The impact of the COVID-19 “Infodemic” on drug-utilization behaviors: implications for Pharmacovigilance
Open accessAbstract
The coronavirus disease 2019 (COVID-19) pandemic that hit the world in 2020 triggered a massive dissemination of information (an "infodemic") about the disease that was channeled through the print, broadcast, web, and social media. This infodemic also included sensational and distorted information about drugs that likely first influenced opinion leaders and people particularly active on social media and then other people, thus affecting choices by individual patients everywhere. In particular, information has spread about some drugs approved for other indications (chloroquine, hydroxychloroquine, nonsteroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, favipiravir, and umifenovir) that could have led to inappropriate and therefore hazardous use. In this article, we analyze the rationale behind the claims for use of these drugs in COVID-19, the communication about their effects on the disease, the consequences of this communication on people's behavior, and the responses of some influential regulatory authorities in an attempt to minimize the actual or potential risks arising from this behavior. Finally, we discuss the role of pharmacovigilance stakeholders in emergency management and possible strategies to deal with other similar crises in the future.
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The consequence of infodemic on the scientific framework is considerable, with implications on possible healthcare choices, already a determining factor in the recent pandemic.
“The consequence on the scientific framework is considerable, even with implications on possible healthcare choices, already a determining factor in the recent pandemic. (58)”
From ChatGPT and the rise of large language models: the new AI-driven infodemic threat in public health (2023) · cites this paper as [58]
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5 retracted
Gautret, P., Lagier, J., Parola, P., Hoang, V. T., Meddeb, L., Mailhe, M., Doudier, B., Courjon, J., Giordanengo, V., Esteves-Vieira, V., et al. (2020) · International Journal of Antimicrobial Agents · doi:10.1016/j.ijantimicag.2020.105949 · Cited by 5,288 · see citing works
RetractedRETRACTED: Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19
Mehra, M. R., Desai, S. S., Kuy, S., Henry, T. D., & Patel, A. N. (2020) · New England Journal of Medicine · doi:10.1056/nejmoa2007621 · Cited by 1,428 · see citing works
RetractedExperimental Treatment with Favipiravir for COVID-19: An Open-Label Control Study
Cai, Q., Yang, M., Liu, D., Chen, J., Shu, D., Xia, J., Liao, X., Gu, Y., Cai, Q., Yang, Y., et al. (2020) · Engineering · doi:10.1016/j.eng.2020.03.007 · Cited by 1,356 · see citing works
RetractedMehra, M. R., Desai, S. S., Ruschitzka, F. T., & Patel, A. N. (2020) · The Lancet · doi:10.1016/s0140-6736(20)31180-6 · Cited by 1,201 · see citing works
RetractedMehra, M. R., Desai, S. S., Kuy, S., Henry, T. D., & Patel, A. N. (2020) · New England Journal of Medicine · doi:10.1056/nejmc2021225 · Cited by 463 · see citing works
RetractedA Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19
Cao, B., Wang, Y., Wen, D., Liu, W., Wang, J., Fan, G., Ruan, L., Song, B., Cai, Y., Wei, M., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmoa2001282 · Cited by 5,187 · see citing works
The proximal origin of SARS-CoV-2
Andersen, K. G., Rambaut, A., Lipkin, W. I., Holmes, E. C., & Garry, R. F. (2020) · Nature Medicine · doi:10.1038/s41591-020-0820-9 · Cited by 5,081 · see citing works
Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?
