Polypharmacy, certain medication classes seem to worsen COVID-19 outcomes

Abstract

Pharmacists are well aware that polypharmacy is a major issue among patients, especially older adults. Recent studies have estimated that approximately 36% of older adults take at least 5 prescription medications, and 67% take 5 or more medications or supplements, including OTCs. But what do clinicians know about polypharmacy and clinical outcomes for COVID-19? Researchers conducted a study, published in JAPhA, to find out. “The key message is that polypharmacy, as well as certain medication classes, has a negative impact on COVID-19 outcomes,” said lead author Sorochi Iloanusi, BPharm, a doctoral candidate in the Department of Pharmaceutical Health Outcomes and Policy at the University of Houston. Examining the available literature from all over the world through an electronic database search, the research team found that 5 out of 7 included studies published between November 2019 and September 2020 connected polypharmacy and negative clinical outcomes among COVID-19 patients. From the sample size, 10,519 patients were COVID-19–positive and 4,818 COVID-19–positive patients were labeled as having experienced polypharmacy. Antipsychotics, non-tricyclic antidepressants, opioid analgesics, and drugs for peptic ulcer and gastroesophageal reflux disease were among the drug classes associated with adverse clinical outcomes for patients with COVID-19. In addition to polypharmacy being associated with an increased risk of contracting COVID-19, polypharmacy was linked with death among male COVID-19 patients, an increased rate of acute kidney injury, and adverse drug reactions, according to the findings. “I would say that the most surprising finding for me during this systematic review was that men and women’s risk profile for adverse COVID-19 outcomes associated with certain drug classes were slightly different,” said Iloanusi. Although non-cardiovascular polypharmacy was associated with adverse COVID-19 outcomes, Iloanusi said cardiovascular polypharmacy showed no such association. She said readers should interpret the findings cautiously, since the studies included in the review were observational in nature and did not control for comorbidities, which is a strong cofounder for polypharmacy. The adverse impact of polypharmacy on various diseases such as pneumonia and influenza is well-documented. “Our findings are consistent with already existing evidence on other diseases,” said Iloanusi. In the research paper, the study authors also point to the high prevalence of polypharmacy in long-term care facilities, noting one systematic review that reported polypharmacy in roughly 91% of patients. “In addition, vulnerable groups, especially older persons, are disproportionately affected by severe COVID-19 infection, as evidenced in the ravaging effect of the disease in [long-term care] facilities and among community-dwelling of older adults worldwide,” the authors write. Iloanusi said their study findings support deprescribing and medication optimization for COVID-19 patients to improve their health outcomes. Pharmacists are taught deprescribing skills as part of comprehensive medication management and review. According to a 2015 JAMA Internal Medicine article, deprescribing is the process of tapering or stopping drugs, aimed at minimizing polypharmacy and improving patient outcomes. A proposed deprescribing protocol is comprised of 5 steps: 1.Ascertain all drugs the patient is currently taking and the reasons for each one,2.Consider overall risk of drug-induced harm in individual patients in determining the required intensity of deprescribing intervention,3.Assess each drug in regard to its current or future benefit potential compared with current or future harm or burden potential,4.Prioritize drugs for discontinuation that have the lowest benefit-harm ratio and lowest likelihood of adverse withdrawal reactions or disease rebound syndromes, and5.Implement a discontinuation regimen and monitor patients closely for improvement in outcomes or onset of adverse effects. Deprescribing should be a shared decision-making process between patient and provider, and it needs to be communicated with other providers caring for the patient. The authors note in the review that it might be wise to incorporate deprescribing early on in the management of patients with COVID-19 to prevent further exacerbation of the disease. “Because increasing level of polypharmacy has been found to increase the risk of getting infected with COVID-19, prophylactically optimizing medication regimens for older adults and individuals with multimorbid conditions might help to lower their risk of getting infected with COVID-19,” study authors write.