Outpatient Antipsychotic Use and Severe COVID-19: Avoiding the Impact of Age in a Real-World Data Study

Abstract

Background The association between use of antipsychotics and COVID-19 outcomes is inconsistent, which may be linked to use of these drugs in age-related diseases. Furthermore, there is little evidence as regards their effect in the non-geriatric population . We aim to assess the association between antipsychotic use and risk of disease progression and hospitalisation due to COVID-19 among the general population, stratifying by age. Methods We conducted a population-based, multiple case-control study to assess: (1) risk of hospitalisation, with cases being patients with a PCR(+)test who required hospitalisation and controls being subjects without a PCR(+) test; and (2) risk of progression to hospitalisation, with cases being the same as those used in the hospitalisation substudy and controls being non-hospitalised PCR(+) patients. We calculated adjusted odds-ratios (aOR) and 95% confidence intervals (CI), both overall and stratified by age. Results Antipsychotic treatment in patients <65 years was not associated with a higher risk of hospitalisation due to COVID-19 (aOR 0.94 [95%CI 0.69–1.27]) and disease progression among PCR(+) patients (aOR 0.96 [95%CI 0.70–1.33]). For patients aged ≥65 years, however, there was a significant, increased risk of hospitalisation (aOR 1.58 [95%CI 1.38–1.80]) and disease progression (aOR 1.31 [95%CI 1.12–1.55]). Conclusions The results of our large-scale real world data study suggest that antipsychotic use is not associated with a greater risk of hospitalisation due to COVID-19 and progression to hospitalisation among patients younger than 65 years. The effect found in the over-65-year age group might be associated with off-label use of antipsychotics.

Antipsychotics, COVID-19, and Secondary Healthcare Databases: Revisiting the Pandemic

“…Chief among these was the inclusion of working-age patients with primary psychotic or mood disorders and older age patients suffering from dementia and medical comorbidities in single cohorts, despite their markedly different clinical profiles and underlying vulnerabilities to COVID-19 ( Boland and Dratcu, 2021 ). Pintos-Rodríguez et al (2024) have demonstrated that, when these shortcomings are addressed, evidence actually shows antipsychotics do not increase COVID-19–associated risks.…”

“…The controversy around the safety of antipsychotics during the COVID-19 pandemic illustrates how potentially misleading outcomes of some such studies may adversely affect clinical practice. Addressing this critical topic, the study by Pintos-Rodríguez et al (2024) raises highly pertinent questions regarding the credibility of large epidemiological studies that are entirely based on data obtained from secondary EMR databases but which fail to adopt adequate methodological safeguards.…”