Risk of Severe COVID-19 in Prevalent Users of Alpha-1 Adrenergic Receptor Antagonists: A National Case-Control Study of Medicare Beneficiaries.

Autor:	Graham DJ; Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Md. Electronic address: david.graham1@fda.hhs.gov., Izurieta HS; Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Md., Zhang D; Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Md., Avagyan A; Acumen, LLC., Lyu H; Acumen, LLC., Wiederhorn R; Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Md., Lu Y; Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Md., Mosholder AD; Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Md., Smith ER; Acumen, LLC., Zhao Y; Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Md., Shangguan S; Acumen, LLC., Tsai HT; Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Md., Pennap D; Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Md., Sandhu AT; Acumen, LLC; Division of Cardiology, Department of Medicine, Stanford University, Calif., Wernecke M; Acumen, LLC., MaCurdy TE; Acumen, LLC; Department of Economics, Stanford University, Calif., Kelman JA; Centers for Medicare & Medicaid Services, Washington, DC., Forshee RA; Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Md.
Jazyk:	angličtina
Zdroj:	The American journal of medicine [Am J Med] 2023 Oct; Vol. 136 (10), pp. 1018-1025.e3. Date of Electronic Publication: 2023 Jul 15.
DOI:	10.1016/j.amjmed.2023.07.003
Abstrakt:	Background: Alpha-1 adrenergic receptor antagonists prevent cytokine storm in mouse sepsis models. This led to the hypothesis that alpha-1 blockers may prevent severe coronavirus disease 2019 (COVID-19), which is characterized by hypercytokinemia and progressive respiratory failure. Methods: We performed an observational case-control study in male Medicare beneficiaries aged 65 years or older, with or without benign prostatic hyperplasia (BPH), and treated with alpha-1 receptor blockers or 5-alpha reductase inhibitors. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated for outcomes of uncomplicated and severe COVID-19 hospitalization (intensive care unit admission, invasive mechanical ventilation, or death). Results: There were 20,963 cases of hospitalized COVID-19 matched to 101,161 controls on calendar date and neighborhood of residence. In the primary analysis (males with BPH), there was no difference in risk of uncomplicated COVID-19 hospitalization (aOR 1.08, 95% CI 0.996-1.17) or hospitalization with severe complications (aOR 0.97, 95% CI 0.88-1.08). In the secondary analysis (males with or without BPH), the corresponding aORs were 1.02 (95% CI, 0.96-1.09) (uncomplicated) and 0.99 (95% CI, 0.91-1.07) (complicated), respectively. Subgroup and sensitivity analyses yielded similar results. Of note, there was no difference in risk of severe COVID-19 hospitalization when comparing non-selective vs selective alpha-1 blocker use (aOR 0.98, 95% CI 0.86-1.10), higher- vs lower-dose alpha-1 blocker use (aOR 0.96, 95% CI 0.86-1.08), or current vs remote alpha-1 blocker use (aOR 1.04, 95% CI 0.91-1.18). Conclusions: Prevalent use of alpha-1 receptor blockers was not associated with a protective or harmful effect on risk of uncomplicated or severe hospitalized COVID-19. (Published by Elsevier Inc.)
Databáze:	MEDLINE
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