TY - JOUR
T1 - Relation of severe COVID-19 to polypharmacy and prescribing of psychotropic drugs
T2 - the REACT-SCOT case-control study
AU - Public Health Scotland COVID-19 Health Protection Study Group
AU - McKeigue, Paul M
AU - Kennedy, Sharon
AU - Weir, Amanda
AU - Bishop, Jen
AU - McGurnaghan, Stuart J
AU - McAllister, David
AU - Robertson, Chris
AU - Wood, Rachael
AU - Lone, Nazir
AU - Murray, Janet
AU - Caparrotta, Thomas M
AU - Smith-Palmer, Alison
AU - Goldberg, David
AU - McMenamin, Jim
AU - Guthrie, Bruce
AU - Hutchinson, Sharon
AU - Colhoun, Helen M
PY - 2021/2/22
Y1 - 2021/2/22
N2 - BACKGROUND: The objective of this study was to investigate the relation of severe COVID-19 to prior drug prescribing.METHODS: Severe cases were defined by entry to critical care or fatal outcome. For this matched case-control study (REACT-SCOT), all 4251 cases of severe COVID-19 in Scotland since the start of the epidemic were matched for age, sex and primary care practice to 36,738 controls from the population register. Records were linked to hospital discharges since June 2015 and dispensed prescriptions issued in primary care during the last 240 days.RESULTS: Severe COVID-19 was strongly associated with the number of non-cardiovascular drug classes dispensed. This association was strongest in those not resident in a care home, in whom the rate ratio (95% CI) associated with dispensing of 12 or more drug classes versus none was 10.8 (8.8, 13.3), and in those without any of the conditions designated as conferring increased risk of COVID-19. Of 17 drug classes postulated at the start of the epidemic to be "medications compromising COVID", all were associated with increased risk of severe COVID-19 and these associations were present in those without any of the designated risk conditions. The fraction of cases in the population attributable to exposure to these drug classes was 38%. The largest effect was for antipsychotic agents: rate ratio 4.18 (3.42, 5.11). Other drug classes with large effects included proton pump inhibitors (rate ratio 2.20 (1.72, 2.83) for = 2 defined daily doses/day), opioids (3.66 (2.68, 5.01) for = 50 mg morphine equivalent/day) and gabapentinoids. These associations persisted after adjusting for covariates and were stronger with recent than with non-recent exposure.CONCLUSIONS: Severe COVID-19 is associated with polypharmacy and with drugs that cause sedation, respiratory depression, or dyskinesia; have anticholinergic effects; or affect the gastrointestinal system. These associations are not easily explained by co-morbidity. Measures to reduce the burden of mortality and morbidity from COVID-19 should include reinforcing existing guidance on reducing overprescribing of these drug classes and limiting inappropriate polypharmacy.REGISTRATION: ENCEPP number EUPAS35558.
AB - BACKGROUND: The objective of this study was to investigate the relation of severe COVID-19 to prior drug prescribing.METHODS: Severe cases were defined by entry to critical care or fatal outcome. For this matched case-control study (REACT-SCOT), all 4251 cases of severe COVID-19 in Scotland since the start of the epidemic were matched for age, sex and primary care practice to 36,738 controls from the population register. Records were linked to hospital discharges since June 2015 and dispensed prescriptions issued in primary care during the last 240 days.RESULTS: Severe COVID-19 was strongly associated with the number of non-cardiovascular drug classes dispensed. This association was strongest in those not resident in a care home, in whom the rate ratio (95% CI) associated with dispensing of 12 or more drug classes versus none was 10.8 (8.8, 13.3), and in those without any of the conditions designated as conferring increased risk of COVID-19. Of 17 drug classes postulated at the start of the epidemic to be "medications compromising COVID", all were associated with increased risk of severe COVID-19 and these associations were present in those without any of the designated risk conditions. The fraction of cases in the population attributable to exposure to these drug classes was 38%. The largest effect was for antipsychotic agents: rate ratio 4.18 (3.42, 5.11). Other drug classes with large effects included proton pump inhibitors (rate ratio 2.20 (1.72, 2.83) for = 2 defined daily doses/day), opioids (3.66 (2.68, 5.01) for = 50 mg morphine equivalent/day) and gabapentinoids. These associations persisted after adjusting for covariates and were stronger with recent than with non-recent exposure.CONCLUSIONS: Severe COVID-19 is associated with polypharmacy and with drugs that cause sedation, respiratory depression, or dyskinesia; have anticholinergic effects; or affect the gastrointestinal system. These associations are not easily explained by co-morbidity. Measures to reduce the burden of mortality and morbidity from COVID-19 should include reinforcing existing guidance on reducing overprescribing of these drug classes and limiting inappropriate polypharmacy.REGISTRATION: ENCEPP number EUPAS35558.
KW - Aged
KW - Aged, 80 and over
KW - COVID-19/chemically induced
KW - Case-Control Studies
KW - Comorbidity
KW - Critical Care/trends
KW - Dose-Response Relationship, Drug
KW - Drug Prescriptions
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Polypharmacy
KW - Psychotropic Drugs/adverse effects
KW - Scotland/epidemiology
KW - Severity of Illness Index
U2 - 10.1186/s12916-021-01907-8
DO - 10.1186/s12916-021-01907-8
M3 - Article
C2 - 33612113
SN - 1741-7015
VL - 19
SP - 51
JO - BMC Medicine
JF - BMC Medicine
IS - 1
ER -