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

{ 'indexed': {'date-parts': [[2023, 10, 4]], 'date-time': '2023-10-04T10:32:07Z', 'timestamp': 1696415527413}, 'reference-count': 55, 'publisher': 'Public Library of Science (PLoS)', 'issue': '4', 'license': [ { 'start': { 'date-parts': [[2022, 4, 18]], 'date-time': '2022-04-18T00:00:00Z', 'timestamp': 1650240000000}, 'content-version': 'vor', 'delay-in-days': 0, 'URL': 'https://creativecommons.org/publicdomain/zero/1.0/'}], 'funder': [ { 'DOI': '10.13039/100000092', 'name': 'U.S. National Library of Medicine', 'doi-asserted-by': 'publisher', 'award': ['Intramural research program']}], 'content-domain': {'domain': ['www.plosone.org'], 'crossmark-restriction': False}, 'abstract': '<jats:sec id="sec001">\n' '<jats:title>Background</jats:title>\n' '<jats:p>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.</jats:p>\n' '</jats:sec>\n' '<jats:sec id="sec002">\n' '<jats:title>Methods</jats:title>\n' '<jats:p>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.</jats:p>\n' '</jats:sec>\n' '<jats:sec id="sec003">\n' '<jats:title>Results</jats:title>\n' '<jats:p>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.</jats:p>\n' '</jats:sec>\n' '<jats:sec id="sec004">\n' '<jats:title>Conclusion</jats:title>\n' '<jats:p>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.</jats:p>\n' '</jats:sec>', 'DOI': '10.1371/journal.pone.0266922', 'type': 'journal-article', 'created': {'date-parts': [[2022, 4, 18]], 'date-time': '2022-04-18T17:27:56Z', 'timestamp': 1650302876000}, 'page': 'e0266922', 'update-policy': 'http://dx.doi.org/10.1371/journal.pone.corrections_policy', 'source': 'Crossref', 'is-referenced-by-count': 7, 'title': 'Effect of common maintenance drugs on the risk and severity of COVID-19 in elderly patients', 'prefix': '10.1371', 'volume': '17', 'author': [ { 'ORCID': 'http://orcid.org/0000-0003-0593-5377', 'authenticated-orcid': True, 'given': 'Kin Wah', 'family': 'Fung', 'sequence': 'first', 'affiliation': []}, {'given': 'Seo H.', 'family': 'Baik', 'sequence': 'additional', 'affiliation': []}, {'given': 'Fitsum', 'family': 'Baye', 'sequence': 'additional', 'affiliation': []}, {'given': 'Zhaonian', 'family': 'Zheng', 'sequence': 'additional', 'affiliation': []}, {'given': 'Vojtech', 'family': 'Huser', 'sequence': 'additional', 'affiliation': []}, {'given': 'Clement J.', 'family': 'McDonald', 'sequence': 'additional', 'affiliation': []}], 'member': '340', 'published-online': {'date-parts': [[2022, 4, 18]]}, 'reference': [ { 'issue': '20', 'key': 'pone.0266922.ref001', 'doi-asserted-by': 'crossref', 'first-page': '2605', 'DOI': '10.1161/CIRCULATIONAHA.104.510461', 'article-title': 'Effect of angiotensin-converting enzyme inhibition and angiotensin II ' 'receptor blockers on cardiac angiotensin-converting enzyme 2', 'volume': '111', 'author': 'C.M. 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