Subgroup Analysis Shows High COVID-19 Burden Is Associated With
Increased Adverse Drug Effect Related Mortality in The United States: A
Retrospective Cohort Study
Abstract
COVID-19 caused substantial damage for the world and more than one
million individuals succumbed to this contagious disease. During the
2020-2021 autumn-winter season, there was a huge wave of new COVID-19
infection cases in the United States (US). We intend to investigate
whether this high COVID-19 burden had a link to adverse drug reactions
in the US, thus we extracted online data from the US Food and Drug
Administration (FDA) comparing the adverse drug effect-related mortality
between two autumn-winter seasons (2020/2021 cohort 1 vs 2022/2023
cohort 2). The primary outcome is measured via multi-variable logistic
regression models which adjust age, sex, and drug indication. A second
analysis investigated the association between the high COVID-19 burden
and the adverse drug effect mortality for the 25 most reported drugs
during the two seasons. The average age is 58.87 vs 59.27 years,
respectively. In Cohort 1 54.29% are females and in Cohort 2 the
percentage is 55.32%. The crude mortality in Cohort 1 is 19.80% and in
Cohort 2 it is 20.72%. We did not find a positively significant primary
outcome and the odd ratio (OR) of high COVID-19 burden for adverse drug
effect mortality is 0.946 (95%CI 0.926-0.965, p < .0001).
However, the subgroup analysis shows for some drugs, most of which
compromise the immune response, the high COVID-19 burden is linked to
increased risk of death significantly. They include adalimumab,
clozapine, duplilumab, lendlidomide, palbocicib, pomalidomide,
rivaroxaban, tofacitib, ibrutinib, and updadacit. Our study probably
provides preliminary evidence supposing that patients suffering an
adverse drug effect involving the immune system from medications might
be at increased risk for deteriorating outcomes during the high pandemic
burden period of a serious and contagious disease. However, future
prospective studies are needed to confirm the results. We think an
adverse drug reaction mitigation strategy during future pandemics is
needed to better protect those who take these drugs.