While use of hydroxychloroquine (HCQ) for the treatment of COVID-19 in the US has declined, its abandonment has been offset by use of remdesivir and dexamethasone, and use of the latter therapies varies considerably across health systems. These were among the results of a retrospective cohort study of the 3 COVID-19 therapies that was recently published in the Annals of Internal Medicine.
Although there are increasing data on the safety and efficacy of treatment options for COVID-19, not much is known about how treatments have been used across the US. To characterize the use of HCQ, remdesivir, and dexamethasone, researchers analyzed data from the National COVID Cohort Collaborative (N3C), a large, multicenter, longitudinal cohort of 137,870 adults with COVID-19, hospitalized largely in academic medical centers, between February 1, 2020 and February 28, 2021.
The researchers found that 8754 (6.3%) patients received HCQ, 29,272 (21.2%) received remdesivir, and 53,909 (39.1%) received dexamethasone. Though both remdesivir and dexamethasone uptake gradually increased over the study period, dexamethasone increased the most. Since release of the RECOVERY (Randomised Evaluation of COVID-19 Therapy) trial results in mid-June, which demonstrated the efficacy of dexamethasone in COVID-19 treatment, 78% to 84% of patients who have had invasive mechanical ventilation have received dexamethasone or other glucocorticoids. In contrast, HCQ use increased during March 2020, peaking at 42%, and by April 2020 started declining.
Remdesivir and dexamethasone use varied substantially across health centers (intraclass correlation coefficient, 14.2% for dexamethasone and 84.6% for remdesivir). This variation was greatest for remdesivir, which has been found to reduce length of hospital stay but not mortality.
“Dexamethasone, an evidence-based treatment of COVID-19, may be underused among persons who are mechanically ventilated,” the researchers concluded. They added that the variation in remdesivir and dexamethasone use across health systems suggested that drug usage was influenced by patient case mix, the ability to access the drugs, treatment protocols, and the quality of care offered.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Mehta HB, An H, Andersen KM, et al; National COVID Cohort Collaborative (N3C). Use of hydroxychloroquine, remdesivir, and dexamethasone among adults hospitalized with COVID-19 in the United States: a retrospective cohort study. Ann Intern Med. Published online August 17, 2021. doi:10.7326/M21-0857