claims data. Our previous study showed that up to one-third of COVID-19 cases could be missed [54]. Medicare claimsbased data may miss services or treatment paid for by private insurance or other means.…”