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

Castro, Victor M; Ross, Rachel A; McBride, Sean MJ; Perlis, Roy H

Objective: Absent 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. Design: In silico cohort using electronic health records from individuals evaluated in the emergency department between March 4, 2020 and July 12, 2020. Setting: Emergency department and inpatient settings from 2 academic medical centers and 4 community hospitals. Participants: All individuals presenting to an emergency department and undergoing COVID-19 testing. Main Outcome or Measure: Inpatient hospitalization; documented requirement for mechanical ventilation. Results: Among 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. Conclusions: These 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 Registration: None