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0 0.5 1 1.5 2+ Case 26% Improvement Relative Risk N-acetylcysteine for COVID-19  Huh et al.  Prophylaxis Does N-acetylcysteine reduce COVID-19 infections? Retrospective 65,149 patients in South Korea Fewer cases with N-acetylcysteine (p<0.000001) c19early.org Huh et al., medRxiv, May 2020 Favors N-acetylcysteine Favors control

Association of previous medications with the risk of COVID-19: a nationwide claims-based study from South Korea

Huh et al., medRxiv, doi:10.1101/2020.05.04.20089904
May 2020  
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14th treatment shown to reduce risk in February 2021
 
*, now known with p = 0.000034 from 24 studies, recognized in 3 countries.
Lower risk for mortality, hospitalization, and cases.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
3,800+ studies for 60+ treatments. c19early.org
Retrospective database analysis of 65,149 in South Korea, showing significantly lower cases with existing N-acetylcysteine treatment. The journal version of this paper does not present the N-acetylcysteine results.
Study covers aspirin and N-acetylcysteine.
risk of case, 26.2% lower, RR 0.74, p < 0.001, treatment 710 of 13,788 (5.1%), control 4,462 of 51,361 (8.7%), adjusted per study, odds ratio converted to relative risk, multivariable.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Huh et al., 4 May 2020, retrospective, database analysis, South Korea, preprint, 10 authors. Contact: eastside1st@gmail.com.
This PaperN-acetylcys..All
Association of previous medications with the risk of COVID-19: a nationwide claims-based study from South Korea
Kyungmin Huh, Wonjun Ji, Minsun Kang, Jinwook Hong, Gi Hwan Bae, Rugyeom Lee, Yewon Na, Hyoseon Choi, Seon Yeong Gong, MD Jaehun Jung
doi:10.1101/2020.05.04.20089904
Background. Identifying the association between medications taken prior to the infection of coronavirus disease (COVID-19) might be useful during the current pandemic until a proven treatment is developed. We aimed to determine whether the risk of developing COVID-19 was associated with the use of various drugs that may increase or decrease susceptibility to severe acute respiratory syndrome coronavirus 2 infection and COVID-19. Methods and Findings: A case-control study was performed using a nationwide claims database of South Korea, where a large testing capacity has been available throughout the pandemic. Exposure was defined as the prescription of study drugs that would have been continued until ≤7 days before the testing for COVID-19. Adults were considered eligible if they were ≥18 years old and tested for COVID-19. Among the 65,149 eligible subjects (mean age, 48.3 years; 49.4% male), 5,172 (7.9%) were diagnosed with COVID-19. Hydroxychloroquine was not significantly associated with the risk of COVID-19 (adjusted odds ratio [aOR], 1.48; 95% CI, 0.95-2.31). In the overall population, lower risks of COVID-19 were associated with the use of camostat (aOR, 0.45; 95% CI, 0.20-1.02) and amiodarone (aOR, 0.54; 95% CI, 0.33-0.89), although the differences were not significant in the subgroup analyses. Angiotensin receptor blockers were also associated with a slightly increased risk of COVID-19 (aOR, 1.13; 95% CI, 1.01-1.26), which was also not observed in the subgroup analysis. The study limitations include potential bias regarding the controls' characteristics, inability to determine prescription compliance, and a lack of information regarding the severity of underlying conditions. Conclusions. No medications were consistently associated with increased or decreased risks of COVID-19. These findings suggest that a more cautious approach is warranted for the clinical use of re-purposed drugs until the results are available from clinical trials. .
Author contributions. Drs Huh and Jung had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Huh, Ji, Jung. Acquisition, analysis or interpretation of data: Huh, Ji, Kang, Hong, Bae, Lee, Na, Choi, Gong, Jung. Drafting of the manuscript: Huh, Ji, Jung. Funding. This work was supported by grants from the Gachon University Gil Medical Center (grant nos. 2018-17 and 2019-11) . The sponsor of the study was not involved in the study design, analysis, and interpretation of data; writing of the report; or the decision to submit the study results for publication. .
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