Assessing risk of COVID-19 reinfection and complications in adults treated with stimulant medications: A retrospective study using electronic health records

Abstract

Despite advancement in vaccines and treatments for COVID-19 over time, many concerns remain about reinfection and waning immunity against COVID-19 and its variants, including among individuals treated with stimulants. The study aimed to evaluate the risk of COVID-19 reinfection and severe illness among adults prescribed stimulants compared to those not on stimulant therapy to elucidate the potential relationship of this therapy to the COVID-19 reinfection-related outcomes. A retrospective cohort study was conducted using the TriNetX database consisting of over 2,563,130 adults (age ≥18 years) with COVID-19 infection from January 1, 2020 to April 30, 2022. COVID-19 reinfection was defined as a new COVID-19 illness documented ≥ 30 days after the initial infection. Logistic regression was applied to assess the odds ratios (ORs) of COVID-19 reinfection and severe illness course (presence of emergence department (ED), hospitalization, and intensive care unit (ICU) care, mortality) within 30 days of reinfection, controlled for demographic and comorbid condition characteristics. Analysis revealed that adults who received at least three prescriptions for stimulants, compared to those without any stimulant prescriptions within six months prior to the initial COVID-19 illness, were more likely to be re-infected by COVID-19 (aOR=1.36, 95% confidence interval (CI): 1.32- 1.41), but less likely to be treated in the ED (aOR=0.77, 95% CI: 0.72-0.82), hospital (aOR=0.72, 95% CI: 0.63-0.82), ICU (aOR=0.68, 95% CI: 0.53-0.89), or die (aOR=0.31, 95% CI: 0.15-0.64) within 30 days of reinfection (all p-values < 0.01). The study offers additional insights into the potential risks and benefits of prescription stimulants to aid in clinical decision making for treating COVID-19 reinfection in adults on stimulant therapy.