Alpha-1 adrenergic antagonists and the risk of hospitalization or death in non-hospitalized patients with COVID-19: A population-based study

Tony Antoniou; Daniel McCormack; Mina Tadrous; Tara Gomes

doi:10.1111/fcp.13004

Alpha-1 adrenergic antagonists and the risk of hospitalization or death in non-hospitalized patients with COVID-19: A population-based study

Fundam Clin Pharmacol. 2024 Apr 4. doi: 10.1111/fcp.13004. Online ahead of print.

Authors

Tony Antoniou^{1

2

3

4}, Daniel McCormack⁴, Mina Tadrous^{4

5

6}, Tara Gomes^{2

4

5

7}

Affiliations

¹ Department of Family and Community Medicine, Unity Health Toronto, Toronto, Ontario, Canada.
² Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada.
³ Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
⁴ Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
⁵ Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
⁶ Women's College Research Institute, Toronto, Ontario, Canada.
⁷ Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.

PMID: 38575851
DOI: 10.1111/fcp.13004

Abstract

Background: Alpha-1 receptor antagonists may interfere with IL-6 signaling and could therefore be a potential treatment for COVID-19. However, the effectiveness of these drugs in mitigating the risk of clinical deterioration among non-hospitalized patients with COVID-19 is unknown.

Objectives: The aim of this study is to examine the association between alpha-1 antagonist exposure and the 30-day risk of a hospital encounter or death in nonhospitalized patients with COVID-19.

Methods: We conducted a population-based cohort study of Ontario residents aged 35 years and older who were eligible for public drug coverage and who had a positive test for SARS-CoV-2 between January 1, 2020, and March 1, 2021. We matched each individual receiving an alpha-1 antagonist at the time of their positive test with two non-exposed individuals using propensity scores. Our outcome was a composite of a hospital admission, emergency department visit, or death, 1 to 30 days following the positive test.

Results: We matched 3289 alpha-1 antagonist exposed patients to 6189 unexposed patients. Overall, there was no difference in the 30-day risk of the primary outcome among patients exposed to alpha-1 antagonists at the time of their diagnosis relative to unexposed individuals (28.8% vs. 28.0%; OR 1.00, 95% CI 0.91 to 1.11). In a secondary analysis, individuals exposed to alpha-1 antagonists had a lower risk of death in the 30 days following a COVID diagnosis (OR 0.79; 95% CI 0.66 to 0.93).

Conclusion: Alpha-1 antagonists did not mitigate the 30-day risk of clinical deterioration in non-hospitalized patients with COVID-19. Our findings do not support the general repurposing of alpha-1 antagonists as a treatment for such patients, although there may be subgroups of patients in whom further research is warranted.

Keywords: COVID‐19; alpha‐1‐adrenergic receptor antagonist; cohort study; coronavirus disease.

Grants and funding

Ontario Health Data Platform