Dataset Information

Use of repurposed and adjuvant drugs in hospital patients with covid-19: multinational network cohort study.

ABSTRACT:

Objective

To investigate the use of repurposed and adjuvant drugs in patients admitted to hospital with covid-19 across three continents.

Design

Multinational network cohort study.

Setting

Hospital electronic health records from the United States, Spain, and China, and nationwide claims data from South Korea.

Participants

303 264 patients admitted to hospital with covid-19 from January 2020 to December 2020.

Main outcome measures

Prescriptions or dispensations of any drug on or 30 days after the date of hospital admission for covid-19.

Results

Of the 303 264 patients included, 290 131 were from the US, 7599 from South Korea, 5230 from Spain, and 304 from China. 3455 drugs were identified. Common repurposed drugs were hydroxychloroquine (used in from <5 (<2%) patients in China to 2165 (85.1%) in Spain), azithromycin (from 15 (4.9%) in China to 1473 (57.9%) in Spain), combined lopinavir and ritonavir (from 156 (<2%) in the VA-OMOP US to 2,652 (34.9%) in South Korea and 1285 (50.5%) in Spain), and umifenovir (0% in the US, South Korea, and Spain and 238 (78.3%) in China). Use of adjunctive drugs varied greatly, with the five most used treatments being enoxaparin, fluoroquinolones, ceftriaxone, vitamin D, and corticosteroids. Hydroxychloroquine use increased rapidly from March to April 2020 but declined steeply in May to June and remained low for the rest of the year. The use of dexamethasone and corticosteroids increased steadily during 2020.

Conclusions

Multiple drugs were used in the first few months of the covid-19 pandemic, with substantial geographical and temporal variation. Hydroxychloroquine, azithromycin, lopinavir-ritonavir, and umifenovir (in China only) were the most prescribed repurposed drugs. Antithrombotics, antibiotics, H2 receptor antagonists, and corticosteroids were often used as adjunctive treatments. Research is needed on the comparative risk and benefit of these treatments in the management of covid-19.

SUBMITTER: Prats-Uribe A

PROVIDER: S-EPMC8111167 | biostudies-literature | 2021 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Use of repurposed and adjuvant drugs in hospital patients with covid-19: multinational network cohort study.

Prats-Uribe Albert A Sena Anthony G AG Lai Lana Yin Hui LYH Ahmed Waheed-Ul-Rahman WU Alghoul Heba H Alser Osaid O Alshammari Thamir M TM Areia Carlos C Carter William W Casajust Paula P Dawoud Dalia D Golozar Asieh A Jonnagaddala Jitendra J Mehta Paras P PP Gong Mengchun M Morales Daniel R DR Nyberg Fredrik F Posada Jose D JD Recalde Martina M Roel Elena E Shah Karishma K Shah Nigam H NH Schilling Lisa M LM Subbian Vignesh V Vizcaya David D Zhang Lin L Zhang Ying Y Zhu Hong H Liu Li L Cho Jaehyeong J Lynch Kristine E KE Matheny Michael E ME You Seng Chan SC Rijnbeek Peter R PR Hripcsak George G Lane Jennifer Ce JC Burn Edward E Reich Christian C Suchard Marc A MA Duarte-Salles Talita T Kostka Kristin K Ryan Patrick B PB Prieto-Alhambra Daniel D

BMJ (Clinical research ed.) 20210511

<h4>Objective</h4>To investigate the use of repurposed and adjuvant drugs in patients admitted to hospital with covid-19 across three continents.<h4>Design</h4>Multinational network cohort study.<h4>Setting</h4>Hospital electronic health records from the United States, Spain, and China, and nationwide claims data from South Korea.<h4>Participants</h4>303 264 patients admitted to hospital with covid-19 from January 2020 to December 2020.<h4>Main outcome measures</h4>Prescriptions or dispensations ...[more]

PMID: 33975825

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Project description:BackgroundWorld Health Organization expert groups recommended mortality trials of four repurposed antiviral drugs - remdesivir, hydroxychloroquine, lopinavir, and interferon beta-1a - in patients hospitalized with coronavirus disease 2019 (Covid-19).MethodsWe randomly assigned inpatients with Covid-19 equally between one of the trial drug regimens that was locally available and open control (up to five options, four active and the local standard of care). The intention-to-treat primary analyses examined in-hospital mortality in the four pairwise comparisons of each trial drug and its control (drug available but patient assigned to the same care without that drug). Rate ratios for death were calculated with stratification according to age and status regarding mechanical ventilation at trial entry.ResultsAt 405 hospitals in 30 countries, 11,330 adults underwent randomization; 2750 were assigned to receive remdesivir, 954 to hydroxychloroquine, 1411 to lopinavir (without interferon), 2063 to interferon (including 651 to interferon plus lopinavir), and 4088 to no trial drug. Adherence was 94 to 96% midway through treatment, with 2 to 6% crossover. In total, 1253 deaths were reported (median day of death, day 8; interquartile range, 4 to 14). The Kaplan-Meier 28-day mortality was 11.8% (39.0% if the patient was already receiving ventilation at randomization and 9.5% otherwise). Death occurred in 301 of 2743 patients receiving remdesivir and in 303 of 2708 receiving its control (rate ratio, 0.95; 95% confidence interval [CI], 0.81 to 1.11; P = 0.50), in 104 of 947 patients receiving hydroxychloroquine and in 84 of 906 receiving its control (rate ratio, 1.19; 95% CI, 0.89 to 1.59; P = 0.23), in 148 of 1399 patients receiving lopinavir and in 146 of 1372 receiving its control (rate ratio, 1.00; 95% CI, 0.79 to 1.25; P = 0.97), and in 243 of 2050 patients receiving interferon and in 216 of 2050 receiving its control (rate ratio, 1.16; 95% CI, 0.96 to 1.39; P = 0.11). No drug definitely reduced mortality, overall or in any subgroup, or reduced initiation of ventilation or hospitalization duration.ConclusionsThese remdesivir, hydroxychloroquine, lopinavir, and interferon regimens had little or no effect on hospitalized patients with Covid-19, as indicated by overall mortality, initiation of ventilation, and duration of hospital stay. (Funded by the World Health Organization; ISRCTN Registry number, ISRCTN83971151; ClinicalTrials.gov number, NCT04315948.).

Dataset Information

Use of repurposed and adjuvant drugs in hospital patients with covid-19: multinational network cohort study.

Objective

Design

Setting

Participants

Main outcome measures

Results

Conclusions

Publications

Use of repurposed and adjuvant drugs in hospital patients with covid-19: multinational network cohort study.

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