ABSTRACT
BACKGROUND: The efficacy and safety of adjunctive statin therapy in hospitalized patients with coronavirus disease 2019 (Covid-19) remains uncertain. METHODS: We systematically searched Medline, Embase, Cochrane, and ClinicalTrial.gov databases from March 2020 to late April 2024 for randomized controlled trials (RCTs) comparing statin versus no statin use in patients hospitalized with Covid-19. We pooled risk ratios (RRs) and hazard ratios (HRs) with 95% confidence intervals (CIs) applying a random-effects model. R version 4.3.1 was used for statistical analyses. RESULTS: We included 7 RCTs comprising 4,262 patients, of whom 2,645 (62%) were randomized to receive statin therapy. Compared with no statin, statin use significantly reduced case-fatality rate (RR 0.88; 95% CI 0.80-0.98; I2=0%). In a time-to-event analysis, we found similar results (HR 0.86; 95% CI 0.75-0.99; I2=0%). Statin use also significantly reduced World Health Organization (WHO) scale at 14 days (mean difference -0.27; 95% CI -0.54 to -0.01; I2=0%). There was no statistically significant difference between the two groups in length of hospital stay, elevation of liver enzymes, and C-reactive protein levels. CONCLUSIONS: In patients hospitalized with Covid-19, statins significantly reduced case-fatality rate and WHO scale score. PRIMARY FUNDING SOURCE: No funding was used for this work. REGISTRATION: A prospective register was recorded in International Prospective Register of Systematic Reviews (PROSPERO) with the number CRD42023479007.
