(116) Rates of Antidepressant, Antiepileptic and Anxiolytic Prescribing Among People Living with Dementia During the COVID-19 Pandemic: A Multinational Interrupted Time-Series Analysis
PhD Student Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK, United Kingdom
Background: Psychotropic medications are often prescribed for behavioural and psychological symptoms of dementia (BPSD), despite being associated with increased risks of adverse outcomes. The COVID-19 pandemic has caused significant disruption to care routines and support for those living with dementia. A previous study has already found that antipsychotic prescribing increased during the early months of the pandemic, but the impact of the pandemic on the use of other psychotropics is unknown.
Objectives: To examine multinational trends in antidepressant, antiepileptic, and anxiolytic prescribing for people living with dementia before and during the COVID-19 pandemic.
Methods: This is a multinational interrupted time-series analysis using electronic health records and claims data from 8 databases in 6 countries: France (IQVIA France LPD), Germany (IQVIA Germany DA), Italy (IQVIA Italy LPD), South Korea (Ajou University School of Medicine and Kangwon National University), UK (IQVIA Medical Research Data UK THIN), and the US (IBM MarketScan Medicare and IQVIA Open Claims). The population was comprised of individuals aged 65 or older with a dementia diagnosis between 1 January 2016, and the last available date of each database (up to 30 November 2021). The prevalence of people living with dementia who were prescribed antidepressants, antiepileptics, and anxiolytics in each database was compared before and after the introduction of population-wide COVID-19 restrictions in April 2020. Negative binomial models were used to quantify changes in prescribing rates for each drug type, with adjustment for autocorrelation and seasonal effects.
Results: A total of 857 238 people with dementia (58% female) were identified in 2016. In US Medicare, there was an immediate increase in the prescribing rate for antidepressants (IRR 1.03; 95% CI, 1.00-1.05) following the introduction of COVID-19 restrictions. There was an immediate decrease in antiepileptic prescribing (IRR, 0.95; (0.91-0.98). There was an immediate increase in the anxiolytic prescribing rate following the imposition of COVID-19 restrictions in both US Medicare (IRR, 1.07; 95% CI, 1.03-1.12) and US Open Claims (IRR, 1.06; 95% CI, 1.04-1.08). All other databases showed no impact of COVID-19 on prescribing rates for those living with dementia.
Conclusions: While COVID-19 had no impact on antidepressant, antiepileptic, and anxiolytic prescribing rates in other countries, additional research is needed to investigate the increased use of antidepressants and anxiolytics in the US. Elsewhere, efforts to improve medication safety for those living with dementia should focus on reducing antipsychotic prescribing before other psychotropic medications.
