背景:自COVID-19大流行以来,许多常用药物被评估为再利用的治疗选择。降脂药的益处在这方面一直存在争议。在这次系统审查中,我们通过纳入随机对照试验(RCTs)评估了这些药物作为COVID-19辅助治疗的效果.
方法:我们搜索了四个国际数据库,包括PubMed、WebofScience,Scopus,和Embase为2023年4月的RCT。主要结果是死亡率,而其他疗效指数被认为是次要结局.为了估计结果的集合效应大小,考虑比值比(OR)或标准化平均差(SMD)和95%置信区间(CI),进行随机效应荟萃分析.
结果:10项研究涉及2,167名使用他汀类药物的COVID-19患者,omega-3脂肪酸,非诺贝特,PCSK9抑制剂,与对照组或安慰剂相比,烟酰胺作为干预措施,包括在内。在死亡率(OR0.96,95%CI0.58至1.59,p值=0.86,I2=20.4%)或住院时间(SMD-0.10,95%CI-0.78至0.59,p值=0.78,I2=92.4%)方面没有发现显着差异。非诺贝特和烟酰胺的趋势相似。PCSK9抑制,然而,导致死亡率降低和总体预后更好。Omega-3补充剂在两项试验中显示出矛盾的结果,这表明需要进一步评估。
结论:尽管一些观察性研究发现使用降脂药的患者的预后有所改善,我们的研究发现添加他汀类药物没有益处,非诺贝特,或烟酰胺治疗COVID-19。另一方面,PCSK9抑制剂可以是进一步评估的良好候选者。最后,使用omega-3补充剂治疗COVID-19有很大的局限性,需要更多的试验来评估这种疗效.
BACKGROUND: Many commonly used drugs were evaluated as repurposed treatment options since the emergence of the COVID-19 pandemic. The benefit of lipid-lowering agents has been controversial in this regard. In this systematic review, we assessed the effect of these medications as adjunctive therapy in COVID-19 by the inclusion of randomized controlled trials (RCTs).
METHODS: We searched four international databases including PubMed, the Web of Science, Scopus, and Embase for RCTs in April 2023. The primary outcome was mortality, while other efficacy indices were considered secondary outcomes. In order to estimate the pooled effect size of the outcomes, considering the odds ratio (OR) or standardized mean difference (SMD) and 95% confidence interval (CI), random-effect meta-analyses was conducted.
RESULTS: Ten studies involving 2,167 COVID-19 patients using statins, omega-3 fatty acids, fenofibrate, PCSK9 inhibitors, and nicotinamide as intervention compared to control or placebo, were included. No significant difference was found in terms of mortality (OR 0.96, 95% CI 0.58 to 1.59, p-value = 0.86, I2 = 20.4%) or length of hospital stay (SMD -0.10, 95% CI -0.78 to 0.59, p-value = 0.78, I2 = 92.4%) by adding a statin to the standard of care. The trend was similar for fenofibrate and nicotinamide. PCSK9 inhibition, however, led to decreased mortality and an overall better prognosis. Omega-3 supplementation showed contradicting results in two trials, suggesting the need for further evaluation.
CONCLUSIONS: Although some observational studies found improved outcomes in patients using lipid-lowering agents, our study found no benefit in adding statins, fenofibrate, or nicotinamide to COVID-19 treatment. On the other hand, PCSK9 inhibitors can be a good candidate for further assessment. Finally, there are major limitations in the use of omega-3 supplements in treating COVID-19 and more trials are warranted to evaluate this efficacy.