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

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Use of Hydroxychloroquine, Remdesivir, and Dexamethasone Among Adults Hospitalized With COVID-19 in the United States
Annals of Internal Medicine ( IF 19.6 ) Pub Date : 2021-08-17 , DOI: 10.7326/m21-0857
Hemalkumar B Mehta ₁ , Huijun An ₁ , Kathleen M Andersen ₁ , Omar Mansour ₂ , Vithal Madhira ₃ , Emaan S Rashidi ₁ , Benjamin Bates ₄ , Soko Setoguchi ₄ , Corey Joseph ₁ , Paul T Kocis ₅ , Richard Moffitt ₆ , Tellen D Bennett ₇ , Christopher G Chute ₈ , Brian T Garibaldi ₉ , G Caleb Alexander ₁₀ ,

Affiliation

Abstract

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.

Primary Funding Source:

National Center for Advancing Translational Sciences; National Heart, Lung, and Blood Institute; and National Institute on Aging.

中文翻译：

美国因 COVID-19 住院的成年人使用羟氯喹、瑞德西韦和地塞米松的情况

**视觉摘要。美国住院成人使用 COVID-19 药物。**
自大流行开始以来，许多药物已被用于治疗 COVID-19。在一项针对 137,870 名确诊或疑似 COVID-19 住院患者的大型多中心队列研究中，研究人员评估了 3 种最广泛使用的药物（羟氯喹、瑞德西韦和地塞米松）使用的时间和机构差异。

抽象的

背景：

在美国，人们对 COVID-19 潜在药物治疗的使用模式知之甚少。

客观的：

利用国家新冠肺炎队列协作组织 (N3C)（一个大型、多中心、纵向队列）来描述羟氯喹、瑞德西韦和地塞米松的整体使用情况以及跨个人、卫生系统和时间的使用情况。

设计：

回顾性队列研究。

环境：

美国有 43 个卫生系统。

参加者：

2020 年 2 月 1 日至 2021 年 2 月 28 日期间，有 137 870 名成年人因 COVID-19 住院。

测量：

住院患者使用羟氯喹、瑞德西韦或地塞米松。

结果：

研究期间，在 137,870 名确诊或疑似 COVID-19 住院患者中，8,754 人（6.3%）接受了羟氯喹治疗，29,272 人（21.2%）接受了瑞德西韦治疗，53,909 人（39.1%）接受了地塞米松治疗。自 6 月中旬 RECOVERY（COVID-19 治疗随机评估）试验结果发布以来，接受过有创机械通气的患者中约有 78% 至 84% 接受了地塞米松或其他糖皮质激素治疗。羟氯喹的使用量在 2020 年 3 月期间有所增加，达到峰值 42%，并于 2020 年 4 月开始下降。相比之下，瑞德西韦和地塞米松的使用量在研究期间逐渐增加。地塞米松和瑞德西韦的使用情况在各个卫生中心差异很大（组内相关系数，地塞米松为 14.2%，瑞德西韦为 84.6%）。