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

Mehta, Hemalkumar B.; An, Huijun; Andersen, Kathleen M.; Mansour, Omar; Madhira, Vithal; Rashidi, E.; Bates, Benjamin; Setoguchi, Soko; Joseph, Cecil S.; Kocis, Paul T; Moffitt, Richard A.; Bennett, Tellen D.; Chute, Christopher G.; Garibaldi, Brian T.; Alexander, G. Caleb

doi:10.7326/m21-0857

Cited by 25 publications

(36 citation statements)

References 31 publications

(29 reference statements)

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“…There was a higher frequency of corticosteroids in those requiring invasive mechanical ventilation. This was like the finding from another study from that time, although they used dexamethasone [ 36 ]. Regardless of methylprednisolone use or not, patients with VTE had higher median d-dimers compared to those with no VTE.…”

Section: Discussionsupporting

confidence: 82%

Methylprednisolone, venous thromboembolism, and association with heparin to 30 days in hospital survival in severe Covid-19 pneumonia

Nyirenda

Bojarian

et al. 2022

BMC Pulm Med

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Background Mortality in severe COVID-19 pneumonia is associated with thrombo-inflammation. Corticosteroids are given to attenuate the inflammation, but they are associated with thrombosis. The aims of this study were to determine the risk of venous thromboembolism between no methylprednisolone and methylprednisolone (dose versus duration) and to evaluate any synergistic dose-dependent association of heparin and methylprednisolone to 30 days in hospital survival. Methods This was a secondary analysis of a retrospective cohort. Patients included in this study were ≥ 18 years of age and admitted for severe COVID-19 pneumonia between March and June 2020 in 13 hospitals in New Jersey, United States. A propensity score analysis between administration of methylprednisolone and no methylprednisolone was fitted for 11 variables and Youden Index Method was used to determine cut-off between low dose and high dose methylprednisolone. Multivariate cox regression was to assess risk. Results In 759 patients, the incidence of venous thromboembolism was 9% of patients who received methylprednisolone and 3% of patients who did not receive methylprednisolone with a [RR 2.92 (95% CI 1.54, 5.55 P < 0.0001)]. There was a higher incidence of mechanical ventilation in the methylprednisolone group. The median d-dimer between patients with venous thromboembolism was higher compared to those without (P < 0.0003). However, the d-dimer was not statistically significant between those who had venous thromboembolism between methylprednisolone and no methylprednisolone groups (P = 0.40). There was no higher risk in high dose versus low dose [RR = 0.524 (95% CI 0.26, 1.06 P 0.4)]; however, the risk for venous thromboembolism between methylprednisolone for > 7 days and ≤ 7 days was statistically significant (RR 5.46 95% CI 2.87, 10.34 P < 0.0001). Patients who received low dose methylprednisolone and therapeutic heparin had a trend towards higher risk of mortality compared to prophylactic heparin (HR 1.81 95% CI 0.994 to 3.294) (P = 0.0522). There was no difference in 30 days in hospital survival between high dose methylprednisolone with prophylactic or therapeutic heparin (HR 0.827 95% CI 0.514 to 1.33) (P = 0.4335). Conclusion Methylprednisolone for > 7 days had a higher association of venous thromboembolism. There was no added benefit of therapeutic heparin to methylprednisolone on mechanically ventilated patients.

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Section: Discussionsupporting

confidence: 82%

Methylprednisolone, venous thromboembolism, and association with heparin to 30 days in hospital survival in severe Covid-19 pneumonia

Nyirenda

Bojarian

et al. 2022

BMC Pulm Med

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“…In inpatient settings, Black inpatients received remdesivir more often, and Black, Asian, and Hispanic inpatients received dexamethasone less often than did comparison groups. This could indicate racial and ethnic differences in clinical indications for medication use (e.g., age distribution and prevalence of comorbidities) or could be reflective of varying prescribing practices, protocols, and drug access by institutions that serve populations of different racial and ethnic distributions (7).…”

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Disparities in Receipt of Medications for Treatment of COVID-19 — United States, March 2020–August 2021

Wiltz¹,

Feehan²,

Molinari³

et al. 2022

MMWR Morb. Mortal. Wkly. Rep.

