Premium
Association Between FIASMAs and Reduced Risk of Intubation or Death in Individuals Hospitalized for Severe COVID‐19: An Observational Multicenter Study
Author(s) -
Hoertel Nicolas,
SánchezRico Marina,
Gulbins Erich,
Kornhuber Johannes,
Carpinteiro Alexander,
Lenze Eric J.,
Reiersen Angela M.,
Abellán Miriam,
Muela Pedro,
Vernet Raphaël,
Blanco Carlos,
Cougoule Céline,
Beeker Nathanaël,
Neuraz Antoine,
Gorwood Philip,
Alvarado Jesús M.,
Meneton Pierre,
Limosin Frédéric
Publication year - 2021
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1002/cpt.2317
Subject(s) - medicine , confidence interval , hazard ratio , clinical endpoint , observational study , proportional hazards model , inverse probability weighting , odds ratio , intubation , emergency medicine , pediatrics , anesthesia , clinical trial , propensity score matching
Several medications commonly used for a number of medical conditions share a property of functional inhibition of acid sphingomyelinase (ASM), or FIASMA. Preclinical and clinical evidence suggest that the ASM/ceramide system may be central to severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2) infection. We examined the potential usefulness of FIASMA use among patients hospitalized for severe coronavirus disease 2019 (COVID‐19) in an observational multicenter study conducted at Greater Paris University hospitals. Of 2,846 adult patients hospitalized for severe COVID‐19, 277 (9.7%) were taking an FIASMA medication at the time of their hospital admission. The primary end point was a composite of intubation and/or death. We compared this end point between patients taking vs. not taking an FIASMA medication in time‐to‐event analyses adjusted for sociodemographic characteristics and medical comorbidities. The primary analysis was a Cox regression model with inverse probability weighting (IPW). Over a mean follow‐up of 9.2 days (SD = 12.5), the primary end point occurred in 104 patients (37.5%) receiving an FIASMA medication, and 1,060 patients (41.4%) who did not. Despite being significantly and substantially associated with older age and greater medical severity, FIASMA medication use was significantly associated with reduced likelihood of intubation or death in both crude (hazard ratio (HR) = 0.71, 95% confidence interval (CI) = 0.58–0.87, P < 0.001) and primary IPW (HR = 0.58, 95%CI = 0.46–0.72, P < 0.001) analyses. This association remained significant in multiple sensitivity analyses and was not specific to one particular FIASMA class or medication. These results show the potential importance of the ASM/ceramide system in COVID‐19 and support the continuation of FIASMA medications in these patients. Double‐blind controlled randomized clinical trials of these medications for COVID‐19 are needed.