Integrative analysis of functional genomic screening and clinical data identifies a protective role for spironolactone in severe COVID-19.

The comparator, metformin, also exhibited a significant negative association with progression to ICU admission (OR 0.49; CI 95 0.35–0.68; p < 0.001) and a nominally significant association with progression to mechanical ventilator status (OR 0.50; CI 95 0.29–0.85; p = 0.014), consistent with the secondary findings of the COVID-OUT randomized controlled trial. 31 We did not observe a significant association with progression to either ICU admission or mechanical ventilator status for either carvedilol or quetiapine following multiple hypothesis correction.

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44 Another interventional trial of 55 patients showed lower mortality for COVID-19 patients on potassium canrenoate, a mineralocorticoid receptor antagonist similar to spironolactone, although this also did not reach statistical significance. 45 However, both studies were conducted in small cohorts and may have been underpowered to detect an effect.

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