TY - JOUR
T1 - Use of hydroxychloroquine, remdesivir, and dexamethasone among adults hospitalized with covid-19 in the united states
T2 - A retrospective cohort study
AU - Mehta, Hemalkumar B.
AU - An, Huijun
AU - Andersen, Kathleen M.
AU - Mansour, Omar
AU - Madhira, Vithal
AU - Rashidi, Emaan S.
AU - Bates, Benjamin
AU - Setoguchi, Soko
AU - Joseph, Corey
AU - Kocis, Paul T.
AU - Moffitt, Richard
AU - Bennett, Tellen D.
AU - Chute, Christopher G.
AU - Garibaldi, Brian T.
AU - Caleb Alexander, G.
N1 - Funding Information:
Acknowledgment: The analyses described in this publication were done with data or tools accessed through the National Center for Advancing Translational Sciences N3C Data Enclave (ncats.nih. gov/n3c/about) and supported by NCATS U24 TR002306. This research was possible because of the patients whose information is included in the data and the organizations and scientists who have contributed to the ongoing development of this community resource: doi.org/10.5281/zenodo.3979622. The authors thank Harold Lehmann, Paul Nagy, Ken Wilkins, and Kunbo Wang for feedback on study design and analytic approach.
Funding Information:
Financial Support: Dr. Mehta receives support from the National Institute on Aging (grant 1K01AG070329-01). Ms. Andersen and Mr. Joseph receive doctoral training support from the National Heart, Lung, and Blood Institute Pharmacoepidemiology T32 Training Program (grant T32HL139426-03). The authors also acknowledge assistance for clinical data coordination and retrieval from the Core for Clinical Research Data Acquisition, supported in part by the Johns Hopkins Institute for Clinical and Translational Research (grant UL1TR001079).
Publisher Copyright:
© 2021 American College of Physicians. All rights reserved.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - Background: Relatively little is known about the use patterns of potential pharmacologic treatments of COVID-19 in the United States. Objective: To use the National COVID Cohort Collaborative (N3C), a large, multicenter, longitudinal cohort, to characterize the use of hydroxychloroquine, remdesivir, and dexamethasone, overall as well as across individuals, health systems, and time. Design: Retrospective cohort study. Setting: 43 health systems in the United States. Participants: 137 870 adults hospitalized with COVID-19 between 1 February 2020 and 28 February 2021. Measurements: Inpatient use of hydroxychloroquine, remdesivir, or dexamethasone. Results: Among 137 870 persons hospitalized with confirmed or suspected COVID-19, 8754 (6.3%) received hydroxychloroquine, 29 272 (21.2%) remdesivir, and 53 909 (39.1%) dexamethasone during the study period. Since the release of results from the RECOVERY (Randomised Evaluation of COVID- 19 Therapy) trial in mid-June, approximately 78% to 84% of people who have had invasive mechanical ventilation have received dexamethasone or other glucocorticoids. The use of hydroxychloroquine increased during March 2020, peaking at 42%, and started declining by April 2020. By contrast, remdesivir and dexamethasone use gradually increased over the study period. Dexamethasone and remdesivir use varied substantially across health centers (intraclass correlation coefficient, 14.2% for dexamethasone and 84.6% for remdesivir). Limitation: Because most N3C data contributors are academic medical centers, findings may not reflect the experience of community hospitals. Conclusion: Dexamethasone, an evidence-based treatment of COVID-19, may be underused among persons who are mechanically ventilated. The use of remdesivir and dexamethasone varied across health systems, suggesting variation in patient case mix, drug access, treatment protocols, and quality of care.
AB - Background: Relatively little is known about the use patterns of potential pharmacologic treatments of COVID-19 in the United States. Objective: To use the National COVID Cohort Collaborative (N3C), a large, multicenter, longitudinal cohort, to characterize the use of hydroxychloroquine, remdesivir, and dexamethasone, overall as well as across individuals, health systems, and time. Design: Retrospective cohort study. Setting: 43 health systems in the United States. Participants: 137 870 adults hospitalized with COVID-19 between 1 February 2020 and 28 February 2021. Measurements: Inpatient use of hydroxychloroquine, remdesivir, or dexamethasone. Results: Among 137 870 persons hospitalized with confirmed or suspected COVID-19, 8754 (6.3%) received hydroxychloroquine, 29 272 (21.2%) remdesivir, and 53 909 (39.1%) dexamethasone during the study period. Since the release of results from the RECOVERY (Randomised Evaluation of COVID- 19 Therapy) trial in mid-June, approximately 78% to 84% of people who have had invasive mechanical ventilation have received dexamethasone or other glucocorticoids. The use of hydroxychloroquine increased during March 2020, peaking at 42%, and started declining by April 2020. By contrast, remdesivir and dexamethasone use gradually increased over the study period. Dexamethasone and remdesivir use varied substantially across health centers (intraclass correlation coefficient, 14.2% for dexamethasone and 84.6% for remdesivir). Limitation: Because most N3C data contributors are academic medical centers, findings may not reflect the experience of community hospitals. Conclusion: Dexamethasone, an evidence-based treatment of COVID-19, may be underused among persons who are mechanically ventilated. The use of remdesivir and dexamethasone varied across health systems, suggesting variation in patient case mix, drug access, treatment protocols, and quality of care.
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U2 - 10.7326/M21-0857
DO - 10.7326/M21-0857
M3 - Review article
C2 - 34399060
AN - SCOPUS:85118377146
SN - 0003-4819
VL - 174
SP - 1395
EP - 1403
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 10
ER -