Fang, L., Karakiulakis, G., & Roth, M. (2020) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(20)30116-8 · Cited by 2,947 · see citing works
Angiotensin-converting enzyme 2 protects from severe acute lung failure
Imai, Y., Kuba, K., Rao, S., Huan, Y., Guo, F., Guan, B., Yang, P., Sarao, R., Wada, T., Leong-Poi, H., et al. (2005) · Nature · doi:10.1038/nature03712 · Cited by 2,453 · see citing works
Zarocostas, J. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30461-x · Cited by 2,344 · see citing works
Ferrario, C. M., Jessup, J. A., Chappell, M. C., Averill, D. B., Brosnihan, K. B., Tallant, E. A., Diz, D. I., & Gallagher, P. E. (2005) · Circulation · doi:10.1161/circulationaha.104.510461 · Cited by 1,567 · see citing works
Discovering drugs to treat coronavirus disease 2019 (COVID-19)
Dong, L., Hu, S., & Gao, J. (2020) · Drug Discoveries & Therapeutics · doi:10.5582/ddt.2020.01012 · Cited by 1,391 · see citing works
Effects of chloroquine on viral infections: an old drug against today's diseases
Savarino, A., Boelaert, J. R., Cassone, A., Majori, G., & Cauda, R. (2003) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(03)00806-5 · Cited by 1,272 · see citing works
A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19
Cortegiani, A., Ingoglia, G., Ippolito, M., Giarratano, A., & Einav, S. (2020) · Journal of Critical Care · doi:10.1016/j.jcrc.2020.03.005 · Cited by 1,158 · see citing works
Devaux, C. A., Rolain, J., Colson, P., & Raoult, D. (2020) · International Journal of Antimicrobial Agents · doi:10.1016/j.ijantimicag.2020.105938 · Cited by 1,099 · see citing works
Renin–Angiotensin–Aldosterone System Blockers and the Risk of Covid-19
Mancia, G., Rea, F., Ludergnani, M., Apolone, G., & Corrao, G. (2020) · New England Journal of Medicine · doi:10.1056/nejmoa2006923 · Cited by 1,071 · see citing works
The Effects of Physician Empathy on Patient Satisfaction and Compliance
Kim, S. S., Kaplowitz, S., & Johnston, M. V. (2004) · Evaluation & the Health Professions · doi:10.1177/0163278704267037 · Cited by 1,063 · see citing works
Renin–Angiotensin–Aldosterone System Inhibitors and Risk of Covid-19
Reynolds, H. R., Adhikari, S., Pulgarin, C., Troxel, A. B., Iturrate, E., Johnson, S. B., Hausvater, A., Newman, J. D., Berger, J. S., Bangalore, S., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmoa2008975 · Cited by 1,058 · see citing works
Ahn, D., Shin, H.-J., Kim, M.-H., Lee, S.-H., Kim, H.-S., Myoung, J., Kim, B., & Kim, S. (2020) · Journal of Microbiology and Biotechnology · doi:10.4014/jmb.2003.03011 · Cited by 997 · see citing works
Structure analysis of the receptor binding of 2019-nCoV
Chen, Y., Guo, Y., Pan, Y., & Zhao, Z. J. (2020) · Biochemical and Biophysical Research Communications · doi:10.1016/j.bbrc.2020.02.071 · Cited by 806 · see citing works
Mathematics Anxiety, Working Memory, and Mathematics Performance in Secondary-School Children
Passolunghi, M. C., Caviola, S., Agostini, R. D., Perin, C., & Mammarella, I. C. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.00042 · Cited by 723 · see citing works
In vitro inhibition of severe acute respiratory syndrome coronavirus by chloroquine
Keyaerts, E., Vijgen, L., Maes, P., Neyts, J. H., & Ranst, M. A. V. (2004) · Biochemical and Biophysical Research Communications · doi:10.1016/j.bbrc.2004.08.085 · Cited by 644 · see citing works
Mahévas, M., Tran, V.-T., Roumier, M., Chabrol, A., Paule, R., Guillaud, C., Foïs, E., Lepeule, R., Szwebel, T., Lescure, F.-X., et al. (2020) · BMJ · doi:10.1136/bmj.m1844 · Cited by 566 · see citing works
Cheng, H., Wang, Y., & Wang, G. (2020) · Journal of Medical Virology · doi:10.1002/jmv.25785 · Cited by 549 · see citing works
Deng, L., Li, C., Zeng, Q., Liu, X., Li, X., Zhang, H., Hong, Z., & Xia, J. (2020) · Journal of Infection · doi:10.1016/j.jinf.2020.03.002 · Cited by 502 · see citing works
Guo, J., Huang, Z. Y. X., Lin, L., & Lv, J. (2020) · Journal of the American Heart Association · doi:10.1161/jaha.120.016219 · Cited by 464 · see citing works
Epidemiology and clinical features of COVID-19: A review of current literature
Siordia, J. A. (2020) · Journal of Clinical Virology · doi:10.1016/j.jcv.2020.104357 · Cited by 426 · see citing works
Favipiravir as a potential countermeasure against neglected and emerging RNA viruses
Delang, L., Abdelnabi, R., & Neyts, J. H. (2018) · Antiviral Research · doi:10.1016/j.antiviral.2018.03.003 · Cited by 402 · see citing works
Glasziou, P., Sanders, S., & Hoffmann, T. (2020) · BMJ · doi:10.1136/bmj.m1847 · Cited by 330 · see citing works
Antiviral Activity of Chloroquine against Human Coronavirus OC43 Infection in Newborn Mice
Keyaerts, E., Li, S., Vijgen, L., Rysman, E., Verbeeck, J., Ranst, M. A. V., & Maes, P. (2009) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.01509-08 · Cited by 311 · see citing works
Infodemic and the spread of fake news in the COVID-19-era
Orso, D., Federici, N., Copetti, R., Vetrugno, L., & Bove, T. (2020) · European Journal of Emergency Medicine · doi:10.1097/mej.0000000000000713 · Cited by 309 · see citing works
Medication errors: what they are, how they happen, and how to avoid them
Aronson, J. K. (2009) · QJM · doi:10.1093/qjmed/hcp052 · Cited by 298 · see citing works
The mechanism of resistance to favipiravir in influenza
Goldhill, D., Velthuis, A. T., Fletcher, R. A., et al. (2018) · Proceedings of the National Academy of Sciences of the United States of America · doi:10.1073/pnas.1811345115 · Cited by 285 · see citing works
Chang, A., Schnall, A. H., Law, R., et al. (2020) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm6916e1 · Cited by 260 · see citing works
[Inhibitors of RAS Might Be a Good Choice for the Therapy of COVID-19 Pneumonia].
