Journal Article

Observational Study of Chlorpromazine in Hospitalized Patients with COVID-19

Vernet, Raphaël, Beeker, Nathanaël, Hoertel, Nicolas, Paris, Nicolas, Blanco, Carlos, Lemaitre, Guillaume, Bernaux, Mélodie, Sánchez-Rico, Marina, Limosin, Frédéric, Gramfort, Alexandre, Airagnes, Guillaume, Bellamine, Ali, Lemogne, Cédric, Jannot, Anne-Sophie, Neuraz, Antoine, Daniel, Christel

2021

Overview

Introduction Chlorpromazine has been suggested as being potentially useful in patients with coronavirus disease 2019 (COVID-19) on the grounds of its potential antiviral and anti-inflammatory effects. Objective The aim of this study was to examine the association between chlorpromazine use and mortality among adult patients hospitalized for COVID-19. Methods We conducted an observational, multicenter, retrospective study at Assistance Publique-Hôpitaux de Paris (AP-HP) Greater Paris University hospitals. Study baseline was defined as the date of first prescription of chlorpromazine during hospitalization for COVID-19. The primary endpoint was death. Among patients who had not been hospitalized in intensive care units (ICUs), we compared this endpoint between those who received chlorpromazine and those who did not, in time-to-event analyses adjusted for patient characteristics, clinical markers of disease severity, and other psychotropic medications. The primary analysis used a Cox regression model with inverse probability weighting. Multiple sensitivity analyses were performed. Results Of the 14,340 adult inpatients hospitalized outside ICUs for COVID-19, 55 patients (0.4%) received chlorpromazine. Over a mean follow-up of 14.3 days (standard deviation [SD] 18.2), death occurred in 13 patients (23.6%) who received chlorpromazine and 1289 patients (9.0%) who did not. In the primary analysis, there was no significant association between chlorpromazine use and mortality (hazard ratio [HR] 2.01, 95% confidence interval [CI] 0.75–5.40; p  = 0.163). Sensitivity analyses included a Cox regression in a 1:5 ratio matched analytic sample that showed a similar result (HR 1.67, 95% CI 0.91–3.06; p  = 0.100) and a multivariable Cox regression that indicated a significant positive association (HR 3.10, 95% CI 1.31–7.34; p  = 0.010). Conclusion Our results suggest that chlorpromazine prescribed at a mean daily dose of 70.8 mg (SD 65.3) was not associated with reduced mortality.

• Publisher: Springer International Publishing,Springer Nature B.V,Springer Verlag
• Subject: Antiviral drugs / Asthma / Child / Clinical trials / Coronaviruses / COVID-19 / COVID-19 Drug Treatment / Delirium / Disease / Disease Progression / Drug administration / Female / Hospitalization / Hospitals / Human health and pathology / Humans / Intensive care / Internal Medicine / Life Sciences / Male / Medicine / Medicine & Public Health / Middle Aged / Mortality / Observational studies / Original Research Article / Patients / Pharmacology/Toxicology / Pharmacotherapy / Proportional Hazards Models / Pulmonary Disease, Chronic Obstructive / Respiratory diseases / Retrospective Studies / SARS-CoV-2 / Severe acute respiratory syndrome coronavirus 2 / Severity of Illness Index / Tumor necrosis factor-TNF / Young Adult