Risk of Severe COVID-19 in Prevalent Users of Alpha-1 Adrenergic Receptor Antagonists: A National Case-Control Study of Medicare Beneficiaries

BACKGROUND

Alpha-1 adrenergic receptor antagonists prevent cytokine storm in mouse sepsis models. This led to the hypothesis that alpha-1 blockers may prevent severe coronavirus disease 2019 (COVID-19), which is characterized by hypercytokinemia and progressive respiratory failure.

METHODS

We performed an observational case-control study in male Medicare beneficiaries aged 65 years or older, with or without benign prostatic hyperplasia (BPH), and treated with alpha-1 receptor blockers or 5-alpha reductase inhibitors. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated for outcomes of uncomplicated and severe COVID-19 hospitalization (intensive care unit admission, invasive mechanical ventilation, or death).

RESULTS

There were 20,963 cases of hospitalized COVID-19 matched to 101,161 controls on calendar date and neighborhood of residence. In the primary analysis (males with BPH), there was no difference in risk of uncomplicated COVID-19 hospitalization (aOR 1.08, 95% CI 0.996-1.17) or hospitalization with severe complications (aOR 0.97, 95% CI 0.88-1.08). In the secondary analysis (males with or without BPH), the corresponding aORs were 1.02 (95% CI, 0.96-1.09) (uncomplicated) and 0.99 (95% CI, 0.91-1.07) (complicated), respectively. Subgroup and sensitivity analyses yielded similar results. Of note, there was no difference in risk of severe COVID-19 hospitalization when comparing non-selective vs selective alpha-1 blocker use (aOR 0.98, 95% CI 0.86-1.10), higher- vs lower-dose alpha-1 blocker use (aOR 0.96, 95% CI 0.86-1.08), or current vs remote alpha-1 blocker use (aOR 1.04, 95% CI 0.91-1.18).

CONCLUSIONS

Prevalent use of alpha-1 receptor blockers was not associated with a protective or harmful effect on risk of uncomplicated or severe hospitalized COVID-19.

Cost analysis of alpha blocker treatments for benign prostatic hyperplasia in Medicare beneficiaries

OBJECTIVES

Tamsulosin is the most widely used alpha-1 blocker medication for managing benign prostatic hyperplasia (BPH) as indicated in the current practice guideline. The aim of this study was to compare all-cause medical costs and BPH-specific medical costs in older male adults with BPH treated with tamsulosin vs other alpha-1 blockers (i.e., doxazosin, terazosin, and alfuzosin).

METHODS

This was a retrospective propensity-score matched cohort study based on 2006-2012 Medicare claims data. All-cause medical costs and BPH-specific medical costs were compared between tamsulosin and other alpha-1 blockers treatment groups using baseline-adjusted quantile regression analyses. The comparisons were performed at different percentiles of the cost distributions.

RESULTS

176,793 older male adults with BPH who used alpha-1 blockers were included in the analysis. All-cause medical costs in 75th and 95th percentiles of the cost distribution are substantially higher in tamsulosin treatment group when compared to other alpha-1 blocker medications (p < 0.05 for all). Tamsulosin treatment group had substantially higher BPH-specific medical costs in 99th percentile of the cost distribution when compared to doxazosin and terazosin (p < 0.001 for all). Overall, the top 5% of the patients with the highest all-cause medical costs accounted for approximately 45% of the overall all-cause medical costs, and the top 1% of the patients with the highest BPH-specific medical costs accounted for 39-51% of those costs.

CONCLUSION

Older adults with BPH who encountered higher medical expenses had substantially higher medical costs when treated with tamsulosin than other common alpha blockers. Cost-related quality of measures should be assessed to improve health outcomes in older adults with BPH.