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Antihistamines and azithromycin as a treatment for COVID-19 on primary health care – A retrospective observational study in elderly patients

Morán Blanco et al., Pulmonary Pharmacology & Therapeutics, doi:10.1016/j.pupt.2021.101989
Apr 2021  
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Symp. case 31% Improvement Relative Risk Proton Pump Inhibitors  Morán Blanco et al.  Prophylaxis Is prophylaxis with proton pump inhibitors beneficial for COVID-19? Retrospective 84 patients in Spain (March - April 2020) Fewer symptomatic cases with proton pump inhibitors (not stat. sig., p=0.34) c19early.org Morán Blanco et al., Pulmonary Pharmac.., Apr 2021 FavorsPPIs Favorscontrol 0 0.5 1 1.5 2+
PPIs for COVID-19
1st treatment shown to increase risk in September 2020, now with p = 0.00000012 from 39 studies.
5,100+ studies for 112 treatments. c19early.org
Retrospective 84 elderly nursing home residents in Spain showing no mortality, hospitalization, or ICU admission with early treatment with antihistamines alone or in combination with azithromycin.
Study covers proton pump inhibitors and antihistamine H1RAs.
risk of symptomatic case, 30.8% lower, RR 0.69, p = 0.34, treatment 12 of 48 (25.0%), control 13 of 36 (36.1%), NNT 9.0.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Morán Blanco et al., 30 Apr 2021, retrospective, Spain, peer-reviewed, mean age 85.0, 6 authors, study period March 2020 - April 2020. Contact: kvillar@jccm.es.
This PaperPPIsAll
Antihistamines and azithromycin as a treatment for COVID-19 on primary health care – A retrospective observational study in elderly patients
Juan Ignacio Morán Blanco, Judith A Alvarenga Bonilla, Sakae Homma, Kazuo Suzuki, Philip Fremont-Smith, Karina Villar Gómez De Las Heras
Pulmonary Pharmacology & Therapeutics, doi:10.1016/j.pupt.2021.101989
Background: Between March and April 2020, 84 elderly patients with suspected COVID-19 living in two nursing homes of Yepes, Toledo (Spain) were treated early with antihistamines (dexchlorpheniramine, cetirizine or loratadine), adding azithromycin in the 25 symptomatic cases. The outcomes are retrospectively reported. The primary endpoint is the fatality rate of COVID-19. The secondary endpoints are the hospital and ICU admission rates. Endpoints were compared with the official Spanish rates for the elderly. The mean age of our population was 85 and 48% were over 80 years old. No hospital admissions, deaths, nor adverse drug effects were reported in our patient population. By the end of June, 100% of the residents had positive serology for COVID-19. Although clinical trials are needed to determine the efficacy of both drugs in the treatment of COVID-19, this analysis suggests that primary care diagnosis and treatment with antihistamines, plus azithromycin in selected cases, may treat COVID-19 and prevent progression to severe disease in elderly patients.
Declaration of competing interest The authors declare no conflict of interest. Abbreviations Authors' contributions JIMB devised the clinical guidance. JIMB and JAB carried out patients' diagnosis, prescription of treatments and the follow-up until their full recovery. JAB performed data extraction from the medical records. KVGH wrote the first draft, made the data analysis and graphs, reviewed the bibliography and wrote the argument. SH, KS, JAB and PFS reviewed and refined the final document. PFS was supported under Air Force Contract No. FA8702-15-D-0001. Any opinions, findings, conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the U.S. Air Force. All authors reviewed and approved this manuscript.
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