Clozapine Is Associated With Higher COVID-19 Infection Rate in Veterans With Schizophrenia or Schizoaffective Disorder

Okusaga, Olaoluwa; Mitchell, B. Greg; Bernard, Jared D.; Walder, Annette

doi:10.4088/jcp.21br14028

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…In fact, unadjusted estimates suggested a significant protective association. This finding stands in contrast to prior EHR studies that found an increased risk of COVID-19 infection associated with clozapine treatment 28 , 29 but is consistent with a prior study limited to inpatients that found a lower risk of infection and a lower risk of symptomatic disease in association with clozapine use. 30 One potential explanation for this discrepancy is surveillance bias because patients receiving clozapine in the general community may be more likely than other outpatients to undergo testing for COVID-19.…”

Section: Discussionsupporting

confidence: 85%

Association Between the Use of Psychotropic Medications and the Risk of COVID-19 Infection Among Long-term Inpatients With Serious Mental Illness in a New York State–wide Psychiatric Hospital System

et al. 2022

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Key Points Question Is psychotropic medication use associated with differences in the risk of COVID-19 infection among adults with serious mental illness? Findings In this cohort study of 1958 inpatients with serious mental illness in a statewide psychiatric hospital system, the use of second-generation antipsychotic medications was associated with a decreased risk of COVID-19 infection; the largest association was observed with the use of paliperidone. Valproic acid use was associated with an increased risk of infection. Meaning These results suggest that individual psychotropic medications are associated with differential risks of COVID-19 infection among patients with serious mental illness.

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Section: Discussionsupporting

confidence: 85%

Association Between the Use of Psychotropic Medications and the Risk of COVID-19 Infection Among Long-term Inpatients With Serious Mental Illness in a New York State–wide Psychiatric Hospital System

et al. 2022

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“…Although factors associated with increased risk of contracting and dying from COVID-19 in the general population (e.g., unvaccinated status, older adult status, obesity, and pre-existing medical illnesses) [14][15][16] are likely to be relevant in patients with schizophrenia, other illness-specific factors might also elevate the risk of CO-VID-19 in patients. For example, patients with schizophrenia spectrum disorders who are treated with clozapine (an antipsychotic medication approved for treatment-resistant psychosis) have a higher risk of contracting COVID-19 than patients without a documented history of treatment with clozapine [17,18]. Therefore, given that schizophrenia may be more prevalent among veterans [3,4] and suicide attempts are relatively common in patients with schizophrenia (lifetime risk of 26.8% [19]) we sought to determine whether a history of suicide attempt in US veterans diagnosed with schizophrenia or schizoaffective disorder is positively associated with CO-VID-19 positivity.…”

Section: Introductionmentioning

confidence: 99%

History of Suicide Attempts and COVID-19 Infection in Veterans with Schizophrenia or Schizoaffective Disorder: Moderating Effects of Age and Body Mass Index

et al. 2021

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Introduction: Relative to the general population, patients with schizophrenia or schizoaffective disorder have higher rates of suicide attempts and mortality from COVID-19 infection. Therefore, determining whether a history of suicide attempt is associated with COVID-19 in patients with schizophrenia or schizoaffective disorder has implications for COVID-19 vulnerability stratification in this patient population. Methods: We carried out cross-sectional analyses of electronic health records (EHR) of veterans with a diagnosis of schizophrenia or schizoaffective disorder that received treatment at any United States Veterans Affairs Medical Center between January 1, 2020 to January 31, 2021. We used logistic regression to estimate unadjusted and adjusted (including age, sex, race, marital status, body mass index (BMI), and a medical comorbidity score) odds ratios (ORs) for COVID-19 positivity in suicide attempters relative to non-attempters. Results: A total of 101,032 Veterans [mean age 56.67 ± 13.13 years; males 91,715 (90.8%)] were included in the analyses. There were 2,703 (2.7%) suicide attempters and 719 (0.7%) patients were positive for COVID-19. The association between history of suicide attempt and COVID-19 positivity was modified by age and BMI, such that the relationship was only significant in patients younger than 59 years, and in obese (BMI ≥ 30) patients (adjusted OR 3.42, 95% CI 2.02 - 5.79 and OR 2.85, 95% CI 1.65 - 4.94, respectively). Conclusions: Higher rates of COVID-19 in young or obese suicide attempters with a diagnosis of schizophrenia or schizoaffective disorder might be due to elevated risk for the infection in this sub-group of patients.

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“…Few cases have been reported globally in patients with mental disorders who received significantly elevated clozapine concentrations after COVID-19 ( 8 – 10 ). Additionally, studies have demonstrated that antipsychotics may exacerbate COVID-19 symptoms, which are mainly related to clozapine-induced granulocytopenia, a side effect of the drug ( 11 , 12 ). Therefore, concentration control should be performed with caution.…”

Section: Introductionmentioning

confidence: 99%

Increased antipsychotic drug concentration in hospitalized patients with mental disorders following COVID-19 infection: a call for attention

Yang,

Wan,

et al. 2024

Front. Psychiatry

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PurposeExamine the alterations in antipsychotic concentrations following coronavirus disease-2019 (COVID-19) infection among hospitalized patients with mental disorders and conduct an analysis of the factors influencing these changes.MethodsData were collected from inpatients at Beijing Huilongguan Hospital between December 12, 2022, and January 11, 2023, pre- and post-COVID-19. Based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, 329 inpatients with mental disorders were included (3 with incomplete data excluded). Primary outcomes assessed changes in antipsychotic concentrations pre- and post-COVID-19, while secondary outcomes examined factors linked to concentration increases and antipsychotic dose adjustments.ResultsClozapine (P < 0.001), aripiprazole (P < 0.001), quetiapine (P = 0.005), olanzapine (P < 0.001), risperidone (P < 0.001), and paliperidone (P < 0.001) concentrations increased post-COVID-19 in patients with mental disorders. Notably, clozapine concentration surpassing pre-infection levels was highest. Clozapine users were more likely to adjust their dose (50.4%) compared to olanzapine (17.5%) and other antipsychotics. Moreover, traditional Chinese patent medicines and antibiotics during COVID-19 infection were associated with antipsychotic reduction or withdrawal (OR = 2.06, P = 0.0247; OR = 7.53, P = 0.0024, respectively).ConclusionAntipsychotic concentrations in hospitalized patients with mental disorders increased after COVID-19 infection, that may be related not only to COVID-19, but also to the use of Chinese patent medicines during infection. The pre-infection concentration and types of antipsychotics, patient’s gender, and combination of traditional Chinese medicine or antibiotics, were factors found to correlate with increased drug concentrations and necessitate dose adjustments.

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Clozapine Is Associated With Higher COVID-19 Infection Rate in Veterans With Schizophrenia or Schizoaffective Disorder

Cited by 4 publications

References 5 publications

Association Between the Use of Psychotropic Medications and the Risk of COVID-19 Infection Among Long-term Inpatients With Serious Mental Illness in a New York State–wide Psychiatric Hospital System

Association Between the Use of Psychotropic Medications and the Risk of COVID-19 Infection Among Long-term Inpatients With Serious Mental Illness in a New York State–wide Psychiatric Hospital System

History of Suicide Attempts and COVID-19 Infection in Veterans with Schizophrenia or Schizoaffective Disorder: Moderating Effects of Age and Body Mass Index

Increased antipsychotic drug concentration in hospitalized patients with mental disorders following COVID-19 infection: a call for attention

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