The pandemic of a koronavirusny disease of 2019 (COVID-19) significantly affected health and life support of millions of people around the world, and the scale and speed of this influence were unprecedented. At the moment there are no certain specific techniques of treatment and prevention of COVID-19. Thus, reorientation of already existing approved drugs for reduction of severity of COVID-19 is considered as strategy, more cost-effective and sensitive to terms.
Statines — primary hypolipidemic drugs with well transferable side effects, are characterized by low cost and are widely available around the world, including developing countries. The expressed antiinflammatory and immunomodulatory effect of statines allows to assume that they can become useful in fight against a koronavirusny infection, including SARS-CoV-2. Observation researches and the randomized controlled studies (RCS) showed that statines possess a considerable protective effect for normalization of function of release of pro-inflammatory cytokines and function of cells at persons with viral and bacterial pneumonia. In newer report on results of the analysis by means of a method of molecular docking it was reported that statines can inhibit penetration of SARS-CoV-2 into cells, directly contacting the main protease of a coronavirus.
These data formed the basis of reasonings on possible therapeutic advantage of statines for treatment of COVID-19. At the same time there were fears whether the persons accepting statines, to higher risk of infection of SARS-CoV-2 and aggravation of COVID-19 as during the researches on laboratory animals it was shown that drugs of this class raise an expression of an angiotensin-converting enzyme 2 (APF2), a virus receptor are exposed. Thus, direct clinical proofs are urgently necessary to answer a question whether use of statines for treatment of the hospitalized patients with COVID-19 is harmful or useful.
In clinical conditions statines are often appointed along with blockers renin-angiotensin-aldosteronovoy of a system (RAAS), in particular, with inhibitors of the angiotensin-converting enzyme (ACE) and blockers of a receptor of angiotensin II (SCONCE), to persons with hypertensia or pathologies of heart. It is remarkable that the question of a clinical use of APF and SCONCE inhibitors for treatment of COVID-19 is the same dilemma, as well as statinovy therapy, in terms of increase in an expression of APF2 in comparison with antiinflammatory and cardiotyre-tread action. One recent research showed that persons about COVID-19 accepting APF or SCONCE inhibitors (IAPF/SCONCE) are exposed to smaller risk of 28-day general mortality, in comparison with patients who do not undergo treatment by means of APF or SCONCE inhibitors. Moreover, the combination therapy with use of statines and the SCONCE yielded the encouraging results in terms of improvement of indicators of survival among the persons infected with Ebola virus. Nevertheless impact of such combination therapy on persons with COVID-19 was not studied.
To answer these important clinical issues, China conducted one of the largest retrospective cohort researches which captured 13,981 clinically confirmed COVID-19 case for the purpose of establishment of interrelation between use of statines in a hospital and a clinical outcome. During the analysis of subgroups additional impact of the combined intake of statines and the IAPF/SCONCE on a clinical outcome of COVID-19 was also considered. Analyses by means of Cox's model with temporary variables, marginal structural model (MSM) and a method of comparison of indicators of compliance consistently showed that patients about COVID-19 undergoing statinovy therapy are subject to lower risk of the general mortality, in comparison with the patients who were not undergoing treatment by means of statines.
Thus, it is possible to draw a conclusion that use of statines for treatment of the hospitalized patients with COVID-19 was associated with the lowered risk of the general mortality and favorable characteristic of the period of recovery. In view of features of such retrospective researches interpretation of the received results needs to be carried out with care; nevertheless these data are the confirming proofs of safety of statines or a combination therapy by means of statines in combination with the IAPF/SCONCE for treatment of patients with COVID-19. Carrying out further researches is urgently necessary for consideration of influence of statines on COVID-19 outcome.