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Real-world evidence with a retrospective cohort of 15,968 COVID-19 hospitalized patients suggests 21 new effective treatments

Loucera et al., Virology Journal, doi:10.1186/s12985-023-02195-9 (date from preprint)
Aug 2022  
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Mortality, combined 40% Improvement Relative Risk Mortality, loratadine 30% Mortality, cetirizine 51% Antihistamine H1RAs  Loucera et al.  Prophylaxis Is prophylaxis with antihistamine H1RAs beneficial for COVID-19? Retrospective 15,968 patients in Spain (January - November 2020) Lower mortality with antihistamine H1RAs (p=0.0028) c19early.org Loucera et al., Virology J., August 2022 FavorsH1RAs Favorscontrol 0 0.5 1 1.5 2+
10th treatment shown to reduce risk in December 2020, now with p = 0.00006 from 15 studies.
Lower risk for mortality, recovery, and cases.
No treatment is 100% effective. Protocols combine treatments.
5,100+ studies for 112 treatments. c19early.org
Retrospective 15,968 COVID-19 hospitalized patients in Spain, showing lower mortality with antihistamine H1RAs, without statistical significance. Since only hospitalized patients are included, results do not reflect different probabilities of hospitalization across treatments.
Study covers antihistamine H1RAs, vitamin B9, HCQ, aspirin, ibuprofen, vitamin C, budesonide, famotidine, and metformin.
risk of death, 39.8% lower, HR 0.60, p = 0.003, treatment 251, control 15,717, combined.
risk of death, 30.4% lower, HR 0.70, p = 0.05, treatment 251, control 15,717, loratadine, Cox proportional hazards, day 30.
risk of death, 50.6% lower, HR 0.49, p = 0.002, treatment 233, control 15,735, cetirizine, Cox proportional hazards, day 30.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Loucera et al., 16 Aug 2022, retrospective, Spain, peer-reviewed, 8 authors, study period January 2020 - November 2020.
This PaperH1RAsAll
Real-world evidence with a retrospective cohort of 15,968 Andalusian COVID-19 hospitalized patients suggests 21 new effective treatments and one drug that increases death risk
Carlos Loucera, Rosario Carmona, Marina Esteban-Medina, Gerrit Bostelmann, Dolores Muñoyerro-Muñiz, Román Villegas, María Peña-Chilet, Joaquin Dopazo
doi:10.1101/2022.08.14.22278751
Despite the extensive vaccination campaigns in many countries, COVID-19 is still a major worldwide health problem because of its associated morbidity and mortality. Therefore, finding efficient treatments as fast as possible is a pressing need. Drug repurposing constitutes a convenient alternative when the need for new drugs in an unexpected medical scenario is urgent, as is the case with COVID-19. Using data from a central registry of electronic health records (the Andalusian Population Health Database, BPS), the effect of prior consumption of drugs for other indications previous to the hospitalization with respect to patient survival was studied on a retrospective cohort of 15,968 individuals, comprising all COVID-19 patients hospitalized in Andalusia between January and November 2020. Covariate-adjusted hazard ratios and analysis of lymphocyte progression curves support a significant association between consumption of 21 different drugs and better patient survival. Contrarily, one drug, furosemide, displayed a significant increase in patient mortality.
Supplementary Material Supplementary Table 1 . Data imported from BPS for each patient: code and definition of the variable. 2 . Log Hazard ratios obtained for the drugs tested, along with standard deviations (SDs), upper and lower coefficient intervals (CI), nominal and FDR-adjusted p-values. Also, Lymphocyte proliferation values (see Methods) along with standard deviations (SDs), upper and lower coefficient intervals (CI), nominal and FDR-adjusted p-values. The two last columns indicate the drugs used in the machine learning drug repurposing prediction study 10 and the significance of the prediction. Supplementary Table
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Risk of ' 'mortality associated with formoterol: a systematic review and ' 'meta-analysis. Eur Respir J. 2009;34(4):803–11. ' 'https://doi.org/10.1183/09031936.00159708.', 'journal-title': 'Eur Respir J'}, { 'key': '2195_CR35', 'doi-asserted-by': 'publisher', 'first-page': '1187818', 'DOI': '10.3389/fphar.2023.1187818', 'volume': '14', 'author': 'S Zhou', 'year': '2023', 'unstructured': 'Zhou S, Yu Z, Chen Z, Ning F, Hu X, Wu T, et al. Olmesartan alleviates ' 'SARS-CoV-2 envelope protein induced renal fibrosis by regulating HMGB1 ' 'release and autophagic degradation of TGF-β1. Front Pharmacol. ' '2023;14:1187818. https://doi.org/10.3389/fphar.2023.1187818.', 'journal-title': 'Front Pharmacol'}, { 'issue': '10', 'key': '2195_CR36', 'doi-asserted-by': 'publisher', 'first-page': '484', 'DOI': '10.1055/a-1236-3041', 'volume': '70', 'author': 'A Ray', 'year': '2020', 'unstructured': 'Ray A, Sharma S, Sadasivam B. 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' 'Association between administration of systemic corticosteroids and ' 'mortality among critically ill patients with COVID-19: a meta-analysis. ' 'JAMA: The Journal of the American Medical Association. ' '2020;324(13):1330–41.', 'journal-title': 'JAMA: The Journal of the American Medical Association'}, { 'issue': '9', 'key': '2195_CR40', 'doi-asserted-by': 'publisher', 'first-page': '5199', 'DOI': '10.1038/s41380-021-01021-4', 'volume': '26', 'author': 'N Hoertel', 'year': '2021', 'unstructured': 'Hoertel N, Sánchez-Rico M, Vernet R, Beeker N, Jannot A-S, Neuraz A, et ' 'al. Association between antidepressant use and reduced risk of ' 'intubation or death in hospitalized patients with COVID-19: results from ' 'an observational study. 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