110

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On January 14, 2022, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr).The COVID-19 pandemic has magnified longstanding health care and social inequities, resulting in disproportionately high COVID-19-associated illness and death among members of racial and ethnic minority groups (1). Equitable use of effective medications (2) could reduce disparities in these severe outcomes (3). Monoclonal antibody (mAb) therapies against SARS-CoV-2, the virus that causes COVID-19, initially received Emergency Use Authorization (EUA) from the Food and Drug Administration (FDA) in November 2020. mAbs are typically administered in an outpatient setting via intravenous infusion or subcutaneous injection and can prevent progression of COVID-19 if given after a positive SARS-CoV-2 test result or for postexposure prophylaxis in patients at high risk for severe illness. † Dexamethasone, a commonly used steroid, and remdesivir, an antiviral drug that received EUA from FDA in May 2020, are used in inpatient settings and help prevent COVID-19 progression § (2). No large-scale studies have yet examined the use of mAb by race and ethnicity. Using COVID-19 patient electronic health record data from 41 U.S. health care systems that participated in the PCORnet, the National Patient-Centered Clinical Research Network, ¶ this study assessed receipt of medications for COVID-19 treatment by race (White, Black, Asian, and Other races [including American Indian or Alaska Native, Native Hawaiian or Other * These authors contributed equally to this report. † Fact sheets for healthcare providers for FDA emergency use authorization are available from https://www.fda.gov/media/145611/download for REGEN-COV (casirivimab and imdevimab) and https://www.fda.gov/ media/145802/download for bamlanivimab and etesevimab. The SARS-CoV-2 B.1.1.529 (Omicron) variant is not neutralized by bamlanivimab and etesevimab or casirivimab and imdevimab, the mAb-based COVID-19 treatments that were most frequently prescribed before the emergence of Omicron. § https://www.covid19treatmentguidelines.nih.gov/management/ clinical-management/ ¶ PCORnet is a national network-of-networks developed to conduct patientcentered outcomes research. The PCORnet infrastructure supports large-scale studies using its distributed data network.

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“…The outcome of the landmark RECOVERY trial that involved confirmed patients of COVID-19 showed that the use of dexamethasone resulted in reduced mortality and need of mechanical ventilators or oxygen supply ( Hamilton et al., 2021 ). Based on this trial, dexamethasone was approved among critically ill patients, either alone or in combination with remdesivir ( Vetter et al., 2020 ; Mehta et al., 2021 ). Interferon-β-1a, a cytokine, exhibits an immunogenic response against viral infection ( Yuen et al., 2020 ).…”

Section: Susceptibility Of Coronavirus Disease 2019 To Clinically Used Drugsmentioning

confidence: 99%

Molecular Evolution of Severe Acute Respiratory Syndrome Coronavirus 2: Hazardous and More Hazardous Strains Behind the Coronavirus Disease 2019 Pandemic and Their Targeting by Drugs and Vaccines

Tuli

Sak²,

Aggarwal

et al. 2021

Front. Cell. Infect. Microbiol.

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Within almost the last 2 years, the world has been shaken by the coronavirus disease 2019 (COVID-19) pandemic, which has affected the lives of all people. With nearly 4.92 million deaths by October 19, 2021, and serious health damages in millions of people, COVID-19 has been the most serious global challenge after the Second World War. Besides lost lives and long-term health problems, devastating impact on economics, education, and culture will probably leave a lasting impression on the future. Therefore, the actual extent of losses will become obvious only after years. Moreover, despite the availability of different vaccines and vaccination programs, it is still impossible to forecast what the next steps of the virus are or how near we are to the end of the pandemic. In this article, the route of molecular evolution of the coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is thoroughly compiled, highlighting the changes that the virus has undergone during the last 2 years and discussing the approaches that the medical community has undertaken in the fight against virus-induced damages.

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

Cited by 25 publications

References 31 publications

Methylprednisolone, venous thromboembolism, and association with heparin to 30 days in hospital survival in severe Covid-19 pneumonia

Methylprednisolone, venous thromboembolism, and association with heparin to 30 days in hospital survival in severe Covid-19 pneumonia

Racial and Ethnic Disparities in Receipt of Medications for Treatment of COVID-19 — United States, March 2020–August 2021

Molecular Evolution of Severe Acute Respiratory Syndrome Coronavirus 2: Hazardous and More Hazardous Strains Behind the Coronavirus Disease 2019 Pandemic and Their Targeting by Drugs and Vaccines

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