CCU031: Evaluation of cardiotonic steroids use and COVID-19 outcomes

Project lead:
Gareth Williams, King's College London

There is still a pressing need to identify drug-based treatments for the continuing COVID-19 pandemic. Large-scale immunisation has been successful in stemming the tide of hospital admissions, but infections remain high with the ever-present risk of new variants arising against which current vaccines may be ineffective.

When lung cells are infected by the coronavirus, they mount a viral defence response. We have found that specific drugs, which stimulate this response, have potent antiviral properties. In particular, a class of drugs prescribed for certain heart conditions have been shown to inhibit the COVID virus replicating. One of these drugs, digoxin, is currently in clinical use.

By analysing electronic health record data, we can determine if people taking digoxin are less likely to get COVID or develop less severe symptoms when infected. If our hypothesis proves to be correct, people on alternative heart medications could be switched to digoxin and, depending on the benefit, it could subsequently be deployed to the wider public as a preventative drug.

The specific aims of the proposal are to:

  1. Determine whether digoxin medication provides protection against SARS-Cov-2 infection and whether it is associated with a better outcome post infection in terms of hospital and critical care admissions. We will look at digoxin effectiveness by making two comparisons:- We will firstly look at SARS-Cov-2 incidence/severity in the digoxin versus non digoxin cohorts.
    – Secondly, we will compare SARS-Cov-2 incidence/severity in the digoxin cohort versus the cohort on alternative arrhythmia medications. We will initially ignore the small population on both digoxin and beta blockers.
    – We will initially define the digoxin cohort to comprise those individuals with at least one dose of the drug. We will then do a sensitivity analysis by including dosing information.
  2. Analyse other possible factors that are correlated with digoxin medication and assess to what extent they explain the beneficial effects.

We predict that the incidence of COVID will be lower, and/or symptoms will be less severe, in people taking digoxin. If this proves to be the case then digoxin could be readily and rapidly prescribed, initially to frontline health workers and carers and then to the wider general population as a preventative/protective treatment against COVID-19 and other strains of coronavirus as they appear.

This would have a massive beneficial impact on the NHS and related services by helping to maintain normal staffing levels and reducing patient admissions due to COVID.  In turn, there would be a more rapid resumption of non-COVID related care and procedures which would help to reduce the huge patient waiting lists.