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Researchers seek to understand COVID-19 medication trends

COVID-19 Meds

Loren Bonner

Chart depicting overall percentage of hospitalized patients using potential therapeutic option between March 2020 and January 2021.

Overall percentage of hospitalized patients using potential therapeutic option between March 2020 and January 2021.
Source: JAMA Netw Open 2021;4(5):e2110775.

Early in the COVID-19 pandemic, the evolution of therapeutic options to treat hospitalized COVID-19 patients was happening at a rapid clip. Many clinicians expressed feeling like they were practicing in the dark.

“We were monitoring the changes in utilization during [the spring 2020] as we went, and the dynamic shifts we saw in hydroxychloroquine, azithromycin, dexamethasone, and remdesivir were monumental—faster than what any of our clinical team had experienced,” said Jonathan Watanabe, PharmD, PhD, BCGP, lead author of a research letter published May 21, 2021 in JAMA Network on medication use patterns in hospitalized COVID-19 patients in California. “The physicians I worked with marveled at how there has never been a time where you were getting so much information, so fast, from so many different places that was affecting patient care.”

Watanabe and colleague’s cohort study found that in March 2020—early in the COVID-19 pandemic—more than 40% of hospitalized patients were given azithromycin. By June 2020, azithromycin use was below 30%.

“The level of azithromycin use that remained after better studies showed it wasn’t effective in hospitalized [patients] was certainly puzzling to my research team,” said Watanabe, who is a professor of clinical pharmacy at the University of California Irvine School of Pharmacy & Pharmaceutical Science.

Enoxaparin use remained above 50% throughout 2020. Dexamethasone and remdesivir use grew substantially, researchers found. Data were analyzed March 10, 2020, through December 31, 2020.

In early April 2020, more than 40% of patients received hydroxychloroquine. By July 2020, fewer than 10% of all patients had been given that medication, according to the study.

“Early anecdotes and small, limited studies led to the ineffective use of hydroxychloroquine,” said Watanabe. “This was halted fairly early in the pandemic by large, well-designed studies that showed it didn’t work. However, the common denominator was rapid dissemination of medication information changing practice.”

The speed of data both harmed and helped patients receive effective medications, said Watanabe.

He added that the pandemic highlighted the phenomenon of rapid change in the clinical setting based on social media, as well.

“Clinicians were remarking how practice was being altered based on tweets,” said Watanabe.

Study design

The sample data set Watanabe and his colleagues analyzed included 22,896 patients hospitalized with COVID-19. Twenty-eight percent were non-Hispanic white, 37% were Hispanic, 7% were Asian, and 6% were Black. The data set originated from the University of California COVID Research Data Set, which contains COVID-19 treatment information from all five University of California Health medical centers—Davis, Irvine, Los Angeles, San Diego, and San Francisco.

“Our study was much more diverse [greater than 35% Hispanic] than many COVID-19 studies,” said Watanabe. “Why does this matter? Because minority populations have been hit much harder by COVID, so we need data that gives us solutions to treat these populations and prepare for the next public health challenge.”

The researchers said the study represents, to their knowledge, the first analysis of medication use for hospitalized patients with COVID-19 in a large, diverse, statewide health system. At the same time, one limitation of the study is that the demographic characteristics are consistent with one state, and not generalizable to the entire United States.

Going forward

Watanabe said the study findings shed light on what medications need to be maintained in stock at hospitals as well as which ones need to be understood clinically. The speed of data on the safety and effectiveness of the therapeutics cuts both ways, he noted.

“We have to adapt the mindset to ensure that quality evidence reaches the public more quickly, and health data that is more limited is clearly presented to the public with caveats,” Watanabe said.