The impact of the COVID-19 pandemic lockdown measures on the prescribing trends and utilization of opioids in the English primary care setting: segmented-liner regression analysis.

BACKGROUND: The COVID-19 lockdown has resulted in limited access to most of the conventional chronic pain management services. Subsequently, changes in opioids' utilization could be expected. This study assessed the impact of the first COVID-19 lockdown on opioid utilization using aggregated-level, community dispensing dataset covering the whole English population. RESEARCH DESIGN AND METHODS: A segmented-linear regression analysis was applied to monthly dispensed opioid prescriptions from March 2019 to March 2021. Opioid utilization was measured using the number of opioids' items dispensed/1000 inhabitants and Defined Daily Dose (DDD)/1000 inhabitants/day during 12-months pre/post the lockdown in March 2020 stratified by strong and weak opioids. RESULTS: For all opioids' classes, there were nonsignificant changes in the number of opioids' items dispensed/1000 inhabitants trend pre-lockdown, small increases in their level immediately post-lockdown, and a non-significant decline in the trend post-lockdown. Similarly, a non-significant reduction in the DDD/1000 inhabitant/day baseline trend pre-lockdown, nonsignificant immediate increases in the level post-lockdown, and declines in the trend post-lockdown for all opioids' classes were observed. CONCLUSION: Unexpectedly, opioid utilization does not appear to have been significantly affected by the lockdown measures during the study period. However, patient-level data is needed to determine more accurate estimates of any changes in the opioid prescribing including incident prescribing/use.

Randomized controlled trial of favipiravir, hydroxychloroquine, and standard care in patients with mild/moderate COVID-19 disease.

Favipiravir has antiviral activity against influenza, West Nile virus, and yellow fever virus and against flaviviruses. The objective of this pilot study was to compare three arms: favipiravir; hydroxychloroquine; standard care (no specific SARS-CoV-2 treatment) only, in symptomatic patients infected by SARS-CoV-2 in an open-labelled randomized clinical trial. The trial was registered with Bahrain National Taskforce for Combatting COVID-19 on the 7th of May 2020 (registration code: NCT04387760). 150 symptomatic patients with COVID-19 disease were randomized into one of three arms: favipiravir, hydroxychloroquine, or standard care only. The primary outcome was the clinical scale at the end of study follow up (day 14 or on discharge/death) based on a points scale. The secondary outcomes were viral clearance, biochemical parameter changes and mortality at 30-days. Baseline characteristics did not differ between groups. The proportion of patients who achieved a clinical scale < 2 did not differ between groups. The favipiravir-treated and hydroxychloroquine-treated group showed increased viral clearance (OR, 95%CI 2.38, 0.83-6.78, OR, 95%CI 2.15, 0.78-5.92, respectively) compared to standard care, but this was not significant. The biochemical profile did not differ between groups, except for the platelet count (P < 0.03) and uric acid (P < 0.004) that were higher with favipiravir-treatment. Primary or secondary outcome measures did not differ between favipiravir, hydroxychloroquine, and standard therapy for mild to moderate COVID-19 disease; therefore, whilst favipiravir therapy appeared safe with a trend to increased viral clearance, there was no superior therapeutic utility.Clinical trials registration. NCT04387760. Registration date: 07/05/2020.