Principal Scientist II Aetion, Inc. Brooklyn, United States
Background: There is a dearth of drug utilization studies describing how COVID-19 treatment patterns evolved once vaccines and updated guidelines were introduced to the treatment landscape; such studies are needed for design and interpretation of observational COVID-19 treatment effectiveness studies with study periods extending into 2021 and beyond.
Objectives: This study describes utilization patterns for corticosteroids (CS), interleukin-6, inhibitors (IL-6i), Janus kinase inhibitors (JAKi), and remdesivir (RDV) among hospitalized adults with COVID-19, overall and by respiratory support required.
Methods: This was a descriptive cohort study of U.S. adults hospitalized with COVID-19 admitted from January 1, 2021 through February 1, 2022. Data included claims and hospital chargemaster data (HealthVerity) to allow for capture of inpatient treatment with CS, IL-6i, JAKi, and RDV. The number and distribution of patients were reported for up to the first three drug/drug regimen lines initiated.
Results: The analytic cohort included 51,066 hospitalized patients with COVID-19, The most common initial drug regimens were CS (23.4%), CS with RDV (25.1%), and RDV (4.4%). IL-6is and JAKis were often included in subsequent drug regimens and more commonly administered with both CS and RDV than with CS alone. While the distribution of patients initiating IL-6i and JAKi as add-on therapies to CS or CS with RDV was similar, IL-6is were more commonly administered than JAKi when patients received high flow oxygen, mechanical ventilation, or extracorporeal membrane oxygenation. While JAKi were not recommended for patients receiving invasive mechanical ventilation or extracorporeal membrane oxygenation during the study period, their use was observed among those patients.
Conclusions: These findings provide important context for comparative studies of COVID-19 inpatient treatments with study periods extending into 2021 and later. Pharmacological management of patients was generally in line with National Institutes of Health COVID-19 treatment guidelines. However, the treatment patterns suggest that prescribing preference and potential confounding by indication, should be considered in the design and interpretation of comparative effectiveness studies. Studies of drugs often initiated later in hospitalization (i.e., IL6-is and JAKis) should also consider prior/concomitant use of other therapeutics as potential confounding factors.
