Shelsey Johnson, MD
Fellow
Boston Medical Center
Boston, Massachusetts
Disclosure information not submitted.
Nicholas Bosch, MD, MSc
Pulmonary and Critical Care Physician
Boston University School of Medicine
Boston, Massachusetts, United States
Disclosure information not submitted.
Emily Sisson
Data Analyst
Boston University School of Public Health, United States
Disclosure information not submitted.
Christopher Sheldrick, PhD
Data Analyst
Boston University School of Public Health, United States
Disclosure information not submitted.
Vishakha Kumar, MD, MBA
Society of Critical Care Medicine
Mount Prospect, Illinois
Disclosure information not submitted.
Karen Boman
Business Analyst
Society of Critical Care Medicine, United States
Disclosure information not submitted.
Scott Bolesta, PharmD, FCCM
Professor
Nesbitt College of Pharmacy at Wilkes University
Wilkes Barre, Pennsylvania
Disclosure information not submitted.
Vikas Bansal, MPH, MBBS
Research Fellow
Mayo Clinic
Rochester, Minnesota
Disclosure information not submitted.
Neha Deo, BS
Medical Student
Mayo Clinic Alix School of Medicine
Disclosure information not submitted.
Juan Pablo Domecq Garces, MD
Assistant Professor of Medicine
Mayo Clinic College of Medicine
North Mankato, Minnesota, United States
Disclosure information not submitted.
Amos Lal, MBBS, FACP (he/him/his)
Fellow, Critical Care Medicine
Mayo Clinic
Rochester, Minnesota
Disclosure information not submitted.
Amy Christie, MD
Surgical Critical Care Physician
Atrium Health Navicent, United States
Disclosure information not submitted.
Valerie Banner-Goodspeed, MPH
Clinical Research Administrator
Beth Israel Deaconess Medical Center, United States
Disclosure information not submitted.
Devang Sanghavi, MD, MHA
Mayo Clinic Hospital Jacksonville
Jacksonville, Florida
Disclosure information not submitted.
Girish Vadgaonkar, MBBS
Internal Medicine Physician
BSES MG Hospital, United States
Disclosure information not submitted.
Ognjen Gajic, MD
Professor
Mayo Clinic
Rochester, Minnesota, United States
Disclosure information not submitted.
Rahul Kashyap, MD, MBA,
Medical Director Research
Wellspan Health-York Hospital
York, Pennsylvania
Disclosure information not submitted.
Allan Walkey, MD (he/him/his)
Professor of Medicine
Boston University
Boston, Massachusetts, United States
Disclosure information not submitted.
Title: Variation in use of repurposed medications among patients with COVID-19
Introduction: In the absence of evidenced-based guidelines, the use of medications repurposed for management of patients with COVID-19 likely varied idiosyncratically and practice patterns of use have not been well-characterized. We aimed to describe the variation and evolution in use of medications repurposed for management of patients hospitalized with COVID-19.
Methods: Observational cohort study of adults hospitalized with COVID-19 between February 15th 2020 and April 12th 2021 across 76 United States and international hospitals using the Society of Critical Care Medicine's Discovery Viral Infection and Respiratory Illness Universal Study COVID-19 registry. Repurposed medications, including antivirals, corticosteroids, hydroxychloroquine, immunomodulators and therapeutic dose anticoagulants were evaluated using multivariable adjusted random effects logistic regression models and unsupervised clustering.
Results: Among 7069 adults hospitalized with COVID-19, 1979 (28%) received antivirals, 2876 (41%) received corticosteroids, 1779 (25%) received hydroxychloroquine, 620 (9%) received immunomodulators and 2154 (31%) received therapeutic dose anticoagulants. Contribution of hospital site to risk-adjusted variation was 46% for antivirals, 30% for corticosteroids, 48% for hydroxychloroquine, 46% for immunomodulators, and 19% for therapeutic dose anticoagulants. Compared to the early pandemic, the later pandemic period was associated with increased use of antivirals (OR 3.14, 95% CI 2.40,4.10), and corticosteroids (OR 5.43, 95% CI 4.23,6.97), with decreased use of hydroxychloroquine (OR 0.02, 95% CI 0.01,0.04) and immunomodulators (OR 0.49, 95% CI 0.34,0.70). There was no clinically significant change in the use of therapeutic dose anticoagulants (OR 1.01, 95% CI 1.01,1.02). Hospital practice phenotypes decreased from 9 to 2 clusters from early to later pandemic stages.
Conclusions: Hospital variation in use of repurposed medications for management of COVID-19 varied widely across hospitals early in the pandemic, and converged in the later stage with the emergence of randomized clinical trials.