Effect of common maintenance drugs on the risk and severity of COVID-19 in elderly patients
Kin Wah Fung , Seo H. Baik, FitsumBaye, ZhaonianZheng, VojtechHuser, Clement J. McDonald
Abstract
Background
Maintenance drugs are used to treat chronic conditions. Several classes of maintenance drugs have attracted attention because of their potential to affect susceptibility to and severity of COVID-19.
Methods
Using claims data on 20% random sample of Part D Medicare enrollees from April to December 2020, we identified patients diagnosed with COVID-19. Using a nested case-control design, non-COVID-19 controls were identified by 1:5 matching on age, race, sex, dual-eligibility status, and geographical region. We identified usage of angiotensin-converting enzyme inhibitors (ACEI), angiotensin-receptor blockers (ARB), statins, warfarin, direct factor Xa inhibitors, P2Y12 inhibitors, famotidine and hydroxychloroquine based on Medicare prescription claims data. Using extended Cox regression models with time-varying propensity score adjustment we examined the independent effect of each study drug on contracting COVID-19. For severity of COVID-19, we performed extended Cox regressions on all COVID-19 patients, using COVID-19-related hospitalization and all-cause mortality as outcomes. Covariates included gender, age, race, geographic region, low-income indicator, and co-morbidities. To compensate for indication bias related to the use of hydroxychloroquine for the prophylaxis or treatment of COVID-19, we censored patients who only started on hydroxychloroquine in 2020.
Results
Up to December 2020, our sample contained 374,229 Medicare patients over 65 who were diagnosed with COVID-19. Among the COVID-19 patients, 278,912 (74.6%) were on at least one study drug. The three most common study drugs among COVID-19 patients were statins 187,374 (50.1%), ACEI 97,843 (26.2%) and ARB 83,290 (22.3%). For all three outcomes (diagnosis, hospitalization and death), current users of ACEI, ARB, statins, warfarin, direct factor Xa inhibitors and P2Y12 inhibitors were associated with reduced risks, compared to never users. Famotidine did not show consistent significant effects. Hydroxychloroquine did not show significant effects after censoring of recent starters.
Conclusion
Analysis of more than 370,000 Medicare enrollees over 65 diagnosed with COVID-19 showed that the use of ACEI, ARB, statins, warfarin, direct factor Xa inhibitors and P2Y12 inhibitors was associated with a reduction in the risk of catching COVID-19 and developing severe disease. Hydroxychloroquine and famotidine were not associated with significant effects in these outcomes.
Acknowledgments
We would like to thank the diligent and helpful staff at the VRDC and Research Data Assistance Center (ResDAC), without them this study would not be possible
Citation: Fung KW, Baik SH, Baye F, Zheng Z, Huser V, McDonald CJ (2022) Effect of common maintenance drugs on the risk and severity of COVID-19 in elderly patients. PLoS ONE 17(4): e0266922. https://doi.org/10.1371/journal.pone.0266922
Editor: Masaki Mogi, Ehime University Graduate School of Medicine, JAPAN
Received: October 1, 2021; Accepted: March 29, 2022; Published: April 18, 2022
This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
Data Availability: The minimal data set relevant to this study is included in the Supporting information. All data in Supporting information can be used without restriction. As for raw data, CMS did not allow the authors to download or distribute any patient level data. The data stayed in their machine and the authors analyzed it with software they provide on their machine. The shared detailed statistical data should be sufficient for anyone to verify the study’s results. If researchers wish to access the raw data, they can contact the CMS Virtual Research Data Center. However, data access requires the payment of a fee. Note that the exact set of subjects may not be available even with access to raw data, because this study is based on a randomly selected 20% sample, and CMS will pull a new 20% sample for any new request. However, the results should be almost identical given the large sample size.
Funding: This research was supported in part by the Intramural Research Program of the NIH, National Library of Medicine. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0266922#abstract0
