Variation in Use of Repurposed Medications Among Patients With Coronavirus Disease 2019. From The Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study: Coronavirus Disease 2019 Registry Investigator Group.
Variation in Use of Repurposed Medications Among Patients With Coronavirus Disease 2019. From The Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study: Coronavirus Disease 2019 Registry Investigator Group.
复制标题
2019年冠状病毒病患者使用重新利用药物的使用变化。从重症监护医学协会发现病毒感染和呼吸道疾病通用研究：2019年冠状病毒疾病登记研究员组。
DOI：
10.1097/cce.0000000000000566
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发表时间：
2021-11
影响因子：
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通讯作者：
Walkey AJ
中科院分区：
文献类型：
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作者：
Garcia MA;Johnson SW;Bosch NA;Sisson EK;Sheldrick CR;Kumar VK;Boman K;Bolesta S;Bansal V;Deo N;Domecq JP;Lal A;Christie AB;Banner-Goodspeed VM;Sanghavi D;Vadgaonkar G;Gajic O;Kashyap R;Walkey AJ
补充数字内容可在文本中找到。在2019年冠状病毒病大流行开始时，在缺乏临床试验证据的情况下，使用了用于治疗2019年冠状病毒病的药物。描述2019年冠状病毒病再利用药物使用的变化和进化。2020年2月15日至2021年4月12日期间，在重症监护医学学会发现病毒感染和呼吸系统疾病通用研究2019冠状病毒病登记处的76家美国和国际医院中，对2019冠状病毒病住院的成人进行观察性队列研究。采用多变量调整随机效应logistic回归模型和无监督聚类对医院变异进行量化。重新使用的药物包括抗病毒药物、皮质类固醇、羟氯喹、免疫调节剂和治疗剂量抗凝剂。在因2019年冠状病毒病住院的7069名成年人中，1979人（28%）接受了抗病毒药物治疗，2876人（41%）接受了皮质类固醇治疗，1779人（25%）接受了羟氯喹治疗，620人（9%）接受了免疫调节剂治疗，2154人（31%）接受了治疗剂量的抗凝剂治疗。医院地点对风险调整变异的贡献为：抗病毒药物46%，皮质类固醇30%，羟氯喹48%，免疫调节剂46%，治疗剂量抗凝剂52%。与早期大流行相比，后期大流行的实践表型趋于一致，抗病毒药物（优势比3.14,95% CI 2.40-4.10）和皮质类固醇（优势比5.43,95% CI 4.23-6.97）的使用增加，羟氯喹（优势比0.02,95% CI 0.01-0.04）和免疫调节剂（优势比0.49,95% CI 0.34-0.70）的使用减少。治疗剂量抗凝剂的使用在临床上无显著变化（优势比1.01;95% CI 1.01 - 1.02）。重新使用药物率高的医院与重新使用药物率低的医院之间的风险调整死亡率没有差异。在大流行早期，各医院在使用再利用药物方面的差异很大，后来随着随机临床试验的出现而趋于一致。在下一次大流行之前，需要开发用于快速激活和纳入重新用途药物临床试验的平台，以加快有效的循证实践。
Supplemental Digital Content is available in the text. At the start of the coronavirus disease 2019 pandemic, medications repurposed for management of coronavirus disease 2019 were used in the absence of clinical trial evidence. To describe the variation and evolution in use of repurposed medications for coronavirus disease 2019. Observational cohort study of adults hospitalized with coronavirus disease 2019 between February 15, 2020, and April 12, 2021, across 76 United States and international hospitals within the Society of Critical Care Medicine’s Discovery Viral Infection and Respiratory Illness Universal Study coronavirus disease 2019 registry. Hospital variation was quantified using multivariable adjusted random effects logistic regression models and unsupervised clustering. Repurposed medications included antivirals, corticosteroids, hydroxychloroquine, immunomodulators, and therapeutic dose anticoagulants. Among 7,069 adults hospitalized with coronavirus disease 2019, 1,979 (28%) received antivirals, 2,876 (41%) received corticosteroids, 1,779 (25%) received hydroxychloroquine, 620 (9%) received immunomodulators, and 2,154 (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 52% for therapeutic dose anticoagulants. Compared with the early pandemic, the later pandemic practice phenotypes converged with increased use of antivirals (odds ratio, 3.14; 95% CI, 2.40–4.10) and corticosteroids (odds ratio, 5.43; 95% CI, 4.23–6.97), with decreased use of hydroxychloroquine (odds ratio, 0.02; 95% CI, 0.01–0.04) and immunomodulators (odds ratio, 0.49; 95% CI, 0.34–0.70). There was no clinically significant change in the use of therapeutic dose anticoagulants (odds ratio, 1.01; 95% CI, 1.01–1.02). There were no differences in risk-adjusted mortality between hospitals with high rates of repurposed medication use compared with hospitals with low rates of use. Hospital variation in the use of repurposed medications varied widely across hospitals early in the pandemic and later converged with the emergence of randomized clinical trials. Platforms developed for rapid activation and enrollment in clinical trials of repurposed medications are needed prior to the next pandemic to expedite effective, evidence-based practice.