Drug use in hospitalized patients with COVID-19

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Patterns of COVID-19 drug use at UC Health medical facilities tracked by UCI and UCSD Medical School researchers during the course of the coronavirus pandemic in 2020. Credit: Jonathan Watanabe / UCI

A record of drug use patterns gathered by an interdisciplinary team of researchers from the University of California, Irvine and the University of San Diego School of Medicine, reveals the thinking, care, and scientific rigor of physicians in the United States. UC Health medical centers applied in the treatment of patients with COVID -19 in 2020.

For a study published today in JAMA network open, the researchers examined data on the use rates of 10 different drugs and categories of drugs to map how drugs were used in people hospitalized with the viral infection.

The authors obtained their data from the University of California’s COVID research data set and tracked 22,896 patients admitted to UC Health medical centers in Davis, Irvine, Los Angeles, San Diego and San Francisco between March 10 and December 31, 2020.

“The publication of this paper is really in the figures based on the UC CORDS database,” said lead author Jonathan Watanabe, a professor of clinical pharmacy at UCI. “You can clearly see how the use of certain medications grew or decreased throughout the pandemic and how these moves were related to the evidence-based decisions made by UC healthcare providers in real time. You can monitor the way we treat our sickest patients. “

A clear example can be seen in the changing acceptance of hydroxychloroquine antimicrobial medication, which was the subject of public debate at White House briefings and significant media attention. In the early stages of the pandemic, the drug was administered to more than 40% of patients, but in June use was less than 5%. The use of another drug of this class, azithromycin, fell from 40 to 30 percent in that same period of time.

“There were some studies done in the first part of the pandemic that were not particularly well designed and had a limited size that seemed to show that hydroxychloroquine was useful,” said Watanabe, who is also the founding associate dean of the UCI. in evaluation and quality in pharmacies School of Pharmacy and Pharmaceutical Sciences of the UCI. “We saw high drug use at first, but then it grew, because as time went on and higher quality trials came along, it proved to be ineffective.”

The opposite can be seen with dexamethasone, which went from being administered to 1.4% of patients per day on March 31 to 67.5% at the end of December. According to Watanabe, generic and economical corticosteroid was found to be effective in large trials in patients hospitalized in the UK.

“At first glance, a lot of people might say you wouldn’t want to use a corticosteroid that could theoretically reduce the in a COVID patient, “he said.” But trials showed that the response-action mechanism was not correct in this case: the anti-inflammatory effect of the drug to tame cytokine storms was clearly more important than any other the strength of the immune response. “

The use of remdesivir grew 12-fold, from 4.9% on June 1 to 62.5% on December 31. and was more widely distributed as time went on.

Enoxaparin, which is used to treat and prevent thrombosis, has also been shown to be effective against COVID-19, of which blood clots are a common symptom. The drug remained above 50% use throughout 2020.

“We tend to put hospitalized patients in general with an anticoagulant to reduce the risk of clots, which can happen because they may be standing still in place for long stretches,” Watanabe said. “But then we started noticing thrombophilia in patients with COVID, so both enoxaparin and heparin were very important not only as prophylaxis but as treatments.”

He noted that the figures for the use of the document show how doctors and other health professionals responded effectively to tests and their own observations in real time and that this information is important for doctors to know for planning purposes. future both in treatment decision-making and in ensuring a robust supply of proven drugs.

“That JAMA the study is a reflective chronicle of the steps doctors, nurses and UC Health medical staff took to help patients with a life-threatening illness, “said Jan Hirsch, founding dean of the Faculty of Pharmacy and Pharmaceutical Sciences. of the ICU. ” , not much was known about the proper course of treatment for COVID-19, but our people learned quickly and responded to tests on what was effective on a daily basis and sometimes even more frequently. ”


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More information:
JAMA network open (2021). DOI: 10.1001 / jamanetworkopen.2021.10775

Citation: Drug Use in Hospitalized Patients with COVID-19 (2021, May 21) Retrieved May 21, 2021 at https://medicalxpress.com/news/2021-05-medication-hospitalized-patients-covid-.html

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