It bears repeating that I am quite the fan of inexpensive, readily available therapies to help save the lives of our patients. When I received this article from Caroline Welch, Pharm D. I was excited because I was hoping it would be a positive study. Unfortunately, it did not pan out and based on these data, atorvastatin does not seem to help out our critically ill patients with COVID-19. I know some people claim that we haven’t tried hard enough to repurpose current therapeutics with known toxicities and effects during this pandemic, and there may be some merit to that, but this is a case where these authors in Iran tried to do exactly that.
What dose of atorvastatin was used for their COVID ICU patients?
They used 20mg daily. Could they have used more? Definitely. But then you run increased risks of hepatotoxicity and elevations in the CK of these patients. They did the best they could in my opinion. As an aside, though, they weren’t getting only atorvastatin. >90% were receiving corticosteroids and >80% were receiving antivirals.
What were the Primary and Secondary Outcomes?
Here is a composite outcome of acute venous thrombosis, arterial thrombosis, treatment with ECMO, or all cause mortality. I am not a fan of these types of composite outcomes, to be honest. Seems like answering a lot of questions at the same time. There were no differences in the secondary outcomes either which included all-cause mortality, venous thromboembolism, and ventilator-free days. I recommend looking at table 1 which shows the baseline characteristics of the patients.
Should we start giving atorvastatin to our COVID patients in the ICU?
Nope. Nothing to do until further notice. If you’re looking for a therapy that does work in ICU patients, try baricitinib. I know that looking at figure 3 which shows the subgroup analysis could be encouraging. After all, it shows odds ratios that lean towards atorvastatin being beneficial in COVID ICU patients. But these are not statistically significant. In a study with almost 500 ICU patients, the claim of it being underpowered is not valid here, in my opinion, in order to find a treatment effect. They did a great job. If the patient was already on a statin, continue it. If not, don’t start it to potentially improve their COVID outcome.
Citation
INSPIRATION-S Investigators. Atorvastatin versus placebo in patients with covid-19 in intensive care: randomized controlled trial. BMJ. 2022 Jan 7;376:e068407. doi: 10.1136/bmj-2021-068407. PMID: 34996756.
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