Among patients hospitalized with COVID-19 in 2021 and early 2022, the most common initial drug regimens were corticosteroids (CS), CS plus remdesivir, and remdesivir, according to study findings published in Open Forum Infectious Diseases.
The observational descriptive cohort study sought to determine drug use patterns for CS, interleukin-6 inhibitors (IL6i), Janus kinase inhibitors (JAKi), and remdesivir among hospitalized adult patients with COVID-19 in the US. The study identified drug use patterns during the patient’s full hospitalization, within the hospitalization categorized by respiratory support requirements, and over calendar time.
Researchers used HealthVerity Hospital Chargemaster and Pharmacy and Medical Claims data to identify patients aged 18 to 84 years who had an inpatient hospital chargemaster event between January 1, 2021, and February 1, 2022, and a diagnosis of COVID-19 at admission or within the previous 7 days.
A total of 51,066 patients who were hospitalized with COVID-19 were eligible for inclusion. Their median age was 55 years (interquartile range, 39-65), and 55% were female. The most frequently used drug regimens initiated were CS monotherapy (33.3%) and CS plus remdesivir (32.8%).
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This study of patients hospitalized with COVID-19 is the first to describe real-world drug utilization patterns for CS, IL6i, JAKi, and remdesivir throughout 2021 and early 2022 in a large US data source.
Of the cohort, 57.7% of participants received at least 1 incident drug regimen of interest during their hospitalization. CS plus remdesivir (25.1%) and CS alone (23.4%) were the most common first-line regimens. These drug regimens were used in a similar proportion of second-line therapies and were less commonly used as third-line treatment. Remdesivir was the next most commonly used first-line regimen (4.4%), although remdesivir monotherapy was rarely used as second- and third-line treatment.
Drug regimens that included IL6i and JAKis were used more frequently during later drug regimens, after initial administration of other drugs, primarily CS and CS plus remdesivir.
Among all respiratory support requirements, CS and CS plus remdesivir were the most commonly used first-line regimens. Second-line CS and CS plus remdesivir were used more frequently in patients who received supplemental oxygen (O2) vs those who received noninvasive ventilation or high-flow oxygen (NIV/HFO) or invasive mechanical ventilation or extracorporeal membrane oxygenation (IMV/ECMO). Third-line CS were used more frequently used in patients who received O2 and NIV/HFO vs IMV/ECMO. Remdesivir monotherapy was used mostly as a first-line drug regimen and was more common in patients who were treated with O2 and NIV/HFO compared with those who received IMV/ECMO.
Among several limitations, some US regions such as the South and Northeast were over-represented and others such as the Midwest were under-represented relative to US census data, resulting in findings that may not be representative of all hospitalized patients with COVID-19 during the study period. Also, the inpatient medication data were primarily from nonadjudicated chargemaster data, which are used for administrative purposes, and the researchers were unable to analyze factors such as barriers to access, which could affect treatment patterns.
“This study of patients hospitalized with COVID-19 is the first to describe real-world drug utilization patterns for CS, IL6i, JAKi, and remdesivir throughout 2021 and early 2022 in a large US data source. As anticipated…the most common therapies over the study period were CS and CS+remdesivir,” the study authors concluded. “The study findings suggest that inpatient prescribing in HealthVerity was generally in line with NIH COVID-19 treatment guidelines.”
Disclosure: Some of the study authors declared affiliations with a health care technology company. Please see the original reference for a full list of authors’ disclosures.
