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Relationship between antidepressants and severity of SARS-CoV-2 Omicron infection: a retrospective cohort study using real-world data

Wang et al., The Lancet Regional Health - Western Pacific, doi:10.1016/j.lanwpc.2023.100716
Feb 2023  
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26th treatment shown to reduce risk in November 2021
*, now with p = 0.00014 from 21 studies, recognized in 3 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,300+ studies for 77 treatments.
PSM retrospective 60,903 hospitalized COVID-19 patients in Hong Kong, showing antidepressants associated with lower mortality, including for SSRIs, and for FIASMA antidepressants.
8 meta analyses show significant improvements with fluvoxamine for mortality1,2, hospitalization1,3-7, progression2,7, and severity8.
Currently there are 21 fluvoxamine for COVID-19 studies, showing 44% lower mortality [15‑63%], 42% lower ventilation [-151‑86%], 10% higher ICU admission [-72‑326%], 51% lower hospitalization [8‑73%], and 27% fewer cases [18‑35%].
Wang et al., 27 Feb 2023, retrospective, China, peer-reviewed, 15 authors.
This PaperFluvoxamineAll
Relationship between antidepressants and severity of SARS-CoV-2 Omicron infection: a retrospective cohort study using real-world data
Huwen Wang, Yuchen Wei, Chi Tim Hung, Xiaoting Jiang, Conglu Li, Katherine Min Jia, Eman Yee Man Leung, Carrie Ho Kwan Yam, Tsz Yu Chow, Shi Zhao, Zihao Guo, Kehang Li, Ziqing Wang, Eng Kiong Yeoh, Ka Chun Chong
The Lancet Regional Health - Western Pacific, doi:10.1016/j.lanwpc.2023.100716
Background Few studies have used real-world data to evaluate the impact of antidepressant use on the risk of developing severe outcomes after SARS-CoV-2 Omicron infection. Methods This is a retrospective cohort study using propensity-score matching to examine the relationship between antidepressant use and COVID-19 severity. Inpatient and medication records of all adult COVID-19 patients in Hong Kong during the Omicron-predominated period were obtained. Severe clinical outcomes including intensive care unit admission and inpatient death after the first positive results of reverse transcription polymerase chain reaction as well as a composite outcome of both were studied. Cox proportional hazard models were applied to estimate the crude and adjusted hazard ratios (HR). Findings Of 60,903 hospitalised COVID-19 patients admitted, 40,459 were included for matching, among which 3821 (9.4%) were prescribed antidepressants. The rates of intensive care unit admission, inpatient death, and the composite event were 3.9%, 25.5%, and 28.3% respectively in the unexposed group, 1.3%, 20.0%, and 21.1% respectively in the exposed group, with adjusted HR equal to 0.332 (95% CI, 0.245-0.449), 0.868 (95% CI, 0.800-0.942), and 0.786 (95% CI, 0.727-0.850) respectively. The result was generally consistent when stratified by selective serotonin reuptake inhibitors (SSRIs) and non-SSRIs. Antidepressants with functional inhibition of acid sphingomyelinase activity, specifically fluoxetine, were also negatively associated with the outcomes. The effect of antidepressants was more apparent in female and fully vaccinated COVID-19 patients. Interpretation Antidepressant use was associated with a lower risk of severe COVID-19. The findings support the continuation of antidepressants in patients with COVID-19, and provide evidence for the treatment potential of antidepressants for severe COVID-19.
Ethics approval and consent to participate This was an observational study based on identity-masked datasets provided by the Department of Health, The Government of the Hong Kong Special Administrative Region. Ethics approval was obtained from the Joint CUHK-NTEC Clinical Research Ethics Committee, The Chinese University of Hong Kong. As this study was a retrospective analysis using secondary data without any personal information, the requirement for obtaining informed consent was waived. Declaration of interests All authors declare no competing interests. Appendix A. Supplementary data Supplementary data related to this article can be found at https://doi. org/10.1016/j.lanwpc.2023.100716.
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