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This is the first time GP data has been linked to this clinically-rich ITU database nationally. It will establish a world-class resource to enable COVID-19 research both in the short and longer term as we get to grips with understanding this new disease and how best to treat it. 

Professor Julia Hippisley-Cox

The national QResearch–Oxford record linkage study is to be used to understand whether drugs commonly taken for chronic conditions such as hypertension or diabetes may exacerbate or reduce the severity of COVID-19 disease.

The study, led jointly by Professor Julia Hippisley-Cox in the Nuffield Department of Primary Care Health Sciences' Primary Care Epidemiology Group, with Professor Peter Watkinson in the Nuffield Department of Clinical Neurosciences, has been awarded funding by the NIHR Oxford Biomedical Research Centre.

It is hoped this study will be able to identify alternative drugs for patients with chronic conditions, as well as possible drugs to treat COVID-19; and identify high-risk patients in primary care.

Around 14 percent of the adult population in England take anti-hypertensive medications, and around five percent receive medication to treat diabetes. The prevalence increases with age, making usage particularly common in those at risk of for severe COVID-19 infections. In many cases drugs from a different class could be used instead.

Prof Watkinson said: “If these drugs are increasing the risk of severe infection, they represent one of the few modifiable risk factors for severe COVID-19 infection. Medical and research communities need rapid large-scale accumulation of data on the outcomes of patients who develop COVID-19 infection whilst taking these drugs to allow appropriate risk assessment and clinical decision making for these patient groups.“

Other drugs in common use in primary care patients are believed to have anti-viral activity to COVID-19, such as hydroxychloroquine, used in rheumatoid arthritis, and lopinavir-ritonavir, used in the treatment of HIV.

There are also immune-suppressive therapies that may either increase the risk of severe illness by preventing the body’s response to infection, or attenuate the hyperinflammation syndrome associated with COVID-19 disease, so preventing severe disease.

“The incidence of severe disease in patient groups taking these medications urgently needs to be established to guide both their management and investigation of COVID-19 treatment strategies,” Prof Watkinson explained.

The Intensive Care National Audit and Research Centre (ICNARC) is already providing up-to-date information on the admission characteristics and outcomes of all patients with severe COVID-19 infection treated on an ICU in England, Wales and Northern Ireland.

Prof Hippisley-Cox and Prof Watkinson’s study will seek to match this against data on prior long-term medication and chronic disease, information contained in the QResearch databases derived from the anonymised general practice health records.

“We estimate we will be able to link over 50 percent of all patients with severe COVID-19 infections in England, Wales and Northern Ireland. We will provide useful knowledge that patients, GPs and intensive care doctors can use to reduce the risk of severe COVID-19 infection within this pandemic,” Prof Watkinson said.

Prof Hippisley-Cox said: “This is an urgent question of international importance which is likely to directly inform policy and patient care. We are uniquely placed to do this research rapidly at scale using the QResearch database which has recently relocated to Oxford and which is already linked to hospital and mortality data.

“This is the first time GP data has been linked to this clinically-rich ITU database nationally. It will establish a world-class resource to enable COVID-19 research both in the short and longer term as we get to grips with understanding this new disease and how best to treat it.”

The study is one of three funded by the NIHR Oxford BRC

The Oxford BRC’s Director, Prof Helen McShane, said: “The researchers we support are already at the forefront of national efforts to find a vaccine for COVID-19, and effective treatments for patients – both in hospitals and general practice – who have contracted the virus.

“Such is the breadth of expertise in our BRC – whether in immunology, technology, big data or imaging – that we are especially well placed to address many different aspects of this pandemic, from developing treatments in the short-term, to looking at the longer-term impacts of the virus. For this reason, we have released funds to get these projects up and running as quickly as possible so that as many patients can benefit as possible.”

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