Lipid-lowering agents offer no clear benefit as an adjunctive therapy for reducing mortality in patients with COVID-19, according to research published in Lipids in Health and Disease. Treatment with proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, however, did decrease mortality among these patients and may show promise as an adjunctive COVID-19 therapy, according to the report.
Researchers performed a systematic review of 4 international databases to examine efficacy outcomes among patients with COVID-19 who used lipid-lowering agents. The team included 10 randomized controlled trials and a total of 2617 patients who were either treated with lipid-lowering therapies (n=1058) or assigned to a control group (n=1109). Lipid lowering agents included statins, omega-3 fatty acid supplements, fibrates, bile acid sequestrant, nicotinic acid, PCSK9 inhibitors, adenosine triphosphate citrate synthase inhibitors, and cholesterol absorption inhibitors. Primary outcome was mortality, and secondary outcomes included the need for mechanical ventilation, length of hospital or intensive care unit stay, and bleeding and clinical deterioration.
Atorvastatin use did not significantly affect mortality among the cohort (odds ratio [OR], 0.96; 95% CI, 0.58-1.59; P =.86), the report shows. A subgroup analysis based on dosage found similar results, with no observable differences noted between individuals receiving 20 mg per day and 40 mg per day dosages (OR, 1.04; 95% CI, 0.41-2.63; P =.93). Statin use did not affect mortality among individuals treated with ventilation. Secondary outcome analysis shows that atorvastatin use did not significantly reduce hospital stay compared with placebo or nontreatment (standardized mean difference [SMD], -0.10; 95% CI, -0.78-0.59; P =.78). Similarly, fenofibrate and nicotinamide did not significantly affect COVID-19-related outcomes, according to the report.
Patients with COVID-19 who underwent supplemental omega-3 fatty acids treatment had a significantly higher 30-day survival rate compared with control group participants who only received nutritional support (21% vs 3%; P =.003) in 1 of the 2 clinical trials that investigated this treatment method. The same investigation also showed improved kidney function, evidenced by increased creatinine levels (1.29 vs 1.68 mg/dL, P =.02). However, the findings differed between the 2 trials, warranting a need for further investigation, according to the report.
PSCK9 inhibition among individuals with severe COVID-19 significantly lowered death rate and the need for intubation (23.3% vs. 53.3%; P <.05). Interleukin-6 levels were lower among patients with COVID-19 assigned to this treatment.
Limitations include the small number of studies used in the investigation and variations in the dosages used between the studies.
“Current evidence does not support the benefit of de novo statin therapy in patients suffering from COVID-19,” according to the researchers. “Concerning omega-3 fatty acids, the extant evidence from RCTs is still scant, and more and larger studies are needed to assess any causal effect on COVID19 mortality. Our study’s findings can be used in clinical settings and prevent the loss of resources on the prescription of ineffective drugs for COVID-19.”
This article originally appeared on Endocrinology Advisor
Khalaji A, Behnoush AH, Alilou S, Rezaee M, Peiman S, Sahebkar A. Adjunctive therapy with lipid-lowering agents in COVID-19: a systematic review and meta-analysis of randomized controlled trials. Lipids Health Dis. Published online May 8, 2023. doi:10.1186/s12944-023-01828-w