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Outpatients prescribed with fluvoxamine around the time of COVID-19 diagnosis are not at a reduced risk of unfavorable COVID-19 course compared to their non-prescribed peers: a nationwide matched cohort study
  • Vladimir Trkulja,
  • Ivan Kodvanj
Vladimir Trkulja
Department of Pharmacology, School of Medicine, University of Zagreb
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Ivan Kodvanj
Department of Pharmacology, School of Medicine, University of Zagreb
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Abstract

Aim. To assess the relationship between a fact of being prescribed fluvoxamine around the time of COVID-19 diagnosis and subsequent hospitalizations and mortality in COVID-19 outpatients. Methods. Using administrative data, we identified adult COVID-19 outpatients diagnosed up to August 15, 2021 in Croatia. Subjects prescribed fluvoxamine around the time of COVID-19 diagnosis (Group A), their peers suffering similar psychiatric difficulties but not prescribed with fluvoxamine (Group B) and those free of psychiatric difficulties/treatments (Group C) were mutually exactly matched on a range of pre-COVID covariates. We determined relative risks of COVID-19-related hospitalization, 30-day all-cause hospitaliziation and of COVID-19-related mortality. Results. Out of 416030 outpatients, 1016 were Group A subjects, 749 of whom were matched to 31336/95984 Group B subjects, while 866 were matched to 22792/275804 Group C subjects. Group B and C patients were matched 82323 to 268778. Matched A vs. B relative risks (95%CI/CrI), frequentist and Bayes with skeptical, otpimistic and pesimistic priors, were: COVID-related hospitalization 1.73 (0.56-3.33), 1.15 (0.55-2.11), 1.03 (0.56.1.96) and 1.43 (0.63-2.94), respectively; 30-day all-cause hospitalization 1.88 (0.76-4.67), 1.76 (1.39-2.25), 1.76 (1.39-2.24) and 1.86 (1.43-2.38), respectively; COVID-19 related mortality 0.73 (0.35-1.55), 0.93 (0.53-1.76), 0.79 (0.40-1.54) and 0.88 (0.37-2.11), respectively. Conslusion. COVID-19 outpatients prescribed fluvoxamine around the time of COVID-19 diagnosis were not at a reduced risk of subsequent hospitalizations and mortality compared to COVID-19 outpatients suffering similar psychiatric difficulties but not prescribed with fluvoxamine, or compared to COVID-19 outpatients free of psychiatric difficulties and related treatments