EPI-PHARE publishes the results of a major pharmaco-epidemiological study on the dispensation of reimbursed prescription drugs in pharmacies during the 8 weeks of confinement in France and in the first week post-confinement.

What did we already know about the subject after the first five weeks of confinement in France?

• After an initial storage of drugs at the begining of confinement for chronic pathologies, under-consumption was observed before a return to a more standardized consumption in week 16 (April 13-19).

• For the treatments whose administration imperatively requires the physical recourse to a health professional, there was a collapse of consumption over the entire initial period of confinement: -35% to -71% for vaccines; -40% for ophthalmological treatment of age-related macular degeneration (AMD), -68% for intrauterine contraceptive devices (IUDs) with progestogen. Products intended for medical diagnostic procedures: preparations for colonoscopy (-82%), iodized products for scanner (-66%), contrast agents for MRI (-67%) also experienced a sharp drop.

• A sharp drop in consumption during confinement was noted for other drugs that can be prescribed in acute or chronic treatments: oral corticosteroid therapy (-64%), NSAIDs (-70%), systemic antibiotic therapy (-37%), antiulcer proton pump inhibitors or PPIs (-13%).

• For the treatment of Covid-19, deliveries on medical prescriptions of chloroquine and hydroxychloroquine were limited in time, in connection with the media coverage of these potential treatments (peaks respectively on February 27 and March 8); ibuprofen dispensation was almost stopped after messages from health officials, while dispensation of prescritpion paracetamol affected up to 1 million patients daily on March 16.

• There were particularities for certain populations: for people living in socially advantaged areas, there was a trend towards greater use of hydroxychloroquine, and a slightly higher rate of storage of drugs for chronic pathologies. Children were given little medical attention during the confinement, a finding that can be explained by a possible effect of stopping of the circulation of all viruses (except SARS-CoV-2) and other infectious agents with the closure of nurseries and schools , but also less vaccination and a significant drop in certain treatments.

What does the study bring after 8 weeks of confinement in France and the first week post-confinement?

• The Covid-19 epidemic has profoundly and lastingly destabilized the consumption of city drugs in France.
• If for chronic pathologies the initial storage of drugs could be considered more reassuring than the reverse, it should not mask the sharp drop of about half of the initiation of treatments for new patients during confinement (-39 % for antihypertensives, -48.5% for anti-diabetics and -49% for statins). These observations corroborate the deficit in the diagnosis of myocardial infarctions and strokes during the confinement, but also the very sharp decrease in general medical activity outside Covid-19, despite the development of teleconsultations. These reductions corresponded to more than 100,000 hypertensive patients, 37,500 diabetics and 70,000 people under statin therapy.

• Confidence in ACE inhibitors and sartans, two major antihypertensive drugs which were initially believed to increase the risk of covid-19 and/or its potential severity, had returned after several studies that seem to remove the initial doubts in the context of the epidemic.

• This new study has confirmed a very large decrease in the delivery and use of products which require administration by a health professional, in particular vaccines, without there being any start of catching up. On the contrary, the consumption observed continues each week to be much lower than the expected consumption . Colonoscopy (-180,000), MRI (-202,366), scanner (-375,000) examinations that are not carried out, are however essential to diagnose certain cancers or serious illnesses and could lead to delays in treatment.

• Hydroxychloroquine, apart from its classic indications such as in lupus and rheumatoid arthritis, was practically no longer prescribed or reimbursed in the city during the last 3 weeks of confinement and during the first week post confinement.

• The collapse in the use of antibiotic therapy remained spectacular and constant in children (- 765,000 antibiotic treatments during the confinement in children aged 0 to 19 compared to the expected). It is possibly linked to the stopping of the circulation of all viruses (excluding SARS-CoV-2) and other infectious agents following the closure of nurseries and schools.

• For emergency contraception and medically assisted procreation, less management continued throughout the period of the Covid-19 epidemic.

• Among the therapeutic classes whose use has increased at the end of confinement and during the first week of post confinement, hypnotics must be emphasized (+ 6.9% in post confinement compared to the expected) and to a lesser degree anxiolytics (+ 1.2% post-confinement). As several surveys point out, affiliates to the French Health Insurance have experienced significant confinement and its professional and economic consequences, with illness or even the death of loved ones, manifest sleep disturbances and anxiety. However, antidepressants were not affected by this increase immediately after the confinement period.

• This follo-up based on the French National Health Data System (SNDS) is essential and will be continued until a return to a normalized situation. It is important in several fields, in particular for vaccines and diagnostic and prevention products, contraception, for chronic diseases at risk of severe complications, for psychiatric diseases, or other diseases at risk of decompensation by confinement.