Abstract
This study aimed to systematically investigate if any of the available drugs in the electronic health record (EHR) can be repurposed as potential treatment for coronavirus disease 2019 (COVID-19). Based on a retrospective cohort analysis of EHR data, drug-wide association studies (DrugWAS) were performed on 9,748 patients with COVID-19 at Vanderbilt University Medical Center (VUMC). For each drug study, multivariable logistic regression with overlap weighting using propensity score was applied to estimate the effect of drug exposure on COVID-19 disease outcomes. Patient exposure to a drug between 3-months prior to the pandemic and the COVID-19 diagnosis was chosen as the exposure of interest. All-cause of death was selected as the primary outcome. Hospitalization, admission to the intensive care unit, and need for mechanical ventilation were identified as secondary outcomes. Overall, 17 drugs were significantly associated with decreased COVID-19 severity. Previous exposure to two types of 13-valent pneumococcal conjugate vaccines, PCV13 (odds ratio (OR), 0.31, 95% confidence interval (CI), 0.12-0.81 and OR, 0.33, 95% CI, 0.15-0.73), diphtheria toxoid and tetanus toxoid vaccine (OR, 0.38, 95% CI, 0.15-0.93) were significantly associated with a decreased risk of death (primary outcome). Secondary analyses identified several other significant associations showing lower risk for COVID-19 outcomes: acellular pertussis vaccine, 23-valent pneumococcal polysaccharide vaccine (PPSV23), flaxseed extract, ethinyl estradiol, estradiol, turmeric extract, ubidecarenone, azelastine, pseudoephedrine, dextromethorphan, omega-3 fatty acids, fluticasone, and ibuprofen. In conclusion, this cohort study leveraged EHR data to identify a list of drugs that could be repurposed to improve COVID-19 outcomes. Further randomized clinical trials are needed to investigate the efficacy of the proposed drugs.
【초록키워드】 COVID-19, coronavirus disease, randomized clinical trial, Coronavirus disease 2019, Efficacy, Vaccine, pandemic, intensive care, mechanical ventilation, Vaccines, Omega-3 fatty acids, omega-3, intensive care unit, COVID-19 severity, drugs, clinical trials, drug, Electronic health record, cohort study, COVID-19 disease, ibuprofen, outcomes, Health, COVID-19 diagnosis, estradiol, death, university, Admission, association, Propensity score, Analysis, Potential treatment, Odds ratio, EHR data, EHR, fatty acids, exposure to, azelastine, diphtheria toxoid, tetanus toxoid, fluticasone, Dextromethorphan, risk of death, health record, Primary outcome, pseudoephedrine, overlap, 95% CI, 95% confidence interval, Secondary outcomes, multivariable logistic regression, lower risk, center, Secondary analyses, list, retrospective cohort, pneumococcal, Weighting, polysaccharide vaccine, secondary, ethinyl estradiol, Flaxseed, pertussis vaccine, ubidecarenone, IMPROVE, identify, performed, significantly, applied, analysis, patients with COVID-19, was selected, 【제목키워드】 COVID-19, repurposing,