Inpatient Administration of Alpha-1-Adrenergic Receptor Blocking Agents Reduces Mortality in Male COVID-19 Patients

Shilong Li, Tomi Jun, Jonathan Tyler, Emilio Schadt, Yu Han Kao, Zichen Wang, Maximilian F. Konig, Chetan Bettegowda, Joshua T. Vogelstein, Nickolas Papadopoulos, Ramon E. Parsons, Rong Chen, Eric E. Schadt, Li Li, William K. Oh

Research output: Contribution to journalArticlepeer-review

Abstract

Apha-1-adrenergic receptor antagonists (α1-blockers) can suppress pro-inflammatory cytokines, thereby potentially improving outcomes among patients with COVID-19. Accordingly, we evaluated the association between α1-blocker exposure (before or during hospitalization) and COVID-19 in-hospital mortality. We identified 2,627 men aged 45 or older who were admitted to Mount Sinai hospitals with COVID-19 between February 24 and May 31, 2020, in New York. Men exposed to α1-blockers (N = 436) were older (median age 73 vs. 64 years, P < 0.001) and more likely to have comorbidities than unexposed men (N = 2,191). Overall, 777 (29.6%) patients died in hospital, and 1,850 (70.4%) were discharged. Notably, we found that α1-blocker exposure was independently associated with improved in-hospital mortality in a multivariable logistic analysis (OR 0.699; 95% CI, 0.498-0.982; P = 0.039) after adjusting for patient demographics, comorbidities, and baseline vitals and labs. The protective effect of α1-blockers was stronger among patients with documented inpatient exposure to α1-blockers (OR 0.624; 95% CI 0.431-0.903; P = 0.012). Finally, age-stratified analyses suggested variable benefit from inpatient α1-blocker across age groups: Age 45-65 OR 0.483, 95% CI 0.216-1.081 (P = 0.077); Age 55-75 OR 0.535, 95% CI 0.323-0.885 (P = 0.015); Age 65-89 OR 0.727, 95% CI 0.484-1.092 (P = 0.124). Taken together, clinical trials to assess the therapeutic value of α1-blockers for COVID-19 complications are warranted.

Original languageEnglish
Article number849222
JournalFrontiers in Medicine
Volume9
DOIs
StatePublished - 28 Feb 2022

Keywords

  • COVID-19
  • alpha-1-adrenergic receptor antagonist
  • coronavirus disease
  • electronic medical record
  • infectious disease
  • multivariate logistic analysis
  • off-label drug use
  • real-world evidence

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