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0 0.5 1 1.5 2+ Mortality 97% Improvement Relative Risk Case -30% Fluvoxamine for COVID-19  Nemani et al.  Prophylaxis Is prophylaxis with fluvoxamine beneficial for COVID-19? Retrospective 1,958 patients in the USA (March - July 2020) More cases with fluvoxamine (not stat. sig., p=0.16) Nemani et al., JAMA Network Open, May 2022 Favors fluvoxamine Favors control

Association Between the Use of Psychotropic Medications and the Risk of COVID-19 Infection Among Long-term Inpatients With Serious Mental Illness in a New York State–wide Psychiatric Hospital System

Nemani et al., JAMA Network Open, doi:10.1001/jamanetworkopen.2022.10743
May 2022  
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Retrospective 1,958 consecutive psychiatric patients in the USA, showing higher cases and lower mortality with fluvoxamine, without statistical significance. There was only 25 fluvoxamine patients.
risk of death, 97.5% lower, RR 0.03, p = 1.00, treatment 0 of 16 (0.0%), control 38 of 953 (4.0%), NNT 25, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm).
risk of case, 29.8% higher, RR 1.30, p = 0.16, treatment 16 of 25 (64.0%), control 953 of 1,933 (49.3%).
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Nemani et al., 6 May 2022, retrospective, USA, peer-reviewed, 12 authors, study period 8 March, 2020 - 1 July, 2020.
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This PaperFluvoxamineAll
Association Between the Use of Psychotropic Medications and the Risk of COVID-19 Infection Among Long-term Inpatients With Serious Mental Illness in a New York State–wide Psychiatric Hospital System
MD Katlyn Nemani, DrPH Sharifa Z Williams, MD Mark Olfson, PhD Emily Leckman-Westin, MD Molly Finnerty, PhD Jammie Kammer, MD Thomas E Smith, MD; Daniel J Silverman, MD Jean-Pierre Lindenmayer, BS Gillian Capichioni, PhD; James Clelland, MD Donald C Goff
JAMA Network Open, doi:10.1001/jamanetworkopen.2022.10743
IMPORTANCE Individuals with serious mental illness are at increased risk of severe COVID-19 infection. Several psychotropic medications have been identified as potential therapeutic agents to prevent or treat COVID-19 but have not been systematically examined in this population. OBJECTIVE To evaluate the associations between the use of psychotropic medications and the risk of COVID-19 infection among adults with serious mental illness receiving long-term inpatient psychiatric treatment. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study assessed adults with serious mental illness hospitalized in a statewide psychiatric hospital system in New York between March 8 and July 1, 2020. The final date of follow-up was December 1, 2020. The study included 1958 consecutive adult inpatients with serious mental illness (affective or nonaffective psychoses) who received testing for SARS-CoV-2 by reverse transcriptase-polymerase chain reaction or antinucleocapsid antibodies and were continuously hospitalized from March 8 until medical discharge or July 1, 2020. EXPOSURES Psychotropic medications prescribed prior to COVID-19 testing. MAIN OUTCOMES AND MEASURES COVID-19 infection was the primary outcome, defined by a positive SARS-CoV-2 reverse transcriptase-polymerase chain reaction or antibody test result. The secondary outcome was COVID-19-related death among patients with laboratory-confirmed infection. RESULTS Of the 2087 adult inpatients with serious mental illness continuously hospitalized during the study period, 1958 (93.8%) underwent testing and were included in the study; 1442 (73.6%) were men, and the mean (SD) age was 51.4 (14.3) years. A total of 969 patients (49.5%) had laboratory-confirmed COVID-19 infection that occurred while they were hospitalized; of those, 38 (3.9%) died. The use of second-generation antipsychotic medications, as a class, was associated with decreased odds of infection (odds ratio [OR], 0.62; 95% CI, 0.45-0.86), whereas the use of mood stabilizers was associated with increased odds of infection (OR, 1.23; 95% CI, 1.03-1.47). In a multivariable model of individual medications, the use of paliperidone was associated with decreased odds of infection (OR, 0.59; 95% CI, 0.41-0.84), and the use of valproic acid was associated with increased odds of infection (OR, 1.39; 95% CI, 1.10-1.76). Clozapine use was associated with reduced odds of mortality in unadjusted analyses (unadjusted OR, 0.25; 95% CI, 0.10-0.62; fully adjusted OR, 0.43; 95% CI, 0.17-1.12). (continued) Key Points Question Is psychotropic medication use associated with differences in the risk of COVID-19 infection among adults with serious mental illness? Findings In this cohort study of 1958 inpatients with serious mental illness in a statewide psychiatric hospital system, the use of second-generation antipsychotic medications was associated with a decreased risk of COVID-19 infection; the largest association was observed with the use of..
Author Contributions: Drs Nemani and Goff had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Nemani, Williams, Olfson, Finnerty, Clelland, Goff. Acquisition, analysis, or interpretation of data: Nemani, Williams, Leckman-Westin, Finnerty, Kammer, Smith, Silverman, Lindenmayer, Capichioni, Goff. Drafting of the manuscript: Nemani, Williams, Capichioni, Goff. Critical revision of the manuscript for important intellectual content: Nemani, Williams, Olfson, Leckman-Westin, Finnerty, Kammer, Smith, Silverman, Lindenmayer, Clelland, Goff. Statistical analysis: Williams. Administrative, technical, or material support: Finnerty, Smith, Silverman, Lindenmayer, Capichioni, Goff. Supervision: Leckman-Westin, Finnerty, Smith, Goff. Conflict of Interest Disclosures: Dr Lindenmayer reported receiving grants from Roche, Takeda, Lundbeck, Avanir, GW/Jazz, Neurocrine, and the National Institute of Mental Health outside the submitted work; and having a patent for the Structured Clinical Interview for the Positive and Negative Syndrome Scale (SCI-PANSS) with royalties paid. No other disclosures were reported.
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Supplement, Efigure, Study Profile eTable 1. Psychotropic Medications Exposure in Full Cohort and by Infection and Death eTable 2. ICD-9/10 Category Codes Used to Identify Medical Conditions and Psychiatric Diagnoses eTable 3. Incidence and Adjusted Odds Ratios of COVID-19 Infection by Psychotropic Medication Exposure in Patients with PCR Testing
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