Community Use of Repurposed Drugs Before and During COVID-19 Pandemic in the Netherlands: An Interrupted Time-Series Analysis

Abstract

Background

Repurposing registered drugs could reduce coronavirus disease (COVID-19) burden before novel drugs are authorized. Little is known about how the pandemic and imposed restrictions changed their dispensing. We aimed to investigate the impact of COVID-19 pandemic on repurposed drugs dispensing in the Netherlands.

Methods

We performed interrupted time-series study using University of Groningen prescription database IADB.nl to evaluate dispensing trends of 24 repurposed drugs before (2017-February 2020) and after (March 2020–2021) the pandemic’ start. Primary outcomes were monthly prevalence and incidence rates. An autoregressive integrated moving average model assessed the effect of pandemic and stringency index (measuring strictness of government’s restriction policies).

Results

Annual number of IADB.nl population ranged from 919,697 to 952,400. Generally, dispensing of common long-term-used drugs was not significantly affected by pandemic. The prevalence of antibacterials (−4.20 users per 1000 people), antivirals (−0.04), corticosteroids (−1.29), prednisolone (−1.32), calcium channel blocker (−0.41), and diuretics (−1.29) was lower than expected after the pandemic’s start, while the prevalence of ivermectin (0.07), sulfonylureas (0.15), sodium-glucose co-transporter-2 (SGLT2) inhibitor (0.17), and anticoagulants (1.95) was higher than expected. The pandemic was associated with statistically significant decreases in the incidence of antibacterials (−1.21), corticosteroids (−0.60), prednisolone (−0.64) and anticoagulants (−0.02), and increases in ivermectin (0.02), aggregated antidiabetic drugs (0.13), and SGLT2 inhibitors (0.06). These trends were positively associated with pandemic and negatively associated with stringency index.

Conclusion

Dispensing of most drugs was not significantly associated with pandemic and government’s response. Despite some statistically significant disruptions, these were not necessarily clinically relevant due to small absolute differences observed.

Keywords:

• COVID-19
• drug utilization
• repurposed drug
• stringency index

Data Sharing Statement

Additional tables and figures supporting our findings are available in the Supplementary Material. The study protocol is available upon request by emailing the corresponding author. Informed consent was not required as no personal information was used in our article. The SQL and R code for data analysis can be shared by emailing the corresponding author.

Ethics Approval and Informed Consent

The University of Groningen IADB.nl community pharmacy dispensing database contains data that is collected in accordance with the Dutch and European guidelines on privacy requirements (GDPR) for handling human data. Approval of the medical ethics committee was not needed nor required for this study.

Acknowledgment

We are grateful to Dr. Susan Hahne from the National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM) for providing the initial concept of the stringency index and information related to the COVID-19 pandemic in the Netherlands.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

All authors declare no competing interests in this work.

Additional information

Funding

This study is funded by internal funding. GZ received a scholarship (file number: 202107720033) from the China Scholarship Council (CSC) for her PhD at the University of Groningen, Groningen, The Netherlands. The funder of this review had no role in study design, data extraction, data synthesis, data interpretation, or writing of the report.