ABSTRACT
Background: The COVID-19 epidemic has disrupted care and access to care in many ways. It was accompanied by an excess of cardiovascular drug treatment discontinuations. We sought to investigate a deeper potential impact of the COVID-19 epidemic on antihypertensive drug treatment disruptions by assessing whether the epidemic induced some changes in the characteristics of disruptions in terms of duration, treatment outcome, and patient characteristics. Methods: From March 2018 to February 2021, a repeated cohort analysis was performed using French national health insurance databases. The impact of the epidemic on treatment discontinuations and resumption of antihypertensive medications was assessed using preformed interrupted time series analyses either on a quarterly basis. Results: Among all adult patients on antihypertensive medication, we identified 2,318,844 (18.7%) who discontinued their antihypertensive treatment during the first blocking period in France. No differences were observed between periods in the characteristics of patients who interrupted their treatment or in the duration of treatment disruptions. The COVID-19 epidemic was not accompanied by a change in the proportion of patients who fully resumed treatment after a disruption, neither in level nor in trend/slope [change in level: 2.66 (-0.11; 5.42); change in slope: -0.67 (-1.54; 0.20)]. Results were similar for the proportion of patients who permanently discontinued treatment within 1 year of disruption [level change: -0.21 (-2.08; 1.65); slope change: 0.24 (-0.40; 0.87)]. Conclusion: This study showed that, although it led to an increase in cardiovascular drug disruptions, the COVID-19 epidemic did not change the characteristics of these. First, disruptions were not prolonged, and post-disruption treatment outcomes remained unchanged. Second, patients who experienced antihypertensive drug disruptions during the COVID-19 outbreak were essentially similar to those who experienced disruptions before it.
ABSTRACT
Contexte L'étude de l'incidence des hospitalisations survenues dans un contexte d'usage de substance psycho-active (SPA) pendant la pandémie de COVID-19 apparaît comme une opportunité unique d'évaluer le poids habituel de l'usage récréatif sur ces hospitalisations. Cette étude avait pour objectif d'évaluer l'impact des confinements sur l'incidence de ces hospitalisations en France selon l'âge des patients, puis de décrire leurs caractéristiques et les SPA impliquées. Méthode Cette étude nationale a été réalisée sur les données de la base nationale ATIH du Programme de médicalisation des systèmes d'information entre le 1er janvier 2014 et le 31 décembre 2020. Une analyse de série chronologique a été réalisée chez les adultes âgés ≥ 30 ans et les jeunes adultes âgés. Résultats Parmi les 1 358 007 séjours inclus, 215 430 étaient des jeunes adultes et 1 142 577 des adultes âgés de plus de 30 ans. Les deux confinements étaient associés à une forte diminution du nombre de séjours associés à une consommation de SPA, en particulier chez les moins de 30 ans avec une baisse maximale de −39 % pendant le 1er confinement (1566 vs. 2 576 ;IC95 % : 2285–2868), contre −20 % chez les plus de 30 ans. La plus importante baisse des séjours concernait la région Nouvelle Aquitaine pendant le 1er confinement (301 vs. 175). Chez les adultes jeunes et par rapport aux plus de 30 ans, on observait une forte baisse de l'implication de l'alcool tout au long de la pandémie et particulièrement pendant le 2eme confinement, tandis que les benzodiazépines étaient très impliquées pendant le 1er confinement (23,4 et 17,4/7 jours 1000 patients hospitalisés dans un contexte d'usage de SPA, respectivement) et le 2e confinement (39,1 et 26,3, respectivement). Le cannabis était beaucoup plus impliqué chez les moins de 30 ans tout au long de la pandémie. Conclusion Les confinements ont réduit l'usage récréatif des SPA et les hospitalisations associées chez les jeunes adultes. L'usage récréatif pourrait être un important levier de prévention.
ABSTRACT
Since pandemic start, patients may have faced difficulties in accessing to care and treatment. This study aimed at assessing the impact of COVID-19 pandemic and its control measures on the use of drugs indicated in cardiovascular prevention and diabetes mellitus in France. From 09/17/2018 to 09/20/2020, a repeated cohort analysis was performed using the French nationwide health insurance databases. The pandemic impact was assessed using time-series analyses and unobserved components model for the weekly number of patients with (i) drug dispensing, (ii) ongoing treatment, (iii) treatment initiation, (iv) treatment disruption. Overall, 14,822,132 patients with cardiovascular drug dispensings and 3,231,618 with antidiabetic ones were identified. After a sharp spike in the amount of dispensings in the week the first national lockdown was announced, the period was marked by decreased levels and trends. Altogether, the estimated impact of the pandemic on dispensings appeared limited over the lockdown period (1-3% lack in dispensings). During lockdown, the weekly numbers of treatment disruptions remained stable whereas a significant decrease in treatment initiations was observed for almost all drug classes (e.g. ß-blockers initiations: - 8.9%). Conversely, the post-lockdown period showed increases in treatment disruptions especially for antihypertensive and lipid lowering drugs (e.g. statins disruptions: + 4.9%). The pandemic and associated measures had a significant impact on cardiovascular and antidiabetic drugs use in France, mostly consisting in decreases of treatment initiations over lockdown and increases in treatment disruptions afterwards. Both could result in increased morbimortality that remains to be assessed.
Subject(s)
COVID-19 , Pandemics , Humans , Pandemics/prevention & control , COVID-19/epidemiology , Cohort Studies , Hypoglycemic Agents/therapeutic use , Communicable Disease Control , France/epidemiologyABSTRACT
The marketing authorization granted to SARS-Cov-2 vaccines was accompanied by reinforced safety monitoring plans. These plans' implementation was part of the usual logic of post-marketing surveillance of new and innovative health products. It was especially adapted to the context of post-marketing monitoring of drugs developed according to the usual scientific quality standards but in an accelerated schedule. In Europe, the reinforced surveillance system relies on the complementary strengths of pharmacovigilance and pharmacoepidemiology. If the performances of pharmacovigilance monitoring are incomparable for the detection of safety signals relating to rare events of atypical presentation, it needs to be completed with pharmacoepidemiology activities for more common events, either multifactorial or frequently classified as idiopathic. The pharmacoepidemiological monitoring developed in Europe was elaborated before the first SARS-Cov-2 vaccines where marketed, taking into account the lessons learned from the vaccination campaign against 2009 A (H1N1) influenza. It includes numerous academic studies as well as studies performed within vaccines risk management plans. In terms of safety, those defined a priori mostly concerns a list of pre-established health events of specific interest. Aside of these planned activities, ad-hoc studies will be latter developed on purpose to investigate safety signals or potential signals that could be identified as the result of pharmacovigilance activities. Aside of these regulated activities, as for today, very few studies have been published regarding SARS-Cov-2 vaccines; most of the existing consist in preprints that should be considered with caution. Pharmacoepidemiology of vaccines is thought to allow near-real time monitoring that needs sufficient time to provide with valid results. In the constant urge for information that accompanies COVID-related science, it is important not to make haste the enemy of speed and to let pharmacoepidemiology provides with what it is expected to do: rock-solid scientific information contributing to evidence-based decision-making.