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Khalaji A, Behnoush AH, Alilou S, Rezaee M, Peiman S, Sahebkar A. Adjunctive therapy with lipid-lowering agents in COVID-19: a systematic review and meta-analysis of randomized controlled trials. Lipids Health Dis 2023; 22:61. [PMID: 37158917 PMCID: PMC10165571 DOI: 10.1186/s12944-023-01828-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/05/2023] [Indexed: 05/10/2023] Open
Abstract
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. CONCLUSION 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.
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Affiliation(s)
- Amirmohammad Khalaji
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Behnoush
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sanam Alilou
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Malihe Rezaee
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheil Peiman
- Department of Internal Medicine, AdventHealth Orlando Hospital, Orlando, FL, USA
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- School of Medicine, The University of Western Australia, Perth, Australia
- Department of Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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Abbas N, Culver EL, Thorburn D, Halliday N, Crothers H, Dyson JK, Phaw A, Aspinall R, Khakoo SI, Kallis Y, Smith B, Patanwala I, McCune A, Chimakurthi CR, Hegade V, Orrell M, Jones R, Mells G, Thain C, Thain RM, Jones D, Hirschfield G, Trivedi PJ. UK-Wide Multicenter Evaluation of Second-line Therapies in Primary Biliary Cholangitis. Clin Gastroenterol Hepatol 2022; 21:1561-1570.e13. [PMID: 35961518 DOI: 10.1016/j.cgh.2022.07.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/15/2022] [Accepted: 07/26/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Thirty-to-forty percent of patients with primary biliary cholangitis inadequately respond to ursodeoxycholic acid. Our aim was to assemble national, real-world data on the effectiveness of obeticholic acid (OCA) as a second-line treatment, alongside non-licensed therapy with fibric acid derivatives (bezafibrate or fenofibrate). METHODS This was a nationwide observational cohort study conducted from August 2017 until June 2021. RESULTS We accrued data from 457 patients; 349 treated with OCA and 108 with fibric acid derivatives. At baseline/pre-treatment, individuals in the OCA group manifest higher risk features compared with those taking fibric acid derivatives, evidenced by more elevated alkaline phosphatase values, and a larger proportion of individuals with cirrhosis, abnormal bilirubin, prior non-response to ursodeoxycholic acid, and elastography readings >9.6kPa (P < .05 for all). Overall, 259 patients (OCA) and 80 patients (fibric acid derivatives) completed 12 months of second-line therapy, yielding a dropout rate of 25.7% and 25.9%, respectively. At 12 months, the magnitude of alkaline phosphatase reduction was 29.5% and 56.7% in OCA and fibric acid groups (P < .001). Conversely, 55.9% and 36.4% of patients normalized serum alanine transaminase and bilirubin in the OCA group (P < .001). The proportion with normal alanine transaminase or bilirubin values in the fibric acid group was no different at 12 months compared with baseline. Twelve-month biochemical response rates were 70.6% with OCA and 80% under fibric acid treatment (P = .121). Response rates between treatment groups were no different on propensity-score matching or on sub-analysis of high-risk groups defined at baseline. CONCLUSION Across the population of patients with primary biliary cholangitis in the United Kingdom, rates of biochemical response and drug discontinuation appear similar under fibric acid and OCA treatment.
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Affiliation(s)
- Nadir Abbas
- National Institute for Health and Care Research Birmingham Biomedical Research Centre, Centre for Liver and Gastroenterology Research, University of Birmingham, United Kingdom; Liver Unit, University Hospitals Birmingham Queen Elizabeth. Birmingham, United Kingdom; Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | - Emma L Culver
- Oxford Liver Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - Douglas Thorburn
- Institute of Liver and Digestive Health, University College London, London, United Kingdom
| | - Neil Halliday
- Institute of Liver and Digestive Health, University College London, London, United Kingdom
| | - Hannah Crothers
- Department of Informatics, University Hospitals Birmingham, United Kingdom
| | - Jessica K Dyson
- Department of Hepatology, Newcastle upon Tyne Hospital National Health Service Foundation Trust, Newcastle, United Kingdom; National Institute for Health and Care Research, Newcastle Biomedical Research Centre, Newcastle University, Newcastle, United Kingdom
| | - April Phaw
- Department of Hepatology, Newcastle upon Tyne Hospital National Health Service Foundation Trust, Newcastle, United Kingdom; National Institute for Health and Care Research, Newcastle Biomedical Research Centre, Newcastle University, Newcastle, United Kingdom
| | - Richard Aspinall
- Department of Gastroenterology and Hepatology, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Salim I Khakoo
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Yiannis Kallis
- Department of Hepatology, Barts Health National Health Service Trust and Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Belinda Smith
- Department of Digestive Diseases, St Mary's Hospital, Imperial College London, London, United Kingdom
| | - Imran Patanwala
- Department of Gastroenterology and Hepatology, Royal Liverpool and Broadgreen University Hospitals National Health Service Trust, Liverpool, United Kingdom
| | - Anne McCune
- Department of Liver Medicine, University Hospitals Bristol National Health Service Foundation Trust, Bristol, United Kingdom
| | - Chenchu R Chimakurthi
- Department of Hepatology, Leeds Teaching Hospital National Health Service Trust, Leeds, United Kingdom
| | - Vinod Hegade
- Department of Hepatology, Leeds Teaching Hospital National Health Service Trust, Leeds, United Kingdom
| | - Michael Orrell
- Oxford Liver Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - Rebecca Jones
- Department of Hepatology, Leeds Teaching Hospital National Health Service Trust, Leeds, United Kingdom
| | - George Mells
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom
| | | | | | - David Jones
- Department of Hepatology, Newcastle upon Tyne Hospital National Health Service Foundation Trust, Newcastle, United Kingdom; National Institute for Health and Care Research, Newcastle Biomedical Research Centre, Newcastle University, Newcastle, United Kingdom
| | - Gideon Hirschfield
- Toronto Centre for Liver Disease, University of Toronto and University Health Network, Toronto, Ontario, Canada
| | - Palak J Trivedi
- National Institute for Health and Care Research Birmingham Biomedical Research Centre, Centre for Liver and Gastroenterology Research, University of Birmingham, United Kingdom; Liver Unit, University Hospitals Birmingham Queen Elizabeth. Birmingham, United Kingdom; Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom; Institute of Applied Health Research, University of Birmingham, United Kingdom.
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