The Use of Adjuvant Therapy in Preventing Progression to Severe Pneumonia in Patients with Coronavirus Disease 2019: A Multicenter Data Analysis

Abstract

medRxiv preprint KEYPOINTS Question: Does the use of adjuvant therapy reduce progression to severe pneumonia in patients with coronavirus disease 2019 (COVID-19)?Findings: In this retrospective, observational cohort study involving 564 patients with confirmed COVID-19, hypertension was an independent risk factor for progression to severe pneumonia irrespective of age and those on angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) therapy were less likely to develop severe COVID-19 pneumonia, while nonspecific antivirals or chloroquine did not have significant impact on clinical progression. ABSTRACT IMPORTANCE Coronavirus disease 2019 (COVID-19) is a global pandemic associated with high mortality and effective treatment to prevent clinical deterioration to severe pneumonia has not yet been well clarified. OBJECTIVE To investigate the role of several adjuvant treatments in preventing severe pneumonia in patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTS Multicenter, retrospective cohort study of 564 consecutively hospitalized patients with confirmed COVID-19 at Third EXPOSURES Nonspecific antivirals (arbidol, lopinavir/ritonavir, and interferon α ), antihypertensives, and chloroquine. MAIN OUTCOMES AND MEASURES The development of severe COVID-19 pneumonia; Demographic, epidemiological, clinical, laboratory, radiological, and treatment data were collected and analyzed. RESULTSOf 564 patients, the median age was 47 years (interquartile range, 36-58 years), and 284 (50.4%) patients were men. Sixty-nine patients (12.2%) developed severe pneumonia.Patients who developed severe pneumonia were older (median age of 59 and 45 years, respectively), and more patients had comorbidities including hypertension (30.4% and 12.3%,

Use of inhibitors of the renin‐angiotensin system in hypertensive patients and COVID‐19 severity: A systematic review and meta‐analysis

“…All of the selected studies were published in 2020 and were all of observational nature 17‐34 . In seven studies, the outcome that matched our research question was death 17,20,21,26‐28,31 ; in two studies, severe pneumonia 23,34 ; in three studies, critical or severe pneumonia 18,19,32 ; in one study, death or critical or severe pneumonia 33 ; in one study, severe pneumonia or death 24 ; and in one study, death, admission to ICU or mechanical ventilation requirement 25 .…”

“…In a qualitative synthesis, seven studies reported a lower risk of the outcome with the use of ACEI/ARB 20,23,27,31‐34 and eleven studies found no association 17‐19,21,22,24‐26,28‐30 …”

Renin-angiotensin system inhibitors and severity of SARS-CoV-2 infection: a meta-analysis

“…After screening 343 citations, 13 observational studies were included (Figure 1) [18][19][20][21][22][23][24][25][26][27][28][29][30], combining to a total sample of 14,364 participants. The characteristics of included studies are summarized in Table 1.…”

“…diabetes, hypertension, cerebrovascular disease, ischemic heart disease) in the absence of ACEi/ARB drugs. For example, Feng et al showed that hypertension without ACEi/ARB therapy was an independent risk factor for developing severe pneumonia irrespective of age [20].…”

ACE Inhibitors and AT1R Blockers for COVID-2019: Friends or Foes ?

“…Finally, in a multicenter retrospective series of 564 Chinese patient, hypertension without receiving ACEI/ARB therapy was an independent risk factor (odds ratio [OR], 2.07; 95% CI, 1.07 to 4.00) for developing severe pneumonia irrespective of age [56].…”