Leukotriene inhibitors with dexamethasone show promise in the prevention of death in COVID-19 patients with low oxygen saturations

Peter L Elkin; Skyler Resendez; Sarah Mullin; Bruce R Troen; Manoj J Mammen; Shirley Chang; Gillian Franklin; Wilmon McCray; Steven H Brown

doi:10.1017/cts.2022.401

Leukotriene inhibitors with dexamethasone show promise in the prevention of death in COVID-19 patients with low oxygen saturations

J Clin Transl Sci. 2022 May 16;6(1):e74. doi: 10.1017/cts.2022.401. eCollection 2022.

Authors

Peter L Elkin^{1

2

3

4}, Skyler Resendez¹, Sarah Mullin^{1

2}, Bruce R Troen^{2

3}, Manoj J Mammen^{2

3}, Shirley Chang^{1

3}, Gillian Franklin^{1

2}, Wilmon McCray^{1

2}, Steven H Brown^{5

6}

Affiliations

¹ Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
² Department of Veterans Affairs, VA Western New York Healthcare System and WNY, VA Research Service, Buffalo, NY, USA.
³ Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
⁴ Faculty of Engineering, University of Southern Denmark, Odense, Denmark.
⁵ Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
⁶ Department of Veterans Affairs, Veterans Health Administration, Office of Health Informatics, Washington, DC, USA.

Abstract

Introduction: COVID-19 is a major health threat around the world causing hundreds of millions of infections and millions of deaths. There is a pressing global need for effective therapies. We hypothesized that leukotriene inhibitors (LTIs), that have been shown to lower IL6 and IL8 levels, may have a protective effect in patients with COVID-19.

Methods: In this retrospective controlled cohort study, we compared death rates in COVID-19 patients who were taking a LTI with those who were not taking an LTI. We used the Department of Veterans Affairs (VA) Corporate Data Warehouse (CDW) to create a cohort of COVID-19-positive patients and tracked their use of LTIs between November 1, 2019 and November 11, 2021.

Results: Of the 1,677,595 cohort of patients tested for COVID-19, 189,195 patients tested positive for COVID-19. Forty thousand seven hundred one were admitted. 38,184 had an oxygen requirement and 1214 were taking an LTI. The use of dexamethasone plus a LTI in hospital showed a survival advantage of 13.5% (CI: 0.23%-26.7%; p < 0.01) in patients presenting with a minimal O₂Sat of 50% or less. For patients with an O₂Sat of <60 and <50% if they were on LTIs as outpatients, continuing the LTI led to a 14.4% and 22.25 survival advantage if they were continued on the medication as inpatients.

Conclusions: When combined dexamethasone and LTIs provided a mortality benefit in COVID-19 patients presenting with an O₂ saturations <50%. The LTI cohort had lower markers of inflammation and cytokine storm.

Keywords: EHR; Informatics; clinical research informatics; drug repurposing; translational medicine.

Abstract

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