Role of Drugs Used for Chronic Disease Management on Susceptibility and Severity of COVID‐19: A Large Case‐Control Study

  1. Huadong Yan
  2. Ana M. Valdes
  3. Amrita Vijay
  4. Shanbo Wang
  5. Lili Liang
  6. Shiqing Yang
  7. Hongxia Wang
  8. Xiaoyan Tan
  9. Jingyuan Du
  10. Susu Jin
  11. Kecheng Huang
  12. Fanrong Jiang
  13. Shun Zhang
  14. Nanhong Zheng
  15. Yaoren Hu
  16. Ting Cai
  17. Guruprasad P. Aithal

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Abstract

This study aimed to investigate whether specific medications used in the treatment chronic diseases affected either the development and/ or severity of coronavirus disease 2019 (COVID‐19) in a cohort of 610 COVID‐19 cases and 48,667 population‐based controls from Zhejiang, China. Using a cohort of 578 COVID‐19 cases and 48,667 population‐based controls from Zhejiang, China, we tested the role of usage of cardiovascular, antidiabetic, and other medications on risk and severity of COVID‐19. Analyses were adjusted for age, sex, and body mass index and for presence of relevant comorbidities. Individuals with hypertension taking calcium channel blockers had significantly increased risk (odds ratio (OR) = 1.73, 95% confidence interval (CI) 1.2–2.3) of manifesting symptoms of COVID‐19, whereas those taking angiotensin receptor blockers and diuretics had significantly lower disease risk (OR = 0.22, 95% CI 0.15–0.30 and OR = 0.30, 95% CI 0.19–0.58, respectively). Among those with type 2 diabetes, dipeptidyl peptidase‐4 inhibitors (OR = 6.02, 95% CI 2.3–15.5) and insulin (OR = 2.71, 95% CI 1.6–5.5) were more and glucosidase inhibitors were less prevalent (OR = 0.11, 95% CI 0.1–0.3) among with patients with COVID‐19. Drugs used in the treatment of hypertension and diabetes influence the risk of development of COVID‐19, but, not its severity.

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  1. Version published to 10.1002/cpt.2047
  2. ScreenIT

    SciScore for 10.1101/2020.04.24.20077875: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The local ethics committees of all hospitals approved the retrospective study of cohorts COVID-19.
    Consent: The requirement for written consent was waived due to the retrospective and anonymous nature of this study.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableSince 2009, this regional system has covered nearly all health-related activities of residents within this region, from birth to death, including children, adolescents, pregnant women, adults and elderly people.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The limitations of our study include the retrospective nature of the COVID-19 cohort, which could lead to possible under-recording of some less common comorbidities and drug history, in particular related to use of glucocorticoids. Even though we included 578 cases, we may have modest power to evaluate potential risk factors with low frequency. In the large case series (n=1099) of COVID-19 patients,3 a number of co-morbidities such as cardiovascular (2.5%), cerebrovascular (1.4%) and chronic obstructive pulmonary diseases (1.1%) were infrequent and cancers, immunodeficiency and chronic kidney disease altogether formed 1.8% of the COVID-19 cases. Most patients with cardiovascular comorbidities qualify for angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) therapy. However, prescribing patterns of these drugs vary widely from China to the UK where ACEIs are much more commonly prescribed.43 Although with a much larger sample size this may prove to be significant if the effect is real, this compared poorly with other factors contributing to severity such hypertension (OR 2.8) or the use of immunosuppressants (OR 5.37). In addition, low case-fatality rate of 0.6% means that we were not able to assess risk factors associated with mortality. Another limitation is the lack of pre-pandemic data on glycemic control, since DPPIV inhibitors and insulin are usually prescribed to patients with poorer glycemic control than those receiving glucosidase inh...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.04.24.20077875 on medRxiv