Antipsychotics Tied to Severe Respiratory Infection Risk

TOPLINE:

Antipsychotic use for schizophrenia or other psychotic disorders is associated with increased risk for severe COVID-19 or other respiratory infection and related hospitalization, a new retrospective study suggests. However, there was no link between antipsychotic use and mild infection outcomes. 

METHODOLOGY:

• Researchers analyzed data from several Danish registries on 85,083 individuals (median age, 45.8 years; 52.1% women) with a schizophrenia spectrum disorder, 30,984 of whom were exposed to antipsychotics between 2020 and 2021.
• Exposure to antipsychotics was defined in a time-varying manner and compared with nonexposure, with risk calculated for mild and severe infection outcomes related to COVID-19 and non–COVID-19 respiratory infections.
• Outcomes were adjusted for demographics, socioeconomic factors, comorbidity, and COVID-19 vaccination.
• Antipsychotics in the study included clozapine, olanzapine, aripiprazole, quetiapine, risperidone, and zuclopenthixol.

TAKEAWAY:

• Exposure to any antipsychotic was associated with a reduced risk for a positive SARS-CoV-2 test (hazard ratio [HR], 0.91; 95% CI, 0.85-0.97) but a significantly increased risk for COVID-related hospitalization (HR, 1.28; 95% CI, 1.07-1.52).
• Hospitalization risk related to COVID-19 was highest among those exposed to antipsychotics aged 70-79 years (HR, 1.68; 95% CI, 1.18-2.41]) and ≥ 80 years (HR, 1.64; 95% CI, 1.04-2.57).
• The risks for other respiratory infection-related hospitalization (HR, 1.61; 95% CI, 1.44-1.79) and death (HR, 1.61; 95 CI, 1.18-2.21) were also higher with antipsychotic use.
• No significant excess risk was observed with exposure to clozapine compared with other antipsychotics.

IN PRACTICE:

“It seems reasonable to initiate infection countermeasures such as pneumococcal vaccination in people older than 40 years with schizophrenia spectrum disorders who commence or are treated with antipsychotics. We do not suggest the avoidance of specific antipsychotics but rather adherence to treatment guidelines and a call for increased vigilance regarding this at-risk group,” the authors wrote.

SOURCE:

The study was led by Vardan Nersesjan, MD, Copenhagen Research Center for Biological and Precision Psychiatry, Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark. It was published online on September 3, 2024, in Lancet Psychiatry.

LIMITATIONS:

The results should be interpreted cautiously as the number of events related to mortality outcomes was low in the effect modification analysis of COVID-19 vaccination. The underlying severity of the schizophrenia spectrum disorder can increase the risk of commencing antipsychotic treatment, introducing confounding by indication. Using the defined daily dose for calculating the antipsychotic treatment periods was a crude measure of exposure duration as individual daily dosages may vary. Antipsychotic medication is available free of charge to newly diagnosed patients for the first 2 years, which is not registered by the National Prescription Registry, potentially resulting in exposure misclassification.

DISCLOSURES:

The study was supported by the Mental Health Services of the Capital Region of Denmark. The authors disclosed no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.