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Clin Drug Investig . Observational Study of Chlorpromazine in Hospitalized Patients with COVID-19

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  • Clin Drug Investig . Observational Study of Chlorpromazine in Hospitalized Patients with COVID-19

    Clin Drug Investig

    . 2021 Feb 9.
    doi: 10.1007/s40261-021-01001-0. Online ahead of print.
    Observational Study of Chlorpromazine in Hospitalized Patients with COVID-19

    Nicolas Hoertel 1 2 3 , Marina S?nchez-Rico 4 5 , Rapha?l Vernet 6 , Anne-Sophie Jannot 3 6 7 , Antoine Neuraz 7 8 , Carlos Blanco 9 , C?dric Lemogne 1 2 3 , Guillaume Airagnes 1 2 3 , Nicolas Paris 10 11 , Christel Daniel 10 12 , Alexandre Gramfort 13 , Guillaume Lemaitre 13 , M?lodie Bernaux 14 , Ali Bellamine 15 , Nathana?l Beeker 15 , Fr?d?ric Limosin 1 2 3 , AP-HP/Universities/INSERM COVID-19 Research Collaboration and AP-HP COVID CDR Initiative

    Collaborators, Affiliations


    Introduction: Chlorpromazine has been suggested as being potentially useful in patients with coronavirus disease 2019 (COVID-19) on the grounds of its potential antiviral and anti-inflammatory effects.
    Objective: The aim of this study was to examine the association between chlorpromazine use and mortality among adult patients hospitalized for COVID-19.
    Methods: We conducted an observational, multicenter, retrospective study at Assistance Publique-H?pitaux de Paris (AP-HP) Greater Paris University hospitals. Study baseline was defined as the date of first prescription of chlorpromazine during hospitalization for COVID-19. The primary endpoint was death. Among patients who had not been hospitalized in intensive care units (ICUs), we compared this endpoint between those who received chlorpromazine and those who did not, in time-to-event analyses adjusted for patient characteristics, clinical markers of disease severity, and other psychotropic medications. The primary analysis used a Cox regression model with inverse probability weighting. Multiple sensitivity analyses were performed.
    Results: Of the 14,340 adult inpatients hospitalized outside ICUs for COVID-19, 55 patients (0.4%) received chlorpromazine. Over a mean follow-up of 14.3 days (standard deviation [SD] 18.2), death occurred in 13 patients (23.6%) who received chlorpromazine and 1289 patients (9.0%) who did not. In the primary analysis, there was no significant association between chlorpromazine use and mortality (hazard ratio [HR] 2.01, 95% confidence interval [CI] 0.75-5.40; p = 0.163). Sensitivity analyses included a Cox regression in a 1:5 ratio matched analytic sample that showed a similar result (HR 1.67, 95% CI 0.91-3.06; p = 0.100) and a multivariable Cox regression that indicated a significant positive association (HR 3.10, 95% CI 1.31-7.34; p = 0.010).
    Conclusion: Our results suggest that chlorpromazine prescribed at a mean daily dose of 70.8 mg (SD 65.3) was not associated with reduced mortality.