A Descriptive Cohort Study of Drug Utilization Patterns Among Patients Hospitalized With Coronavirus Disease 2019 in the United States, January 2021-February 2022

Sarah E Vititoe; Priya Govil; Aidan Baglivo; Elisha Beebe; Elizabeth M Garry; Nicolle M Gatto; Tamar Lasky; Aloka Chakravarty; Marie C Bradley; Silvia Perez-Vilar; Donna R Rivera; Kenneth Quinto; Andrew Clerman; Anil Rajpal; Vera Frajzyngier

doi:10.1093/ofid/ofad339

A Descriptive Cohort Study of Drug Utilization Patterns Among Patients Hospitalized With Coronavirus Disease 2019 in the United States, January 2021-February 2022

Open Forum Infect Dis. 2023 Jul 10;10(7):ofad339. doi: 10.1093/ofid/ofad339. eCollection 2023 Jul.

Authors

Affiliations

¹ Aetion, Inc, Scientific Research and Strategy, New York, New York, USA.
² Office of the Commissioner, US Food and Drug Administration, Silver Spring, Maryland, USA.
³ Division of Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA.
⁴ Oncology Center of Excellence, US Food and Drug Administration, Silver Spring, Maryland, USA.
⁵ Office of Medical Policy, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA.
⁶ Division of Pulmonology, Allergy, and Critical Care, Office of Immunology and Inflammation, Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA.
⁷ Division of Rheumatology and Transplant Medicine, Office of Immunology and Inflammation, Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA.

PMID: 37496608
PMCID: PMC10368445 (available on 2024-07-10)
DOI: 10.1093/ofid/ofad339

Abstract

Background: There is a dearth of drug utilization studies for coronavirus disease 2019 (COVID-19) treatments in 2021 and beyond after the introduction of vaccines and updated guidelines; such studies are needed to contextualize ongoing COVID-19 treatment effectiveness studies during these time periods. This study describes utilization patterns for corticosteroids, interleukin-6 (IL-6) inhibitors, Janus kinase inhibitors, and remdesivir among hospitalized adults with COVID-19, over the entire hospitalization, and within hospitalization periods categorized by respiratory support requirements.

Methods: This descriptive cohort study included United States adults hospitalized with COVID-19 admitted from 1 January 2021 through 1 February 2022; data included HealthVerity claims and hospital chargemaster. The number and distribution of patients were reported for the first 3 drug regimen lines initiated.

Results: The cohort included 51 066 patients; the most common initial drug regimens were corticosteroids (23.4%), corticosteroids plus remdesivir (25.1%), and remdesivir (4.4%). IL-6 inhibitors and Janus kinase inhibitors were included in later drug regimens and were more commonly administered with both corticosteroids and remdesivir than with corticosteroids alone. IL-6 inhibitors were more commonly administered than Janus kinase inhibitors when patients received high-flow oxygen or ventilation.

Conclusions: These findings provide important context for comparative studies of COVID-19 treatments with study periods extending into 2021 and later. While prescribing generally aligned with National Institutes of Health COVID-19 treatment guidelines during this period, these findings suggest that prescribing preference, potential confounding by indication, and confounding by prior/concomitant use of other therapeutics should be considered in the design and interpretation of comparative studies.

Keywords: COVID-19; Janus kinase inhibitors; drug utilization; interleukin-6 inhibitors.

Published by Oxford University Press on behalf of Infectious Diseases Society of America 2023.