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Identification of antiviral antihistamines for COVID-19 repurposing

Reznikov et al., Biochemical and Biophysical Research Communications, doi:10.1016/j.bbrc.2020.11.095
Jan 2021  
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Case, age groups combined 45% Improvement Relative Risk Case, azelastine, 61+ 59% Case, azelastine, 31-60 29% Azelastine for COVID-19  Reznikov et al.  Prophylaxis Does azelastine reduce COVID-19 infections? Retrospective study in the USA Fewer cases with azelastine (p=0.028) c19early.org Reznikov et al., Biochemical and Bioph.., Jan 2021 Favorsazelastine Favorscontrol 0 0.5 1 1.5 2+
Retrospective 219,000 patients showing lower risk of COVID-19 with antihistamine H1RA use.
In Vitro study showing these drugs exhibit direct antiviral activity against SARS-CoV-2. Molecular docking suggests hydroxyzine and azelastine may exert antiviral effects by binding ACE2 and the sigma-1 receptor.
2 preclinical studies support the efficacy of azelastine for COVID-19:
Standard of Care (SOC) for COVID-19 in the study country, the USA, is very poor with very low average efficacy for approved treatments3. Only expensive, high-profit treatments were approved. Low-cost treatments were excluded, reducing the probability of treatment—especially early—due to access and cost barriers, and eliminating complementary and synergistic benefits seen with many low-cost treatments.
Study covers azelastine and antihistamine H1RAs.
risk of case, 45.5% lower, RR 0.55, p = 0.03, adjusted per study, age groups combined.
risk of case, 58.8% lower, OR 0.41, p < 0.001, adjusted per study, inverted to make OR<1 favor treatment, azelastine, 61+, multivariable, RR approximated with OR.
risk of case, 28.6% lower, OR 0.71, p = 0.17, adjusted per study, inverted to make OR<1 favor treatment, azelastine, 31-60, multivariable, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Reznikov et al., 31 Jan 2021, retrospective, USA, peer-reviewed, 9 authors.
This PaperAzelastineAll
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