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Pharmacotherapy prescribing pattern and outcome for hospitalized patients with severe and critical COVID-19

Assad, H., Current Issues in Pharmacy and Medical Sciences, doi:10.2478/cipms-2022-0020
Oct 2022  
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Mortality 60% Improvement Relative Risk HCQ for COVID-19  Assad et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 291 patients in Iraq (June - September 2020) Lower mortality with HCQ (p=0.0019) c19hcq.org Assad, H., Current Issues in Pharmacy .., Oct 2022 FavorsHCQ Favorscontrol 0 0.5 1 1.5 2+
HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
 
*, now with p < 0.00000000001 from 411 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,300+ studies for 75 treatments. c19hcq.org
Retrospective 346 hospitalized patients in Iraq, showing lower mortality with HCQ in unadjusted results. HCQ results are only provided within the 93% of patients treated with enoxaparin.
This study is excluded in the after exclusion results of meta analysis: unadjusted results with no group details; confounding by time possible, propensity to use HCQ changed significantly during the study period.
risk of death, 59.7% lower, RR 0.40, p = 0.002, treatment 9 of 72 (12.5%), control 68 of 219 (31.1%), NNT 5.4, enoxaparin+HCQ vs. enoxaparin.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Assad et al., 21 Oct 2022, retrospective, Iraq, peer-reviewed, 1 author, study period June 2020 - September 2020. Contact: hayderc.allami@uokufa.edu.iq.
This PaperHCQAll
Pharmacotherapy prescribing pattern and outcome for hospitalized patients with severe and critical COVID-19
Hayder Assad
Current Issues in Pharmacy and Medical Sciences, doi:10.2478/cipms-2022-0020
INTRODUCTION Coronavirus Disease 2019 (COVID-19) is a pandemic disease originating in late 2019 in the People's Republic of China that spread rapidly worldwide [1]. The first reported case in the Najaf governorate, Iraq, was confirmed on February 24, 2020 [2]. As of early June 2021, the global reported cases of COVID-19 have exceeded 170 million with over 3 million deaths [3]. The clinical spectrum of this illness ranges from asymptomatic infection, to acute respiratory distress syndrome (ARDS), circulatory shock, multiorgan failure, and ultimately death [4] . The death rate related to COVID-19 is relatively high -ranging from 5% to 35%, especially in elderly patients and those who have comorbidities [5] . Although different treatment strategies have been explored and used based on emergency approval and evidence-based
ORCID iDs Hayder Assad https://orcid.org/0000-0003-3499-3007
References
Alsharidah, Ayed, Ameen, Alhuraish, Rouheldeen et al., COVID-19 convalescent plasma treatment of moderate and severe cases of SARS-CoV-2 infection: A multicenter interventional study, Int J Infect Dis
Arshad, Kilgore, Chaudhry, Jacobsen, Wang et al., Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19, Int J Infect Dis
Bajwah, Wilcock, Towers, Costantini, Bausewein et al., Managing the supportive care needs of those affected by COVID-19, Eur Respir J
Beigel, Tomashek, Dodd, Mehta, Zingman et al., Remdesivir for the treatment of COVID-19 -Final Report, N Engl J Med
Best, Kong, Kaplan-Lewis, Brawley, Baden et al., Treatment patterns in US patients hospitalized with COVID-19 and pulmonary involvement, J Med Virol
Campos Dm De, Fulco, De Oliveira, Oliveira, SARS-CoV-2 virus infection: Targets and antiviral pharmacological strategies, J Evid Based Med
Chappell, Horby, Lim, Emberson, Mafham et al., Dexamethasone in hospitalized patients with COVID-19 -preliminary report, N Engl J Med
Chibber, Haq, Ahmed, Andrabi, Singh, Advances in the possible treatment of COVID-19: A review, Eur J Pharmacol
Freedberg, Conigliaro, Wang, Tracey, Callahan et al., Famotidine use is associated with improved clinical outcomes in hospitalized COVID-19 patients: A propensity score matched retrospective cohort study, Gastroenterol
Kewan, Covut, Mj, Rose, Gopalakrishna et al., Tocilizumab for treatment of patients with severe COVID-19: A retrospective cohort study, E Clinical Medicine
Lin, Schneeweiss, Tesfaye, Andrea, Liu et al., Pharmacotherapy for hospitalized patients with COVID-19: Treatment patterns by disease severity, Drugs
Mk, Ma, Incidence of the COVID-19 in Iraq -Implications for travellers, Travel Med Infect Dis
Padhy, Mohanty, Das, Meher, Therapeutic potential of ivermectin as add on treatment in COVID 19: A systematic review and meta-analysis, J Pharm Pharm Sci
Phelan, Katz, Lo, The Novel Coronavirus Originating in Wuhan, China: Challenges for Global Health Governance, JAMA
