Association Between FIASMAs and Reduced Risk of Intubation or Death in Individuals Hospitalized for Severe COVID-19: An Observational Multicenter Study

Hoertel N, Sanchez-Rico M, Gulbins E, Kornhuber J, Carpinteiro A, Lenze EJ, Reiersen AM, Abellan M, De La Muela P, Vernet R, Blanco C, Cougoule C, Beeker N, Neuraz A, Gorwood P, Alvarado JM, Meneton P, Limosin F (2021)

Publication Type: Journal article

Publication year: 2021

Journal

Clinical Pharmacology & Therapeutics American Society for Clinical Pharmacology and Therapeutics

DOI: 10.1002/cpt.2317

Abstract

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.

Authors with CRIS profile

Johannes Kornhuber Lehrstuhl für Psychiatrie und Psychotherapie

Involved external institutions

University of Paris 4 - Paris-Sorbonne / Université paris IV Paris-Sorbonne FR France (FR) Universität Duisburg-Essen (UDE) DE Germany (DE) Washington University US United States (USA) (US) National Institute on Drug Abuse (NIDA) US United States (USA) (US) Université Fédérale de Toulouse Midi-Pyrénées FR France (FR) Hôpital Cochin FR France (FR) Universidad Complutense de Madrid (UCM) ES Spain (ES) Georges Pompidou European Hospital / Hôpital Européen Georges-Pompidou (HEGP) FR France (FR)

How to cite

APA:

Hoertel, N., Sanchez-Rico, M., Gulbins, E., Kornhuber, J., Carpinteiro, A., Lenze, E.J.,... Limosin, F. (2021). Association Between FIASMAs and Reduced Risk of Intubation or Death in Individuals Hospitalized for Severe COVID-19: An Observational Multicenter Study. Clinical Pharmacology & Therapeutics. https://dx.doi.org/10.1002/cpt.2317

MLA:

Hoertel, Nicolas, et al. "Association Between FIASMAs and Reduced Risk of Intubation or Death in Individuals Hospitalized for Severe COVID-19: An Observational Multicenter Study." Clinical Pharmacology & Therapeutics (2021).

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