Sex Differences in Reported Adverse Drug Reactions to COVID-19 Drugs in a Global Database of Individual Case Safety Reports

Drug Saf. 2020 Dec;43(12):1309-1314. doi: 10.1007/s40264-020-01000-8. Epub 2020 Sep 25.

Abstract

Introduction: In late 2019, a new coronavirus-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-was discovered in Wuhan, China, and the World Health Organization later declared coronavirus disease 2019 (COVID-19) a pandemic. Numerous drugs have been repurposed and investigated for therapeutic effectiveness in the disease, including those from "Solidarity," an international clinical trial (azithromycin, chloroquine, hydroxychloroquine, the fixed combination lopinavir/ritonavir, and remdesivir).

Objective: Our objective was to evaluate adverse drug reaction (ADR) reporting for drugs when used in the treatment of COVID-19 compared with use for other indications, specifically focussing on sex differences.

Method: We extracted reports on COVID-19-specific treatments from the global ADR database, VigiBase, using an algorithm developed to identify reports that listed COVID-19 as the indication. The Solidarity trial drugs were included, as were any drugs reported ≥ 100 times. We performed a descriptive comparison of reports for the same drugs used in non-COVID-19 indications. The data lock point date was 7 June 2020.

Results: In total, 2573 reports were identified for drugs used in the treatment of COVID-19. In order of frequency, the most reported ADRs were electrocardiogram QT-prolonged, diarrhoea, nausea, hepatitis, and vomiting in males and diarrhoea, electrocardiogram QT-prolonged, nausea, vomiting, and upper abdominal pain in females. Other hepatic and kidney-related events were included in the top ten ADRs in males, whereas no hepatic or renal terms were reported for females. COVID-19-related reporting patterns differed from non-pandemic reporting for these drugs.

Conclusion: Review of a global database of suspected ADR reports revealed sex differences in the reporting patterns for drugs used in the treatment of COVID-19. Patterns of ADR sex differences need further elucidation.

MeSH terms

  • Abdominal Pain / chemically induced
  • Abdominal Pain / epidemiology
  • Adenosine Monophosphate / adverse effects
  • Adenosine Monophosphate / analogs & derivatives
  • Alanine / adverse effects
  • Alanine / analogs & derivatives
  • Antibodies, Monoclonal, Humanized / adverse effects
  • Antiviral Agents / adverse effects*
  • Azithromycin / adverse effects
  • COVID-19 Drug Treatment*
  • Chemical and Drug Induced Liver Injury / epidemiology
  • Chemical and Drug Induced Liver Injury / etiology
  • Chloroquine / adverse effects
  • Databases, Pharmaceutical
  • Diarrhea / chemically induced
  • Diarrhea / epidemiology
  • Drug Combinations
  • Drug Eruptions / epidemiology
  • Drug Eruptions / etiology
  • Drug Repositioning
  • Drug-Related Side Effects and Adverse Reactions / epidemiology*
  • Female
  • Humans
  • Hydroxychloroquine / adverse effects
  • Long QT Syndrome / chemically induced
  • Long QT Syndrome / epidemiology
  • Lopinavir / adverse effects
  • Male
  • Nausea / chemically induced
  • Nausea / epidemiology
  • Oseltamivir / adverse effects
  • Ritonavir / adverse effects
  • Sex Distribution
  • Sex Factors
  • Vomiting / chemically induced
  • Vomiting / epidemiology

Substances

  • Antibodies, Monoclonal, Humanized
  • Antiviral Agents
  • Drug Combinations
  • lopinavir-ritonavir drug combination
  • Oseltamivir
  • Lopinavir
  • remdesivir
  • Adenosine Monophosphate
  • Hydroxychloroquine
  • Azithromycin
  • Chloroquine
  • tocilizumab
  • Ritonavir
  • Alanine