Pharmacotherapy for Hospitalized Patients with COVID-19: Treatment Patterns by Disease Severity

Abstract

Background Treatment decisions for Coronavirus Disease 2019 (COVID-19) depend on disease severity, but the prescribing pattern by severity and drivers of therapeutic choices remain unclear. Objectives The objectives of the study were to evaluate pharmacological treatment patterns by COVID-19 severity and identify the determinants of prescribing for COVID-19. Methods Using electronic health record data from a large Massachusetts-based healthcare system, we identified all patients aged ≥ 18 years hospitalized with laboratory-confirmed COVID-19 from 1 March to 24 May, 2020. We defined five levels of COVID-19 severity at hospital admission: (1) hospitalized but not requiring supplemental oxygen; (2–4) hospitalized and requiring oxygen ≤ 2, 3–4, and ≥ 5 L per minute, respectively; and (5) intubated or admitted to an intensive care unit. We assessed the medications used to treat COVID-19 or as supportive care during hospitalization. Results Among 2821 patients hospitalized for COVID-19, we found inpatient mortality increased by severity from 5% for level 1 to 23% for level 5. As compared to patients with severity level 1, those with severity level 5 were 3.53 times (95% confidence interval 2.73–4.57) more likely to receive a medication used to treat COVID-19. Other predictors of treatment were fever, low oxygen saturation, presence of co-morbidities, and elevated inflammatory biomarkers. The use of most COVID-19 relevant medications has dropped substantially while the use of remdesivir and therapeutic anticoagulants has increased over the study period. Conclusions Careful consideration of disease severity and other determinants of COVID-19 drug use is necessary for appropriate conduct and interpretation of non-randomized studies evaluating outcomes of COVID-19 treatments. Electronic supplementary material The online version of this article (10.1007/s40265-020-01424-7) contains supplementary material, which is available to authorized users.

Current trends and geographical differences in therapeutic profile and outcomes of COVID-19 among pregnant women - a systematic review and meta-analysis

“…Like another study demonstrating a significant drop in most COVID-19 medications [ 101 ], our cumulative meta-analysis demonstrated considerable drop in most therapeutics and associated outcomes for COVID-19 in pregnant women. As health care professionals learned through their own experiences and evidence accumulated from clinical trials, the decline in the most common therapeutics associated with no clear evidence of benefits was observed.…”

“…As oxygen supplementation is required in the majority of critically ill patients [ 100 ], we also observed a high rate of ICU admission and preterm birth with a high proportion of oxygen support both in average-risk and severe cases of COVID-19. Although the reason for the potential association between oxygen therapy and preterm birth is unclear, the use of oxygen therapy was associated with an increased use of COVID-19 specific medications and inpatient mortality [ 101 ]. Given no evidence of optimal strategy for oxygen therapy in COVID-19 patients [ 99 ], a careful consideration is needed for oxygen therapy in pregnant patients.…”

Real‐World Evidence for Assessing Pharmaceutical Treatments in the Context of COVID‐19

“…For patients with mild COVID-19 disease, supportive care has been the preferred management strategy 32 ; pharmacological treatment with possible antiviral effects has been primarily used for patients with moderate to severe disease requiring hospitalization. 33,34 Identifying treatments that can reduce morbidity and mortality in hospitalized patients is also one of the most urgent evidence needs related to COVID-19. Therefore, the majority of comparative effectiveness research of COVID-19 specific medications has been focused on evaluating treatment strategies to avoid death or intubation in patients hospitalized for COVID-19.…”

Use of Hydroxychloroquine, Remdesivir, and Dexamethasone Among Adults Hospitalized With COVID-19 in the United States

“…Despite rapidly accumulating evidence on safety and efficacy, far less is known about how treatments have been used in the United States. For example, although several studies have documented increases in use of hydroxychloroquine ( 12 , 13 ) and remdesivir ( 14 ) and others have examined potential drivers of such use ( 14 ), analyses have generally been limited to aggregated, national-level claims or single institutions. Furthermore, how much the use of these products has varied across patients and health systems is unclear ( 15 , 16 ).…”