Sun, M. L., Yang, J. M., Sun, Y., & Su, G. (2020) · PubMed · doi:10.3760/cma.j.issn.1001-0939.2020.0014 · Cited by 228 · see citing works
Lian, N., Xie, H. B., Lin, S., et al. (2020) · Clinical Microbiology and Infection · doi:10.1016/j.cmi.2020.04.026 · Cited by 227 · see citing works
A review of the safety of favipiravir – a potential treatment in the COVID-19 pandemic?
Pilkington, V., Pepperrell, T., & Hill, A. (2020) · Journal of virus eradication · doi:10.1016/s2055-6640(20)30016-9 · Cited by 202 · see citing works
WHO launches global megatrial of the four most promising coronavirus treatments
(2020) · AAAS Articles DO Group · doi:10.1126/science.abb8497 · Cited by 167 · see citing works
Nucleosides for the treatment of respiratory RNA virus infections
Jordan, P. C., Stevens, S., & Deval, J. (2018) · Antiviral chemistry & chemotherapy · doi:10.1177/2040206618764483 · Cited by 142 · see citing works
Favipiravir: A New Medication for the Ebola Virus Disease Pandemic
Nagata, T., Lefor, A. K., Hasegawa, M., et al. (2014) · Disaster Medicine and Public Health Preparedness · doi:10.1017/dmp.2014.151 · Cited by 141 · see citing works
Ibuprofen Attenuates Cardiac Fibrosis in Streptozotocin-Induced Diabetic Rats
Qiao, W., Wang, C., Chen, B., Zhang, F., Liu, Y., Lü, Q., Guo, H., Yan, C., Sun, H. B., Hu, G., et al. (2015) · Cardiology · doi:10.1159/000375362 · Cited by 137 · see citing works
Haviernik, J., Štefánik, M., Fojtíková, M., et al. (2018) · Viruses · doi:10.3390/v10040184 · Cited by 135 · see citing works
Shi, L., Xiong, H., He, J., Deng, H., Li, Q., Zhong, Q., Hou, W., Cheng, L., Xiao, H., & Yang, Z. (2007) · Archives of Virology · doi:10.1007/s00705-007-0974-5 · Cited by 132 · see citing works
Clinical and demographic characteristics of patients dying from COVID‐19 in Italy vs China
Lippi, G., Mattiuzzi, C., Sanchis‐Gomar, F., & Henry, B. M. (2020) · Journal of Medical Virology · doi:10.1002/jmv.25860 · Cited by 121 · see citing works
A Review about Functional Illiteracy: Definition, Cognitive, Linguistic, and Numerical Aspects
Vágvölgyi, R., Coldea, A., Dresler, T., Schrader, J., & Nuerk, H. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.01617 · Cited by 111 · see citing works
Topology comparison of Twitter diffusion networks effectively reveals misleading information
Pierri, F., Piccardi, C., & Ceri, S. (2020) · Scientific Reports · doi:10.1038/s41598-020-58166-5 · Cited by 85 · see citing works
Covid-19: European drugs agency to review safety of ibuprofen
Day, M. J. (2020) · BMJ · doi:10.1136/bmj.m1168 · Cited by 75 · see citing works
Jin, Z., Tucker, K., Lin, X., et al. (2015) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.01391-15 · Cited by 67 · see citing works
Caster, O., Dietrich, J., Kürzinger, M., Lerch, M., Maskell, S. R., Norén, G. N., Tcherny‐Lessenot, S., Vroman, B., Wisniewski, A. F. Z., & van Stekelenborg, J. (2018) · Drug Safety · doi:10.1007/s40264-018-0699-2 · Cited by 64 · see citing works
Developing a vaccine for covid-19
Caddy, S. (2020) · BMJ · doi:10.1136/bmj.m1790 · Cited by 64 · see citing works
Clinical efficacy of umifenovir in influenza and ARVI (study ARBITR).
