Alpha-1 adrenergic antagonists and the risk of hospitalization or death in non-hospitalized patients with COVID-19: A population-based study

IF 2.1 4区医学 Q3 PHARMACOLOGY & PHARMACY Fundamental & Clinical Pharmacology Pub Date : 2024-04-04 DOI:10.1111/fcp.13004

Tony Antoniou, Daniel McCormack, Mina Tadrous, Tara Gomes

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Abstract

Background

Alpha-1 receptor antagonists may interfere with IL-6 signaling and could therefore be a potential treatment for COVID-19. However, the effectiveness of these drugs in mitigating the risk of clinical deterioration among non-hospitalized patients with COVID-19 is unknown.

Objectives

The aim of this study is to examine the association between alpha-1 antagonist exposure and the 30-day risk of a hospital encounter or death in nonhospitalized patients with COVID-19.

Methods

We conducted a population-based cohort study of Ontario residents aged 35 years and older who were eligible for public drug coverage and who had a positive test for SARS-CoV-2 between January 1, 2020, and March 1, 2021. We matched each individual receiving an alpha-1 antagonist at the time of their positive test with two non-exposed individuals using propensity scores. Our outcome was a composite of a hospital admission, emergency department visit, or death, 1 to 30 days following the positive test.

Results

We matched 3289 alpha-1 antagonist exposed patients to 6189 unexposed patients. Overall, there was no difference in the 30-day risk of the primary outcome among patients exposed to alpha-1 antagonists at the time of their diagnosis relative to unexposed individuals (28.8% vs. 28.0%; OR 1.00, 95% CI 0.91 to 1.11). In a secondary analysis, individuals exposed to alpha-1 antagonists had a lower risk of death in the 30 days following a COVID diagnosis (OR 0.79; 95% CI 0.66 to 0.93).

Conclusion

Alpha-1 antagonists did not mitigate the 30-day risk of clinical deterioration in non-hospitalized patients with COVID-19. Our findings do not support the general repurposing of alpha-1 antagonists as a treatment for such patients, although there may be subgroups of patients in whom further research is warranted.

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α-1肾上腺素能拮抗剂与COVID-19非住院患者的住院或死亡风险：一项基于人群的研究

背景α-1受体拮抗剂可能会干扰IL-6信号传导，因此可能成为COVID-19的一种潜在治疗方法。本研究旨在研究 COVID-19 非住院患者中，α-1 受体拮抗剂暴露与 30 天内住院或死亡风险之间的关系。方法我们对符合公共药物保险资格且在 2020 年 1 月 1 日至 2021 年 3 月 1 日期间 SARS-CoV-2 检测呈阳性的 35 岁及以上安大略居民进行了一项基于人群的队列研究。我们采用倾向分数法将检测结果呈阳性时接受α-1拮抗剂治疗的每个人与两个未接受治疗的人进行配对。结果我们将 3289 名暴露于α-1 拮抗剂的患者与 6189 名未暴露的患者进行了配对。总体而言，诊断时暴露于α-1拮抗剂的患者与未暴露者相比，30 天内发生主要结果的风险没有差异（28.8% 对 28.0%；OR 1.00，95% CI 0.91 至 1.11）。结论 α-1拮抗剂并不能降低COVID-19非住院患者30天内临床恶化的风险。我们的研究结果并不支持将α-1拮抗剂作为治疗此类患者的通用药物，尽管可能存在需要进一步研究的亚组患者。

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来源期刊

Fundamental & Clinical Pharmacology 医学-药学

CiteScore

5.30

自引率

6.90%

发文量

111

审稿时长

6-12 weeks

期刊介绍： Fundamental & Clinical Pharmacology publishes reports describing important and novel developments in fundamental as well as clinical research relevant to drug therapy. Original articles, short communications and reviews are published on all aspects of experimental and clinical pharmacology including: Antimicrobial, Antiviral Agents Autonomic Pharmacology Cardiovascular Pharmacology Cellular Pharmacology Clinical Trials Endocrinopharmacology Gene Therapy Inflammation, Immunopharmacology Lipids, Atherosclerosis Liver and G-I Tract Pharmacology Metabolism, Pharmacokinetics Neuropharmacology Neuropsychopharmacology Oncopharmacology Pediatric Pharmacology Development Pharmacoeconomics Pharmacoepidemiology Pharmacogenetics, Pharmacogenomics Pharmacovigilance Pulmonary Pharmacology Receptors, Signal Transduction Renal Pharmacology Thrombosis and Hemostasis Toxicopharmacology Clinical research, including clinical studies and clinical trials, may cover disciplines such as pharmacokinetics, pharmacodynamics, pharmacovigilance, pharmacoepidemiology, pharmacogenomics and pharmacoeconomics. Basic research articles from fields such as physiology and molecular biology which contribute to an understanding of drug therapy are also welcomed.