Nathanael R. Fillmore
Publications / 2021
paper
PLOS ONE2021doi:10.1371/journal.pone.0259061

Disulfiram use is associated with lower risk of COVID-19: A retrospective cohort study.

Nathanael Fillmore†, Steven Bell†, Ciyue Shen†, Vinh Nguyen, Jennifer La, Maureen Dubreuil, Judith Strymish, Mary Brophy, Gautam Mehta, Hao Wu, Judy Lieberman, Nhan Do‡, Chris Sander‡

† Equal first authorship · ‡ Equal senior authorship

Summary

Patients taking disulfiram, a medication for alcohol use disorder, demonstrated a 34% lower risk of SARS-CoV-2 infection compared to those not using the drug. These findings suggest that disulfiram may reduce both the incidence and severity of COVID-19, supporting the need for further clinical trials.

Key result

Disulfiram use was associated with a 34% lower risk of SARS-CoV-2 infection (HR 0.66; 95% CI 24-43%) and zero COVID-19 related deaths among 188 positive patients (P = 0.03).

Abstract

Effective, low-cost therapeutics are needed to prevent and treat COVID-19. Severe COVID-19 disease is linked to excessive inflammation. Disulfiram is an approved oral drug used to treat alcohol use disorder that is a potent anti-inflammatory agent and an inhibitor of the viral proteases. We investigated the potential effects of disulfiram on SARS-CoV-2 infection and disease severity in an observational study using a large database of clinical records from the national US Veterans Affairs healthcare system. A multivariable Cox regression adjusted for demographic information and diagnosis of alcohol use disorder revealed a reduced risk of SARS-CoV-2 infection with disulfiram use at a hazard ratio of 0.66 (34% lower risk, 95% confidence interval 24-43%). There were no COVID-19 related deaths among the 188 SARS-CoV-2 positive patients treated with disulfiram, in contrast to 5-6 statistically expected deaths based on the untreated population (P = 0.03). Our epidemiological results suggest that disulfiram may contribute to the reduced incidence and severity of COVID-19. These results support carefully planned clinical trials to assess the potential therapeutic effects of disulfiram in COVID-19.

Key figure

Key figure from Disulfiram use is associated with lower risk of COVID-19: A retrospective cohort study.