Pshenichnaya, N., Bulgakova, V., Lvov, N., et al. (2019) · Терапевтический архив · doi:10.26442/00403660.2019.03.000127 · Cited by 45 · see citing works
The usefulness of listening social media for pharmacovigilance purposes: a systematic review
Convertino, I., Ferraro, S., Blandizzi, C., & Tuccori, M. (2018) · Expert Opinion on Drug Safety · doi:10.1080/14740338.2018.1531847 · Cited by 38 · see citing works
Self-citationIdentification of Falsified Chloroquine Tablets in Africa at the Time of the COVID-19 Pandemic
Gnegel, G., Hauk, C., Neci, R., et al. (2020) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.20-0363 · Cited by 34 · see citing works
The Combined Effect of Oseltamivir and Favipiravir on Influenza A Virus Evolution
Ormond, L., Liu, P., Matuszewski, S., Renzette, N., Bank, C., Zeldovich, K. B., Bolon, D. N. A., Kowalik, T. F., Finberg, R. W., Jensen, J. D., et al. (2017) · Genome Biology and Evolution · doi:10.1093/gbe/evx138 · Cited by 32 · see citing works
Haviernik, J., Štefánik, M., Fojtíková, M., et al. (2018) · Preprints.org · doi:10.20944/preprints201802.0134.v1 · Cited by 27 · see citing works
ACE Inhibitors and AT1R Blockers for COVID-2019: Friends or Foes ?Preprint
Focosi, D., Tuccori, M., & Maggi, F. (2020) · Preprints.org · doi:10.20944/preprints202004.0151.v2 · Cited by 2 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 4
- [23]Mehra MR, Desai SS, Ruschitzka F, Patel AN. Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. Lancet (London, England) [Internet]. Elsevier Ltd; 2020;6736:31324. http://www.ncbi.nlm.nih.gov/pubmed/32450107. PMC7255293 32450107
- [31]Cuppini L. Aifa: Clorochina non approvata per prevenire infezione da Sars-CoV-2 [Internet]. Corr. della Sera. [cited 2020 Apr 28]. https://www.corriere.it/salute/malattie_infettive/20_aprile_01/aifa-clorochina-non-approvata-prevenire-infezione-sars-cov-2-53179152-7370-11ea-bc49-338bb9c7b205.shtml.
- [61]European Medicines Agency. EMA gives advice on the use of non-steroidal anti-inflammatories for COVID-19 | European Medicines Agency. Eur Med Agency [Internet]. 2020;31:18–9. https://www.ema.europa.eu/en/news/ema-gives-advice-use-non-steroidal-anti-inflammatories-covid-19.
- [72][no author listed]. La bufala del farmaco Arbidol [Internet]. Corr. della Sera. 2020 [cited 2020 Apr 27]. https://video.corriere.it/bufala-farmaco-arbidol/277e5b16-6c3b-11ea-8403-94d97cb6fb9f.
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ChatGPT and the rise of large language models: the new AI-driven infodemic threat in public health
De Angelis, L., Baglivo, F., Arzilli, G., Privitera, G. P., Ferragina, P., Tozzi, A. E., & Rizzo, C. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1166120 · Cited by 708 · see citing works
ChatGPT and the Rise of Large Language Models: The New AI-Driven Infodemic Threat in Public Health
De Angelis, L., Baglivo, F., Arzilli, G., Privitera, G. P., Ferragina, P., Tozzi, A. E., & Rizzo, C. (2023) · doi:10.2139/ssrn.4352931 · Cited by 708 · see citing works
- Authors
- Tuccori, M., Convertino, I., Ferraro, S., Cappello, E., Valdiserra, G., Focosi, D., & Blandizzi, C.
- Affiliations
- University of Pisa (IT)
- Corresponding author
- Tuccori, Marco
- ORCID
- Venue
- Drug Safety
- Published
- 2020-06-22
- Volume
- 43
- Issue
- 8
- Pages
- 699-709
- ISSN
- 0114-5916 (ISSN-L)
- 1179-1942
- PMC
- PMC7307939
- OpenAlex
- W3036835209
- Cited by
- 80
- References
- 56
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 9 · 2023: 8 · 2022: 28 · 2021: 25 · 2020: 4
- FWCI
- 21.72
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Drug Safety (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- Topics
- Social Sciences › Sociology and Political Science › Misinformation and Its Impacts
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmaceutical industry and healthcare
- Keywords
- COVID-19 pandemic, infodemic, pharmacovigilance, off-label drug use, chloroquine, hydroxychloroquine, favipiravir, umifenovir, ACE inhibitors, angiotensin receptor blockers, nonsteroidal anti-inflammatory drugs, misinformation, social media, regulatory response, emergency management, crisis communication
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, COVID-19 Drug Treatment, Attitude to Health, Drug Utilization, Humans, Pneumonia, Viral, Public Health, Social Medicine, Coronavirus Infections, Information Dissemination, Medication Therapy Management, Pandemics, Pharmacovigilance, Social Media
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