(P) In-Hospital Treatment Patterns Among Patients Hospitalized with COVID-19 in the United States

Publication Number: 640

Background: Treatments for hospitalized COVID-19 patients remain important due to emerging variants, waning vaccine effectiveness, and suboptimal vaccine uptake. Several COVID-19 treatments have received emergency use authorization (EUA) by the FDA, including remdesivir in May 2020. Several studies have described the use of individual treatments, but few have described treatment patterns over the course of hospitalization.

Objectives: To describe COVID-19 treatment patterns for hospitalized patients in the United States.

Methods: Using hospital chargemaster data from 297 hospitals in the United States, we identified adults admitted with a COVID-19 diagnosis between February 2020 and November 2021. Treatments (aspirin, dexamethasone, antivirals, remdesivir, biologics, convalescent plasma) were identified by NDC codes and text search. We used Sankey diagrams to visualize treatment pathways and patient disposition over the course of a hospitalization. We estimated the cross-sectional proportion of treatment states, discharge, and death at admission, and 1-, 2-, 5-, 15-, and 30-days after admission. When patients entered the discharge or death state, they remained in that state until the final time point. We created one Sankey diagram that included all admitted patients, and monthly Sankey diagrams to visualize patients admitted each calendar month of our study period.

Results: The study consisted of 380708 admitted patients. On the day of admission, overall 14% of patients received remdesivir, 27% received dexamethasone, and 52% were untreated. By day 30, 84% of patients were discharged and 12% of patients had died. From March 2020 to October 2021, the proportion of untreated patients decreased from 93% to 45%, and the proportion of in-hospitality mortality at 30 days decreased from 21% to 12%. A higher proportion of rural hospital patients were untreated compared to urban (56% vs. 51%), but rural hospitals had a higher proportion of patients treated with remdesivir (18% vs. 13%). Of patients administered remdesivir at admission, by day 2 66% persist and 22% switch to dexamethasone. Remdesivir use grew from < 1% in May 2020 to a peak of 22% in July 2021. Antivirals, biologics, and convalescent plasma use remained low, under 1% each.

Conclusions: In a cohort of hospitalized COVID-19 patients, the proportion of patients untreated at admission and in-hospital mortality decreased over the course of the pandemic. Dexamethasone was the most common treatment overall, but remdesivir was most common in rural hospitals. After the EUA, remdesivir use increased substantially, but persistence was low, with one-third discontinuing by day 2. Patients discontinuing remdesivir commonly switched to dexamethasone.