Association between FIASMA psychotropic medications and reduced risk of intubation or death in individuals with psychiatric disorders hospitalized for severe COVID-19: an observational multicenter study

Abstract

The acid sphingomyelinase (ASM)/ceramide system may provide a useful framework for better understanding SARS-CoV-2 infection and the repurposing of psychotropic medications functionally inhibiting the acid sphingomyelinase/ceramide system (named FIASMA psychotropic medications) against COVID-19. We examined the potential usefulness of FIASMA psychotropic medications in patients with psychiatric disorders hospitalized for severe COVID-19, in an observational multicenter study conducted at Greater Paris University hospitals. Of 545 adult inpatients, 164 (30.1%) received a FIASMA psychotropic medication upon hospital admission for COVID-19. We compared the composite endpoint of intubation or death between patients who received a psychotropic FIASMA medication at baseline and those who did not in time-to-event analyses adjusted for sociodemographic characteristics, psychiatric and other medical comorbidity, and other medications. FIASMA psychotropic medication use at baseline was significantly associated with reduced risk of intubation or death in both crude (HR = 0.42; 95%CI = 0.31-0.57; p < 0.01) and primary inverse probability weighting (IPW) (HR = 0.50; 95%CI = 0.37-0.67; p < 0.01) analyses. This association was not specific to one FIASMA psychotropic class or medication. Patients taking a FIASMA antidepressant at baseline had a significantly reduced risk of intubation or death compared with those taking a non-FIASMA antidepressant at baseline in both crude (HR = 0.57; 95%CI = 0.38-0.86; p < 0.01) and primary IPW (HR = 0.57; 95%CI = 0.37-0.87; p < 0.01) analyses. These associations remained significant in multiple sensitivity analyses. Our results show the potential importance of the ASM/ceramide system framework in COVID-19 and support the continuation of FIASMA psychotropic medications in these patients and the need of large- scale clinical trials evaluating FIASMA medications, and particularly FIASMA antidepressants, against COVID-19.

Fig. 1

Study cohort.

Fig. 2. Kaplan-Meier curves for the composite endpoint of intubation or death among patients with psychiatric disorders hospitalized for severe COVID-19, according to FIASMA psychotropic medication use at baseline.

Kaplan–Meier curves for the composite endpoint of intubation or death in the full sample crude analysis (N = 545) (A), in the full sample analysis with IPW (N = 545) (B), and in the matched analytic sample using a 1:1 ratio (N = 328) (C) among patients with psychiatric disorders hospitalized for severe COVID-19, according to FIASMA psychotropic medication use at baseline.

Fig. 3. Kaplan-Meier curves for the composite endpoint of intubation or death among patients with psychiatric disorders hospitalized for severe COVID-19 and receiving a FIASMA versus a non-FIASMA antidepressant at baseline.

Kaplan–Meier curves for the composite endpoint of intubation or death in the full sample crude analysis (N = 238) (A), in the full sample analysis with IPW (N = 238) (B), and in the matched analytic sample using a 1:1 ratio (N = 180) (C) among patients with psychiatric disorders hospitalized for severe COVID-19 and receiving a FIASMA versus a non-FIASMA antidepressant at baseline.