(149) Trends in COVID-19-Related Medication Use in United States Nursing Homes

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 823

Presenting Author(s)

Andrew R. Zullo, PharmD, PhD
– Associate Professor, Brown University School of Public Health, Brown University, Providence, Rhode Island, United States

Co-Author(s)

Yuan Zhang, MPH
– Data Analyst, Brown University School of Public Health, Providence, Rhode Island, United States
Kaley N. Hayes, PhD
– Assistant Professor, Brown University School of Public Health, Brown University, Providence, Rhode Island, United States
Yoojin Lee
– Director of Programming, Brown University Center for Gerontology and Healthcare Research, Providence, RI, United States

Background: The utilization patterns of potential pharmacologic treatments for COVID-19 have been well-documented for settings other than nursing homes (NHs). Little is known about how treatment patterns have evolved over time in NHs despite the devastating impact of COVID-19 in this setting.

Objectives: To describe the changes in COVID-19-related medication use over time among NH residents in the United States (US).

Methods: This retrospective cohort study used electronic medical records (EMR) from 12 different US NH corporations comprising over 1,100 facilities between Jan 1, 2018 and Sep 30, 2021. Medication orders in the EMR were used to identify the residents with use of medications approved for COVID-19-related conditions or known to be used off-label for COVID-19: atazanavir, azithromycin, dexamethasone, hydroxychloroquine, ivermectin, remdesivir, ritonavir, and tocilizumab. We described the trends in the use of each drug per 1000 NH residents over calendar time (quarters).

Results: The study population included 390,281 NH residents. Azithromycin, dexamethasone, and hydroxychloroquine were the most commonly used COVID-19-related medications. Dexamethasone use remained steady from 2018Q1 to 2020Q2, and then increased sharply from 4 per 1000 individuals in 2020Q2 to a peak of 34 per 1000 individuals in 2020Q4 before quickly decreasing. The use of azithromycin increased from 11 per 1000 individuals in 2019Q3 to a peak of 28 per 1000 individuals in 2020Q4 before decreasing markedly in 2021Q2. Hydroxychloroquine use sharply increased from 3 per 1000 individuals in 2020Q1 to 8 per 1000 individuals in 2020Q2, but otherwise steadily increased from 2 per 1000 individuals in 2019Q1 to 3 per 1000 individuals in 2021Q3. There was no use of remdesivir from 2018Q1 to 2020Q2, then < 1 per 1000 individuals were identified with use from 2020Q3 to 2021Q3.

Conclusions: Use of COVID-19-related medications among US NH residents was volatile over time. Rates of dexamethasone use in NHs changed most dramatically after the onset of the pandemic, increasing more than 8-fold. Azithromycin use nearly tripled during this period. Use of both drugs in NHs decreased to pre-pandemic levels within a year. Hydroxychloroquine use increased only briefly at the start of the pandemic. As in other settings, COVID-19-related medication use in NHs appears to have changed in response to the shifting evidence base and availability of medications.