Abstract

This systematic review and meta-analysis evaluated the clinical and biochemical effects of atorvastatin as an adjunct therapy in hospitalized adults with coronavirus disease 2019 (COVID-19). The review was conducted in line with Cochrane guidance and reported findings according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The major databases and clinical trial registries were searched to identify randomized controlled trials comparing atorvastatin with placebo or standard care in hospitalized patients with confirmed COVID-19. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the revised Cochrane tool for randomized trials. The dichotomous and continuous outcomes were pooled using a random-effects model and conducted sensitivity analyses to assess the stability of current study findings. Across eligible trials, atorvastatin did not demonstrate a clinically meaningful benefit for key outcomes, including mortality, need for mechanical ventilation, intensive care unit admission, or length of hospitalization. Although some studies suggested reductions in inflammatory markers, these biochemical changes did not consistently align with improved clinical outcomes. Heterogeneity in background therapies, illness severity, and outcome definitions might have influenced pooled estimates. Current evidence does not support the routine use of atorvastatin solely for treating COVID-19 in hospitalized patients. Atorvastatin should remain reserved for established indications until further data clarify whether earlier use in the disease course or specific subgroups may benefit.

Key words: Atorvastatin, COVID-19, inflammation, mortality, SARS-CoV-2, systematic review.