Adults who are hospitalized with serious mental illness (SMI) and taking second-generation antipsychotics may be at lower risk of COVID-19 infection than those who do not take these medications, suggests a report in JAMA Network Open. In contrast, mood stabilizers may increase the risk of infection in this population.
“[T]o our knowledge, this is the largest study to systematically assess associations between the use of individual medications and the risk of COVID-19 infection among inpatients with serious mental illness,” wrote Katlyn Nemani, M.D., of the Nathan S. Kline Institute for Psychiatric Research in New York and colleagues.
Nemani and colleagues analyzed electronic health record data of adults aged 18 or older with serious mental illness who were treated at 18 psychiatric hospitals operated by the New York State Office of Mental Health. Beginning in March 2020, these hospitals started testing patients for COVID-19 and tracking their clinical status (for example, transfers to other facilities for COVID-19 treatment and COVID-19–related deaths).
The researchers focused specifically on 1,958 adults (average age 51.4 years) with schizophrenia, schizoaffective disorder, bipolar I disorder, or depression with psychotic features who were tested for COVID-19 and were continuously hospitalized from March 8, 2020, until medical discharge for COVID-19 or July 1, 2020. Patients were considered to have been exposed to a medication if it was prescribed before their COVID-19 test, used for at least seven days, and was administered on a schedule (as-needed medications were not considered for the analysis).
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 authors noted. The patients prescribed second-generation antipsychotics (for example, olanzapine, clozapine, risperidone, aripiprazole, quetiapine, or paliperidone) were 38% less likely to test positive for COVID-19 than those not prescribed second-generation antipsychotics. In contrast, patients prescribed mood stabilizers (for example, valproic acid, lithium, or lamotrigine) were 23% more likely to test positive for COVID-19 than those who were not prescribed these medications.
After controlling for such characteristics as age, sex, medical risk factors, and exposure to other medications, the researchers found that the use of paliperidone remained significantly associated with decreased risk of infection (41% less likely) whereas use of valproic acid remained significantly associated with increased risk of infection (39% more likely). Clozapine was the only medication associated with decreased odds of mortality; however, this association did not remain statistically significant after adjusting for age, sex, and medical risk factors.
“Considering that antipsychotic drug classes notably differ in terms of adverse effect profiles and drug-drug interactions, this finding suggests that clinical surveillance may identify a major factor associated with the minimization of the potential adverse effects or drug-drug interactions,” wrote Benedetta Vai, Ph.D., and Mario Gennaro Mazza, M.D., both of IRCCS San Raffaele Scientific Institute, Milan, Italy, in an accompanying commentary. “Future studies considering outpatient clinical settings, as well as prospective cohort designs, are needed to confirm the potential protective role played by antipsychotics with regard to the risk of COVID-19 infection or the association of the use of antipsychotics with the risk of mortality, as well as the detrimental effect of valproic acid use.”
For related information, see the Psychiatric News article “Antidepressants May Reduce Severity of COVID-19.”
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