MyMedR

PURPOSE: Previously, we have reported potential clinical benefits with the use of statins in patients with coronavirus disease 2019 (COVID-19) in a meta-analysis, where there was a significantly reduced hazard for a fatal or severe course of illness with the use of statins, but the meta-analysis was limited by the small number of studies included, with small heterogeneity among studies, due to the unavailability of more studies at the point of literature search. We aimed to perform an updated systematic review and meta-analysis to summarize the existing evidence on the effect of statins on the clinical outcomes of patients with COVID-19.

METHODS: Electronic databases, including PubMed, Google Scholar, and Scopus, and preprint servers were searched (last updated June 3, 2021) to identify studies investigating the association between the use of statins in patients with COVID-19 and the development of severe disease and/or mortality. Random-effects model meta-analyses were performed to estimate the pooled odds ratio (OR) or hazard ratio (HR) with 95% confidence intervals (CIs). The outcomes of interest were (1) all-cause mortality and (2) a composite endpoint of severe illness of COVID-19.

RESULTS: Upon systematic literature search, we identified 35 studies, of which 32 studies reported the outcome of all-cause mortality and 15 studies reported the composite endpoint of severe COVID-19 illness between statin users versus non-statin users with COVID-19. Our meta-analysis revealed that the use of statins was associated with a significantly lower risks of all-cause mortality (HR = 0.70, 95% CI 0.58-0.84, n = 21,127, and OR = 0.63, 95% CI 0.51-0.79, n = 115,097) and the composite endpoint of severe illness (OR = 0.80, 95% CI 0.73-0.88, n = 10,081) in patients with COVID-19, compared to non-use of statins, at the current sample size.

CONCLUSION: Statin use is associated with a better prognosis in patients with COVID-19. Our findings provide a rationale to investigate the use of statins among patients with COVID-19 in large scale clinical trials.

Fulltext Pharmacotherapeutic considerations for systemic rheumatic diseases amid the COVID-19 pandemic: more questions than answers

Kow CS, Hasan SS

Drugs Ther Perspect, 2020 Aug 16.

PMID: 32837197 DOI: 10.1007/s40267-020-00767-1

Thus far, associations between the presence of systemic rheumatic disease and an increased risk of novel coronavirus disease 2019 (COVID-19) acquisition or a worse prognosis from COVID-19 have not been conclusive. It is not known for certain if there is an association between any pharmacological agent used for rheumatologic treatment, including biological and non-biological disease-modifying antirheumatic drugs (DMARDs), and an increased risk of COVID-19 acquisition or adverse outcomes from COVID-19, although these agents have been associated with an overall higher risk of infections. The pharmacological management of patients with a rheumatic disease without COVID-19 should currently follow usual treatment approaches. Individualized approaches to adjusting DMARD regimens in patients with documented COVID-19 seems prudent, with specific attention paid to the severity of the infection. Patients receiving antimalarials (hydroxychloroquine/chloroquine) may continue treatment with these agents. Treatment with sulfasalazine, methotrexate, leflunomide, immunosuppressants and biological agents other than interluekin-6 receptor inhibitors and JAK inhibitors should be stopped or withheld. It should be reasonable to resume DMARD treatment when patients are no longer symptomatic and at least 2 weeks after documentation of COVID-19, although the decision should be individualized, preferably based on infection severity.

Do sleep quality and sleep duration before or after COVID-19 vaccination affect antibody response?

Kow CS, Hasan SS

Chronobiol Int, 2021 07;38(7):941-943.

PMID: 33771061 DOI: 10.1080/07420528.2021.1900216

Fulltext The risk of mortality in patients with COVID-19 with pre-diagnosis use of NSAIDs: a meta-analysis

Kow CS, Hasan SS

Inflammopharmacology, 2021 Jun;29(3):641-644.

PMID: 33881684 DOI: 10.1007/s10787-021-00810-1

The notion that the use of non-steroidal anti-inflammatory drugs (NSAIDs) may lead to adverse outcomes upon acquisition of coronavirus disease 2019 (COVID-19) should be discredited with a review of the real-life evidence. We aimed to perform a meta-analysis to summarize the risk of mortality with the preadmission/pre-diagnosis use of NSAIDs in patients with COVID-19. A systematic literature search was performed to identify eligible studies in electronic databases. The outcome of interest was the development of a fatal course of COVID-19. Adjusted hazard ratio or odds ratio/relative risk and the corresponding 95% confidence interval from each study were pooled using a random-effects model to produce pooled hazard ratio and pooled odds ratio, along with 95% confidence interval. The meta-analysis of 3 studies with a total of 2414 patients with COVID-19 revealed no difference in the hazard for the development of a fatal course of COVID-19 between NSAID users and non-NSAID users (pooled hazard ratio = 0.86; 95% confidence interval 0.49-1.51). Therefore, NSAIDs should not be avoided in patients who are appropriately indicated during the COVID-19 pandemic.

Fulltext Do the Meta-Analyses Provide a Clean Bill of Health to the Use of Renin-angiotensin System Inhibitors in Coronavirus Disease 2019 (COVID-19)?

Kow CS, Hasan SS

Clin Infect Dis, 2021 07 01;73(1):164-165.

PMID: 32770237 DOI: 10.1093/cid/ciaa1167

Fulltext Corticosteroid-related In-Hospital Hyperglycemia: Does It Negate Mortality Benefits in Coronavirus Disease 2019?

Kow CS, Hasan SS

Clin Infect Dis, 2021 11 02;73(9):e2848-e2849.

PMID: 32948881 DOI: 10.1093/cid/ciaa1423

Fulltext Role of frailty in COVID-19 patients

Kow CS, Hasan SS

Intensive Care Med, 2020 10;46(10):1956-1957.

PMID: 32638046 DOI: 10.1007/s00134-020-06172-6