Relation of severe COVID-19 to polypharmacy and prescribing of psychotropic drugs: the REACT-SCOT case-control study

{ 'indexed': {'date-parts': [[2024, 7, 19]], 'date-time': '2024-07-19T00:54:48Z', 'timestamp': 1721350488291}, 'reference-count': 25, 'publisher': 'Springer Science and Business Media LLC', 'issue': '1', 'license': [ { 'start': { 'date-parts': [[2021, 2, 22]], 'date-time': '2021-02-22T00:00:00Z', 'timestamp': 1613952000000}, 'content-version': 'tdm', 'delay-in-days': 0, 'URL': 'http://creativecommons.org/licenses/by/4.0/'}, { 'start': { 'date-parts': [[2021, 2, 22]], 'date-time': '2021-02-22T00:00:00Z', 'timestamp': 1613952000000}, 'content-version': 'vor', 'delay-in-days': 0, 'URL': 'http://creativecommons.org/licenses/by/4.0/'}], 'content-domain': {'domain': ['link.springer.com'], 'crossmark-restriction': False}, 'published-print': {'date-parts': [[2021, 12]]}, 'abstract': '<jats:title>Abstract</jats:title><jats:sec>\n' ' <jats:title>Background</jats:title>\n' ' <jats:p>The objective of this study was to investigate the relation of severe ' 'COVID-19 to prior drug prescribing.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Methods</jats:title>\n' ' <jats:p>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.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Results</jats:title>\n' ' <jats:p>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.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Conclusions</jats:title>\n' ' <jats:p>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.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Registration</jats:title>\n' ' <jats:p>ENCEPP number https://EUPAS35558</jats:p>\n' ' </jats:sec>', 'DOI': '10.1186/s12916-021-01907-8', 'type': 'journal-article', 'created': {'date-parts': [[2021, 2, 22]], 'date-time': '2021-02-22T02:02:59Z', 'timestamp': 1613959379000}, 'update-policy': 'http://dx.doi.org/10.1007/springer_crossmark_policy', 'source': 'Crossref', 'is-referenced-by-count': 38, 'title': 'Relation of severe COVID-19 to polypharmacy and prescribing of psychotropic drugs: the ' 'REACT-SCOT case-control study', 'prefix': '10.1186', 'volume': '19', 'author': [ { 'ORCID': 'http://orcid.org/0000-0002-5217-1034', 'authenticated-orcid': False, 'given': 'Paul M.', 'family': 'McKeigue', 'sequence': 'first', 'affiliation': []}, { 'name': 'on behalf of Public Health Scotland COVID-19 Health Protection Study Group', 'sequence': 'first', 'affiliation': []}, {'given': 'Sharon', 'family': 'Kennedy', 'sequence': 'additional', 'affiliation': []}, {'given': 'Amanda', 'family': 'Weir', 'sequence': 'additional', 'affiliation': []}, {'given': 'Jen', 'family': 'Bishop', 'sequence': 'additional', 'affiliation': []}, {'given': 'Stuart J.', 'family': 'McGurnaghan', 'sequence': 'additional', 'affiliation': []}, {'given': 'David', 'family': 'McAllister', 'sequence': 'additional', 'affiliation': []}, {'given': 'Chris', 'family': 'Robertson', 'sequence': 'additional', 'affiliation': []}, {'given': 'Rachael', 'family': 'Wood', 'sequence': 'additional', 'affiliation': []}, {'given': 'Nazir', 'family': 'Lone', 'sequence': 'additional', 'affiliation': []}, {'given': 'Janet', 'family': 'Murray', 'sequence': 'additional', 'affiliation': []}, {'given': 'Thomas M.', 'family': 'Caparrotta', 'sequence': 'additional', 'affiliation': []}, {'given': 'Alison', 'family': 'Smith-Palmer', 'sequence': 'additional', 'affiliation': []}, {'given': 'David', 'family': 'Goldberg', 'sequence': 'additional', 'affiliation': []}, {'given': 'Jim', 'family': 'McMenamin', 'sequence': 'additional', 'affiliation': []}, {'given': 'Bruce', 'family': 'Guthrie', 'sequence': 'additional', 'affiliation': []}, {'given': 'Sharon', 'family': 'Hutchinson', 'sequence': 'additional', 'affiliation': []}, {'given': 'Helen M.', 'family': 'Colhoun', 'sequence': 'additional', 'affiliation': []}], 'member': '297', 'published-online': {'date-parts': [[2021, 2, 22]]}, 'reference': [ { 'key': '1907_CR1', 'doi-asserted-by': 'publisher', 'first-page': 'm1313', 'DOI': '10.1136/bmj.m1313', 'volume': '369', 'author': 'JK Aronson', 'year': '2020', 'unstructured': 'Aronson JK, Ferner RE. 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HC receives or has recently received non-binding research support ' 'from AstraZeneca and Novo-Nordisk. SH received honoraria from Gilead.', 'order': 2, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Competing interests'}}], 'article-number': '51'}