Following coronavirus (COVID-19) infection, many people experienced long COVID (also known as post COVID) which is a new emerging condition with no specific clinical treatment guideline and agreed definition that requires further study. Many people with adverse drug events(ADRs), the unintended response to the medication, may be facing long COVID following coronavirus infection. As ADRs have become a significant problem in the primary care setting in the UK, it significantly raises healthcare costs and frequently results in hospital admissions, leads to intensive care unit requirement and death. Recent study has shown that COVID-19 patients with penicillin allergy labelled had more risk of worsening clinical outcomes compared to COVID-19 patients without penicillin allergy. However, no evidence investigated if patients with ADRs will be more likely to develop long COVID after coronavirus infection than patients without ADR.
The purpose of this study is 1) to summarise the characteristics of long COVID symptoms among ADR patients 2) to evaluate whether ADR increases the risk of developing long COVID among coronavirus infection patients 3) to investigate the increased risk of long COVID among penicillin allergy labelled patients/patients with ADRs from COVID vaccine 4) to investigate the risk of subsequent clinical outcomes after long COVID among ADR patients 5) to investigate the risk of subsequent clinical outcomes after long COVID among penicillin allergy labelled patients/patients with ADRs from COVID vaccine.
This research will provide evidence to support clinical practice and to raise awareness of developing a clinical guideline and managing long COVID in ADR patients.
Approximately 3.3% of UK population experienced long COVID after SARS-CoV-2 infection(5), and more research is needed to seek the best way of managing long COVID. In the UK primary care setting, adverse drug reactions (ADRs) have become a significant problem.(7) A recent study has shown that COVID-19 patients with penicillin allergy labelled had a high risk of worsening clinical outcomes compared to those without penicillin allergy(6). Nonetheless, there is a lack of studies on the impacts of ADRs on the risk of long COVID at population level.
The purpose of this study is 1.) to evaluate whether ADR increases the risk of developing long COVID among coronavirus infection patients 2.) to investigate the risk of subsequent cardiovascular outcomes after long COVID including hospitalisation, nonfatal stroke, nonfatal infarction, and cardiovascular death.
We will conduct a cohort study using data from CPRD GOLD and Aurum linked with HES APC, HES A&E data and ONS. The study population will be individuals with a confirmed positive SARS-CoV-2 infection while the exposure group will be ADR patients (individuals who had at least one valid Read code for ADR before SARS-CoV-2 infection in the medical file). The control group will be non-ADR individuals with a confirmed positive SARS-CoV-2 infection. Logistic regression will be used to assess whether the risk of long COVID is increased among patients with ADR compared to non-ADR. We will detect the mediating role of long COVID on the associations between COVID patients with ADR and subsequent cardiovascular outcomes by using mediation analysis. We will do the pre-specified subgroup analysis in penicillin allergy labelled patients who had a record of penicillin allergy in medical file using Read Codes which we will repeat the same analysis as objectives 1 and 2. Moreover, we will adjust for the potential confounding by using the propensity-scores-based approach.
1.) Long COVID
2.) Subsequent clinical outcomes after long COVID including any hospitalisation, the 3-point major adverse cardiovascular events (MACE) including nonfatal stroke, nonfatal infarction and cardiovascular death (Code lists for MACE outcome are presented in Appendix 1.)
Li Wei - Chief Investigator - University College London ( UCL )
Ubonphan Chaichana - Corresponding Applicant - University College London ( UCL )
Kenneth Man - Collaborator - University College London ( UCL )
HES Accident and Emergency;HES Admitted Patient Care;ONS Death Registration Data;Practice Level Index of Multiple Deprivation