Introduction

Concomitant experimental/compassionate drug administration has been all-pervasive in the treatment of COVID-19 patients. The objective of this study was to study the relationship between patient severity, the number of experimental/compassionate medications received (main outcome measure), and patient outcomes [survival to hospital discharge and length of hospital stay (LOS)].

Methods

Retrospective analysis of data collected in real time during the first pandemic wave in a tertiary care hospital. Data included patient demographics, comorbidities, admission vital signs, laboratory values, most extreme respiratory intervention during hospitalization, and data regarding treatment with compassionate/experimental drugs during their stay.

Results

Overall, 292 PCR-confirmed patients with symptoms of COVID-19 were studied (March/April, 2020). Increasing respiratory support correlated with both LOS and mortality. Patients were more likely to receive more than 1 experimental/compassionate drugs as respiratory support escalated, ranging from 3% (n = 4/136) among patients on room air to 77.3% (n = 17/22) of mechanically ventilated/ECMO patients (P < 0.001, linear by linear association). The mean number of experimental/compassionate drugs received also increased with escalating respiratory support (P < 0.001, one-way ANOVA). After adjustment for severity of patient condition, administration of more experimental/compassionate drugs was unrelated to survival (P = 0.24), but was related to increased LOS (P < 0.001).

Conclusion

Patients that were hospitalized in worse condition were more likely to receive more experimental/compassionate drugs. Treatment was unrelated to survival but may have been related to LOS. This finding raises questions regarding the results of studies on medication effects that adjusted for multiple drug administration.

中文翻译：

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COVID-19 大流行第一波期间的实验性和同情用药：一项回顾性单中心研究

介绍

伴随的实验性/同情性药物给药在 COVID-19 患者的治疗中无处不在。本研究的目的是研究患者严重程度、接受的实验性/同情性药物的数量（主要结果测量）和患者结果 [出院存活率和住院时间 (LOS)] 之间的关系。

方法

对三级医院第一波大流行期间实时收集的数据进行回顾性分析。数据包括患者人口统计学、合并症、入院生命体征、实验室值、住院期间最极端的呼吸干预，以及住院期间使用同情/实验药物治疗的数据。

结果

总体而言，研究了 292 名具有 COVID-19 症状的 PCR 确诊患者（2020 年 3 月/4 月）。增加呼吸支持与 LOS 和死亡率相关。随着呼吸支持的升级，患者更有可能接受超过 1 种实验性/同情性药物，范围从 使用室内空气的患者的3% ( n = 4/136) 到 机械通气/ECMO 患者的77.3% ( n = 17/22) （P  < 0.001，线性关联）。接受的实验/同情药物的平均数量也随着呼吸支持的增加而增加（P  < 0.001，单向方差分析）。根据患者病情的严重程度调整后，给予更多的实验性/同情性药物与生存无关（P = 0.24），但与增加的 LOS 相关（P  < 0.001）。

结论

住院条件较差的患者更有可能接受更多的实验性/同情性药物。治疗与生存无关，但可能与 LOS 相关。这一发现对针对多种药物给药进行调整的药物效应研究结果提出了质疑。