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Disclosures: The authors report no relevant financial disclosures.
September 22, 2021
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Antipsychotics do not increase COVID-19 mortality risk

Disclosures: The authors report no relevant financial disclosures.
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Antipsychotic treatment did not increase risk for mortality among adults with serious mental illness diagnosed with COVID-19 infection, according to study results in a research letter published in JAMA Psychiatry.

Katlyn Nemani

“We previously found that a schizophrenia spectrum disorder diagnosis is associated with near threefold increased mortality in the setting of COVID-19 infection, a finding that has been consistently replicated across studies,” Katlyn Nemani, MD, research assistant professor in the department of psychiatry at NYU Grossman School of Medicine, told Healio Psychiatry. “This increased risk has been observed after taking a comprehensive list of demographic and medical risk factors into account. We still don’t understand why.”

Possible explanations for this increased risk include adverse effects linked to medications used for treating psychiatric symptoms among this population, according to Nemani.

In the current retrospective cohort study, Nemani and colleagues aimed to determine whether antipsychotic use correlated with mortality among patients with serious mental illness who were diagnosed with COVID-19. They analyzed data of 464 patients (mean age, 53 years; 51.5% men) from this population who were included in the NYU Langone Health electronic health record system between March 3, 2020, and Feb. 17, 2021, with a preexisting diagnosis of schizophrenia, schizoaffective disorder or bipolar disorder according to ICD-10 codes. They assigned those with schizophrenia or schizoaffective disorder to the schizophrenia spectrum disorder group and hierarchically categorized those with more than one diagnosis. Antipsychotic use at COVID-19 diagnosis served as the exposure of interest.

The researchers reviewed EHRs to verify prescription accuracy. They assigned those with antipsychotic discontinuation or nonadherence to the unexposed group. Death within 60 days of COVID-19 diagnosis served as the primary endpoint. As potential confounders, the researchers assessed sociodemographic characteristics, such as patient-reported race and ethnicity, age and insurance type, as well as psychiatric diagnosis and medical comorbidities, including BMI and smoking status.

A total of 42.2% were treated with antipsychotic medication, and 8.8% died. Nemani and colleagues reported a 60-day case fatality rate among patients with a schizophrenia spectrum disorder (n = 182) of 13.7%, as well as a case fatality rate of 5.7% among patients with bipolar disorder (n = 282). Groups differed based on age, BMI, insurance type and psychiatric diagnosis, which were included in the fully adjusted model. The researchers observed no significant association between antipsychotic treatment and mortality (OR = 1; 95% CI, 0.48-2.08). However, they noted an association between schizophrenia spectrum disorder diagnosis and an approximate threefold increased risk for mortality compared with bipolar disorder (OR = 2.88; 95% CI, 1.36-6.11).

“Findings from this study should not be used to guide clinical decision making, and we cannot rule out the possibility that individual medications may be associated with harmful or protective effects,” Nemani said. “However, we continue to observe a significant increase in COVID-19 mortality associated with a diagnosis of schizophrenia and schizoaffective disorder. This underscores the importance of protective interventions for this group, including priority vaccination.”

Nemani added that further research is needed to understand what underlies increased susceptibility to severe infection among this population.