Medication Use Among Patients With COVID‐19 in a Large, National Dataset: Cerner Real‐World Data™

Abstract

Purpose The outbreak of the novel coronavirus (COVID-19) required clinicians to use knowledge of therapeutic mechanisms of established drugs to piece together treatment regimens. The purpose of this study is to examine the trends in medication utilization among COVID-19 patients across the United States using a national dataset. Methods We conducted a cross-sectional study of the COVID-19 cohort in the Cerner Real-World Data ™ warehouse, which includes de-identified patient information for encounters associated with COVID-19 from December 1, 2019 through June 30, 2020. The primary variables of interest were medications given to patients during their inpatient COVID-19 treatment. We also collected demographics, calculated the proportion of patients with each medication, and stratified by demographic variables. Findings Our sample included 51,169 inpatients from every region of the United States. Males and females were equally represented, and the majority of patients were white and non-Hispanic. The largest proportion of patients were older than 45 years old. Steroids had the highest utilization among all patients (56.5%), followed by hydroxychloroquine (17.4%), tocilizumab (3.1%), and lopinavir/ritonavir (1.1%). We found substantial variation in medication utilization by region, race, ethnicity, sex, age and insurance status. Implications Variations in medication use are likely attributable to multiple factors, including the timing of the pandemic by region in the United States and processes by which medications are introduced and disseminated. This study is the first of its kind to assess trends in medication utilization in a national dataset and is the first large descriptive study of pharmacotherapy in hospitalized COVID-19 patients. It provides an important glimpse into prescribing patterns during a novel pandemic.

Prescription Patterns of Drugs Given to Hospitalized COVID-19 Patients: A Cross-Sectional Study in Colombia

“…This analysis allowed us to characterize the hospital pharmacological treatment of a group of patients with a confirmed diagnosis of COVID-19 treated in eight cities of Colombia. In general, most of the findings of this report regarding sociodemographic data, comorbidities and pharmacological treatment were consistent with what has been described in other studies carried out in the world [13][14][15][16][17][18][19][20][21][22]. The median age was similar to that found in other studies (55.0-60.0 years) [13,14,23] and lower than that reported by others (50.4-68.1 years) [19][20][21][22]24], with a predominance of men, as identified in the majority of studies [13,14,20,[22][23][24][25][26], which may be due to biological factors such as genes, sex hormones and microbiome that may influence the host immune responses to infections [27]; though some reports have had a higher proportion of women (51.2-64.6%) [15,16,28].…”

“…In general, most of the findings of this report regarding sociodemographic data, comorbidities and pharmacological treatment were consistent with what has been described in other studies carried out in the world [13][14][15][16][17][18][19][20][21][22]. The median age was similar to that found in other studies (55.0-60.0 years) [13,14,23] and lower than that reported by others (50.4-68.1 years) [19][20][21][22]24], with a predominance of men, as identified in the majority of studies [13,14,20,[22][23][24][25][26], which may be due to biological factors such as genes, sex hormones and microbiome that may influence the host immune responses to infections [27]; though some reports have had a higher proportion of women (51.2-64.6%) [15,16,28]. The most frequently found comorbidities were arterial hypertension, diabetes mellitus, and chronic obstructive pulmonary disease, in line with other studies [13,14,[20][21][22][23][24]29].…”

“…Most patients received some systemic corticosteroids, similar to earlier reports (56.5-69.7%) [15][16][17]23,34] but contrasting with others that prescribed them less often [19,24,25]. The most often prescribed one was dexamethasone, consistent with what was found in the United States and Colombia [16,24,33,34] but different from what was found in Spain and Peru, where the use of methylprednisolone predominated [17,25,28], and in Pakistan, where hydrocortisone predominated [26].…”

“…Tocilizumab is another drug that has growing evidence in favor of its use [36,37]. In this report, it was prescribed in a small portion of the patients, contrasting with the 3.1-10.8% in other studies [13,15,18,24,28]. Some guidelines recommend it in combination with systemic corticosteroids for hospitalized adults who have rapid respiratory decompensation due to COVID-19 [36,37].…”

“…There were evident differences in the prescription of these drugs between men and women, by age group, and by geographical region of the country. This dynamic is not unheard of [15,24]. For example, in two studies conducted in the US, Stroever et al found that the prescription of corticosteroids predominated in women, and the use of medications such as hydroxychloroquine, tocilizumab, lopinavir/ritonavir, and corticosteroids increased with age up to 65 years.…”