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. 2021 May:167:105534.
doi: 10.1016/j.phrs.2021.105534. Epub 2021 Mar 4.

Associations between COVID-19 and 30-day thromboembolic events and mortality in people with dementia receiving antipsychotic medications

Stephanie L Harrison  1 , Benjamin J R Buckley  2 , Deirdre A Lane  3 , Paula Underhill  4 , Gregory Y H Lip  3
Affiliations

Associations between COVID-19 and 30-day thromboembolic events and mortality in people with dementia receiving antipsychotic medications

Stephanie L Harrison et al. Pharmacol Res. 2021 May.

Abstract

Background: Antipsychotic medications are frequently prescribed to people with dementia to manage behavioural and psychological symptoms. Using a global federated research network, the objectives were to determine: 1) if COVID-19 is associated with 30-day thromboembolic events and mortality for people with dementia receiving antipsychotic medications; and 2) if the proportion of people with dementia receiving antipsychotics is higher during the COVID-19 pandemic compared to 2019.

Methods: A retrospective cohort study was conducted using TriNetX, a global federated health research network. The network was searched for people aged ≥ 65 years with dementia, COVID-19 and use of antipsychotics in the 30-days prior to COVID-19 recorded in electronic medical records between 20/01/2020 and 05/12/2020. These individuals were compared to historical controls from 2019 with dementia and use of antipsychotics in the 30-days before a visit to a participating healthcare organisation. Propensity score matching for age, sex, race, co-morbidities and use of antidepressants and anticonvulsants was used to balance cohorts with and without COVID-19.

Results: Within the TriNetX network, 8414 individuals with COVID-19, dementia and use of antipsychotics and 31,963 historical controls were identified. After propensity score matching there were 8396 individuals with COVID-19 and 8396 historical controls. The cohorts were well balanced for age, sex, race, co-morbidities and use of antidepressants and anticonvulsants. The odds of 30-day thromboembolic events and all-cause mortality were significantly higher in adults with COVID-19 (Odds Ratios: 1.36 (95% confidence interval (CI): 1.21-1.52) and 1.93 (1.71-2.17), respectively). The number of people with dementia with a visit to a participating healthcare organisation was lower between 20/01/2020 and 05/12/2020 (n = 165,447) compared to the same period in 2019 (n = 217,391), but the proportion receiving antipsychotics increased from 14.7% (95%CI: 14.6-14.9%) to 16.4% (95%CI: 16.2-16.5%), P < .0001.

Conclusions: These findings add to the evidence base that during the COVID-19 pandemic there was an increase in the proportion of people with dementia receiving antipsychotics. The negative effects of antipsychotics in patients with dementia may be compounded by concomitant COVID-19.

Keywords: Alzheimer’s disease; Antipsychotics; COVID-19; Dementia; Mortality.

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Conflict of interest statement

Stephanie Harrison has received funding from Bristol Myers Squibb (BMS). Benjamin JR Buckley has received funding from BMS/Pfizer. Deirdre A Lane has received investigator-initiated educational grants from BMS, has been a speaker for Boehringer Ingeheim, and BMS/Pfizer and has consulted for BMS, Boehringer Ingelheim, and Daiichi-Sankyo. Paula Underhill is an employee of TriNetX LLC. Gregory Lip: consultant for Bayer/Janssen, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon and Daiichi-Sankyo and speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo. No fees are directly received to Gregory Lip personally.

Figures

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Graphical abstract
Fig. 1
Fig. 1
Kaplan-Meier curve of thromboembolic events for people with dementia, COVID-19 and use of antipsychotics compared to historical controls.
Fig. 2
Fig. 2
Kaplan-Meier curve of all-cause mortality for people with dementia, COVID-19 and use of antipsychotics compared to historical controls.
See this image and copyright information in PMC

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