Identifying common pharmacotherapies associated with reduced COVID-19 morbidity using electronic health records

ObjectiveAbsent a vaccine or any established treatments for the novel and highly infectious coronavirus-19 (COVID-19), rapid efforts to identify potential therapeutics are required. We sought to identify commonly prescribed medications that may be associated with lesser risk of morbidity with COVID-19 across 6 Eastern Massachusetts hospitals. DesignIn silico cohort using electronic health records from individuals evaluated in the emergency department between March 4, 2020 and July 12, 2020. SettingEmergency department and inpatient settings from 2 academic medical centers and 4 community hospitals. ParticipantsAll individuals presenting to an emergency department and undergoing COVID-19 testing. Main Outcome or MeasureInpatient hospitalization; documented requirement for mechanical ventilation. ResultsAmong 7,360 individuals with COVID-19 positive test results by PCR, 3,693 (50.2%) were hospitalized in one of 6 hospitals. In models adjusted for sociodemographic features and overall burden of medical illness, medications significantly associated with diminished risk for hospitalization included ibuprofen and sumatriptan. Among individuals who were hospitalized, 962(26.0%) were admitted to the intensive care unit and 608 (16.5%) died; ibuprofen and naproxen were also more commonly prescribed among individuals not requiring intensive care. ConclusionsThese preliminary findings suggest that electronic health records may be applied to identify medications associated with lower risk of morbidity with COVID-19, but larger cohorts will be required to address the substantial problem of confounding by indication, such that extreme caution is warranted in interpreting nonrandomized results. Trial RegistrationNone Summary BoxesO_ST_ABSSection 1: What is already known on this topicC_ST_ABSAbsent a vaccine or any established treatments for the novel and highly infectious coronavirus-19 (COVID-19), rapid efforts to identify potential therapeutics are required. Section 2: What this study addsThis cohort study across 6 hospitals identified medications enriched among individuals positive for COVID-19 who are less likely to experience adverse outcomes including hospitalization, intensive care, or death.