Skip to main content
main-content

23.02.2021 | COVID-19 | Research article | Ausgabe 1/2021 Open Access

BMC Medicine 1/2021

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

Zeitschrift:
BMC Medicine > Ausgabe 1/2021
Autoren:
Paul M. McKeigue, Sharon Kennedy, Amanda Weir, Jen Bishop, Stuart J. McGurnaghan, David McAllister, Chris Robertson, Rachael Wood, Nazir Lone, Janet Murray, Thomas M. Caparrotta, Alison Smith-Palmer, David Goldberg, Jim McMenamin, Bruce Guthrie, Sharon Hutchinson, Helen M. Colhoun, on behalf of Public Health Scotland COVID-19 Health Protection Study Group
Wichtige Hinweise

Supplementary Information

The online version contains supplementary material available at (https://​doi.​org/​10.​1186/​s12916-021-01907-8).

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Abstract

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
Zusatzmaterial
Literatur
Über diesen Artikel

Weitere Artikel der Ausgabe 1/2021

BMC Medicine 1/2021 Zur Ausgabe

Coronavirus Corona-Update

Die aktuelle Entwicklung im Überblick: Nachrichten, Webinare, Übersichtsarbeiten.

Passend zum Thema

ANZEIGE

Der komplexe Weg eines Impfstoffs

Moderne Impfstoffe sind gut verträglich und ermöglichen es uns, bestimmten Infektionskrankheiten vorzubeugen. Sie können uns sogar in die Lage versetzen, einzelne Krankheitserreger auszurotten. Doch wie werden Impfstoffe eigentlich hergestellt?

ANZEIGE

Antworten auf 10 häufige Impf-Einwände

Ein Gespräch mit impfkritischen Patienten kann schnell zur Herausforderung werden.[1] Mit welchen Argumenten kann man versuchen, die Bedenken dieser Patienten abzubauen? Wir haben für Sie zusammengefasst, welche Antworten das Robert Koch-Institut (RKI) und das Paul-Ehrlich-Institut (PEI) geben.

ANZEIGE

Impfungen – vom Säugling bis zum Senior

Als eines der global führenden Gesundheitsunternehmen besitzt MSD mehr als 100 Jahre Erfahrung in der Entwicklung von Impfstoffen. Hier finden Sie Informationen zu einigen der von der STIKO empfohlenen Immunisierungen, z.B. der MMRV- und der HPV-Impfung sowie der Pneumokokken-Impfung für Senioren.

Bildnachweise