Wang Huwen, Wei Yuchen, Hung Chi Tim, Jiang Xiaoting, Li Conglu, Jia Katherine Min, Leung Eman Yee Man, Yam Carrie Ho Kwan, Chow Tsz Yu, Zhao Shi, Guo Zihao, Li Kehang, Wang Ziqing, Yeoh Eng Kiong, Chong Ka Chun
School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
Lancet Reg Health West Pac. 2023 May;34:100716. doi: 10.1016/j.lanwpc.2023.100716. Epub 2023 Feb 27.
Few studies have used real-world data to evaluate the impact of antidepressant use on the risk of developing severe outcomes after SARS-CoV-2 Omicron infection.
This is a retrospective cohort study using propensity-score matching to examine the relationship between antidepressant use and COVID-19 severity. Inpatient and medication records of all adult COVID-19 patients in Hong Kong during the Omicron-predominated period were obtained. Severe clinical outcomes including intensive care unit admission and inpatient death after the first positive results of reverse transcription polymerase chain reaction as well as a composite outcome of both were studied. Cox proportional hazard models were applied to estimate the crude and adjusted hazard ratios (HR).
Of 60,903 hospitalised COVID-19 patients admitted, 40,459 were included for matching, among which 3821 (9.4%) were prescribed antidepressants. The rates of intensive care unit admission, inpatient death, and the composite event were 3.9%, 25.5%, and 28.3% respectively in the unexposed group, 1.3%, 20.0%, and 21.1% respectively in the exposed group, with adjusted HR equal to 0.332 (95% CI, 0.245-0.449), 0.868 (95% CI, 0.800-0.942), and 0.786 (95% CI, 0.727-0.850) respectively. The result was generally consistent when stratified by selective serotonin reuptake inhibitors (SSRIs) and non-SSRIs. Antidepressants with functional inhibition of acid sphingomyelinase activity, specifically fluoxetine, were also negatively associated with the outcomes. The effect of antidepressants was more apparent in female and fully vaccinated COVID-19 patients.
Antidepressant use was associated with a lower risk of severe COVID-19. The findings support the continuation of antidepressants in patients with COVID-19, and provide evidence for the treatment potential of antidepressants for severe COVID-19.
This research was supported by Health and Medical Research Fund [grant numbers COVID190105, COVID19F03, INF-CUHK-1], Collaborative Research Fund of University Grants Committee [grant numbers C4139-20G], National Natural Science Foundation of China (NSFC) [71974165], and Group Research Scheme from The Chinese University of Hong Kong.
很少有研究使用真实世界数据来评估使用抗抑郁药对感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）奥密克戎变异株后发生严重后果风险的影响。
这是一项回顾性队列研究，采用倾向得分匹配法来研究使用抗抑郁药与新型冠状病毒肺炎（COVID-19）严重程度之间的关系。获取了香港在以奥密克戎变异株为主的时期内所有成年COVID-19患者的住院和用药记录。研究了包括重症监护病房（ICU）收治情况、逆转录聚合酶链反应首次检测呈阳性后的住院死亡情况以及两者的综合结果等严重临床结局。应用Cox比例风险模型来估计粗风险比和调整后风险比（HR）。
在60903例住院的COVID-19患者中，40459例被纳入匹配分析，其中3821例（9.4%）被开具了抗抑郁药。未暴露组的ICU收治率、住院死亡率和综合事件发生率分别为3.9%、25.5%和28.3%，暴露组分别为1.3%、20.0%和21.1%，调整后的HR分别为0.332（95%置信区间[CI]，0.245 - 0.449）、0.868（95%CI，0.800 - 0.942）和0.786（95%CI，0.727 - 0.850）。按选择性5-羟色胺再摄取抑制剂（SSRI）和非SSRI进行分层时，结果总体一致。对酸性鞘磷脂酶活性有功能抑制作用的抗抑郁药，特别是氟西汀，也与这些结局呈负相关。抗抑郁药的作用在女性和完全接种疫苗的COVID-19患者中更为明显。
使用抗抑郁药与发生严重COVID-19的风险较低相关。这些发现支持COVID-19患者继续使用抗抑郁药，并为抗抑郁药治疗严重COVID-19的潜在作用提供了证据。
本研究由健康与医学研究基金[资助编号COVID190105、COVID19F03、INF-CUHK-1]、大学教育资助委员会协作研究基金[资助编号C4139-20G]、中国国家自然科学基金（NSFC）[71974165]以及香港中文大学的群组研究计划资助。
