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

IMPORTANCE:. 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. OBJECTIVES:. To describe the variation and evolution in use of repurposed medications for coronavirus disease 201...

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Autores principales:	Michael A. Garcia, MD, Shelsey W. Johnson, MD, Nicholas A. Bosch, MD, MSc, Emily K. Sisson, MA, Christopher R. Sheldrick, PhD, Vishakha K. Kumar, MD, MBA, Karen Boman, BS, Scott Bolesta, PharmD, Vikas Bansal, MBBS, MPH, Neha Deo, BS, J. P. Domecq, MD, Amos Lal, MD, Amy B. Christie, MD, Valerie M. Banner-Goodspeed, MPH, Devang Sanghavi, MD, MHA, Girish Vadgaonkar, MBBS, Ognjen Gajic, MD, MSc, Rahul Kashyap, MBBS, MBA, Allan J. Walkey, MD, MSc, for the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study Investigators
Formato:	article
Lenguaje:	EN
Publicado:	Wolters Kluwer 2021
Materias:	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/4229d2cd21fe43d581de669661ca16df
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spelling	oai:doaj.org-article:4229d2cd21fe43d581de669661ca16df2021-11-25T07:56:59ZVariation 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 Group2639-802810.1097/CCE.0000000000000566https://doaj.org/article/4229d2cd21fe43d581de669661ca16df2021-11-01T00:00:00Zhttp://journals.lww.com/10.1097/CCE.0000000000000566https://doaj.org/toc/2639-8028IMPORTANCE:. 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. OBJECTIVES:. To describe the variation and evolution in use of repurposed medications for coronavirus disease 2019. DESIGN, SETTING, AND PARTICIPANTS:. 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. MAIN OUTCOMES AND MEASURES:. 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. RESULTS:. 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. CONCLUSIONS AND RELEVANCE:. 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.Michael A. Garcia, MDShelsey W. Johnson, MDNicholas A. Bosch, MD, MScEmily K. Sisson, MAChristopher R. Sheldrick, PhDVishakha K. Kumar, MD, MBAKaren Boman, BSScott Bolesta, PharmDVikas Bansal, MBBS, MPHNeha Deo, BSJ. P. Domecq, MDAmos Lal, MDAmy B. Christie, MDValerie M. Banner-Goodspeed, MPHDevang Sanghavi, MD, MHAGirish Vadgaonkar, MBBSOgnjen Gajic, MD, MScRahul Kashyap, MBBS, MBAAllan J. Walkey, MD, MScfor the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study InvestigatorsWolters KluwerarticleMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENCritical Care Explorations, Vol 3, Iss 11, p e0566 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Michael A. Garcia, MD Shelsey W. Johnson, MD Nicholas A. Bosch, MD, MSc Emily K. Sisson, MA Christopher R. Sheldrick, PhD Vishakha K. Kumar, MD, MBA Karen Boman, BS Scott Bolesta, PharmD Vikas Bansal, MBBS, MPH Neha Deo, BS J. P. Domecq, MD Amos Lal, MD Amy B. Christie, MD Valerie M. Banner-Goodspeed, MPH Devang Sanghavi, MD, MHA Girish Vadgaonkar, MBBS Ognjen Gajic, MD, MSc Rahul Kashyap, MBBS, MBA Allan J. Walkey, MD, MSc for the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study Investigators 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
description	IMPORTANCE:. 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. OBJECTIVES:. To describe the variation and evolution in use of repurposed medications for coronavirus disease 2019. DESIGN, SETTING, AND PARTICIPANTS:. 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. MAIN OUTCOMES AND MEASURES:. 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. RESULTS:. 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. CONCLUSIONS AND RELEVANCE:. 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.
format	article
author	Michael A. Garcia, MD Shelsey W. Johnson, MD Nicholas A. Bosch, MD, MSc Emily K. Sisson, MA Christopher R. Sheldrick, PhD Vishakha K. Kumar, MD, MBA Karen Boman, BS Scott Bolesta, PharmD Vikas Bansal, MBBS, MPH Neha Deo, BS J. P. Domecq, MD Amos Lal, MD Amy B. Christie, MD Valerie M. Banner-Goodspeed, MPH Devang Sanghavi, MD, MHA Girish Vadgaonkar, MBBS Ognjen Gajic, MD, MSc Rahul Kashyap, MBBS, MBA Allan J. Walkey, MD, MSc for the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study Investigators
author_facet	Michael A. Garcia, MD Shelsey W. Johnson, MD Nicholas A. Bosch, MD, MSc Emily K. Sisson, MA Christopher R. Sheldrick, PhD Vishakha K. Kumar, MD, MBA Karen Boman, BS Scott Bolesta, PharmD Vikas Bansal, MBBS, MPH Neha Deo, BS J. P. Domecq, MD Amos Lal, MD Amy B. Christie, MD Valerie M. Banner-Goodspeed, MPH Devang Sanghavi, MD, MHA Girish Vadgaonkar, MBBS Ognjen Gajic, MD, MSc Rahul Kashyap, MBBS, MBA Allan J. Walkey, MD, MSc for the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study Investigators
author_sort	Michael A. Garcia, MD
title	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
title_short	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
title_full	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
title_fullStr	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
title_full_unstemmed	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
title_sort	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
publisher	Wolters Kluwer
publishDate	2021
url	https://doaj.org/article/4229d2cd21fe43d581de669661ca16df
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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

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