Rattanaumpawan, Jirajariyavej, Lerdlamyong, Palavutitotai, Saiyarin, Real-world experience with favipiravir for treatment of COVID-19 in Thailand: Results from a multi-center observational study, doi:10.1101/2020.06.24.20133249
Richardson, Hirsch, Narasimhan, Crawford, Mcginn et al., Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area, JAMA
Sahebnasagh, Avan, Saghafi, Mojtahedzadeh, Sadremomtaz et al., Pharmacological treatments of COVID-19, Pharmacol Rep
Salazar, Christensen, Graviss, Nguyen, Castillo et al., Treatment of Coronavirus Disease 2019 patients with convalescent plasma reveals a signal of significantly decreased mortality, Am J Pathol
Sanders, Monogue, Jodlowski, Cutrell, Pharmacologic treatments for Coronavirus Disease 2019 (COVID-19): A review, JAMA
Wang, Hu, Hu, Zhu, Liu et al., Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China, JAMA
Wang, Zhang, Du, Du, Zhao et al., Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebocontrolled, multicentre trial, Lancet
Watanabe, Kwon, Abeles, Jia, Mehta, Medication use patterns in hospitalized patients with COVID-19 in California During the pandemic, JAMA Netw Open
Who, None
Who, None
Zanasi, Mazzolini, Kantar, A reappraisal of the mucoactive activity and clinical efficacy of bromhexine, Multidiscip Respir Med
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Therefore, authors designed this study to assess prescribing patterns and the ' 'clinical outcome for hospitalized patients with severe and critical COVID-19 so as to ' 'determine the most effective approach.</jats:p>\n' ' <jats:p>Authors conducted a retrospective observational study on 346 adult ' 'patients with either severe or critical COVID-19, who were admitted to public hospitals in ' 'Al-Najaf city, Iraq from June to September 2020. Patients’ information, medications and ' 'outcomes were collected from their medical records in the registered office of the ' 'hospital.</jats:p>\n' ' <jats:p>A total of 346 patients were enrolled, with a majority of patients ' 'being adults above 35 years old and male (70.2%). Most patients (81%) received corticosteroid ' 'as dexamethasone, and about 45% of all patients were given convalescent plasma therapy, while ' 'a few patients were prescribed antiviral favipiravir (23%) and lopinavir/ritonavir (19%). As ' 'supportive care medications, anticoagulant such as enoxaparin was administered to most of the ' 'patients (93%) and more than half of all patients received the broad-spectrum antibiotic, ' 'meropenem.</jats:p>\n' ' <jats:p>The majority of the patients recovered and were discharged alive ' '(66%), however, the in- hospital mortality rate was 26%. Interestingly, patients treated with ' 'enoxaparin alone or in combination with hydroxychloroquine were associated with better ' 'outcome.</jats:p>\n' ' <jats:p>The prescribing pattern of COVID-19 specific medications and ' 'supportive care is aligned with guideline recommendations and associated with a beneficial ' 'therapeutic outcome.</jats:p>', 'DOI': '10.2478/cipms-2022-0020', 'type': 'journal-article', 'created': { 'date-parts': [[2022, 10, 21]], 'date-time': '2022-10-21T13:20:19Z', 'timestamp': 1666358419000}, 'source': 'Crossref', 'is-referenced-by-count': 0, 'title': 'Pharmacotherapy prescribing pattern and outcome for hospitalized patients with severe and ' 'critical COVID-19', 'prefix': '10.2478', 'volume': '0', 'author': [ { 'ORCID': 'http://orcid.org/0000-0003-3499-3007', 'authenticated-orcid': False, 'given': 'Hayder', 'family': 'Assad', 'sequence': 'first', 'affiliation': [ { 'name': 'Department of Clinical Pharmacy, Faculty of Pharmacy , ' 'University of Kufa , Najaf , Iraq'}]}], 'member': '374', 'published-online': {'date-parts': [[2022, 10, 21]]}, 'reference': [ { 'key': '2022102203230152355_j_cipms-2022-0020_ref_001', 'doi-asserted-by': 'crossref', 'unstructured': '1. Phelan AL, Katz R, Gostin LO. The Novel Coronavirus Originating in ' 'Wuhan, China: Challenges for Global Health Governance. JAMA. ' '2020;323(8):709-10.10.1001/jama.2020.109731999307', 'DOI': '10.1001/jama.2020.1097'}, { 'key': '2022102203230152355_j_cipms-2022-0020_ref_002', 'doi-asserted-by': 'crossref', 'unstructured': '2. Al-Malkey MK, Al-Sammak MA. Incidence of the COVID-19 in Iraq – ' 'Implications for travellers. Travel Med Infect Dis. ' '2020;38:101739.10.1016/j.tmaid.2020.101739721936332405265', 'DOI': '10.1016/j.tmaid.2020.101739'}, { 'key': '2022102203230152355_j_cipms-2022-0020_ref_003', 'unstructured': '3. WHO; 2021. [https://covid19.who.int/] (access: 04 June 2021)'}, { 'key': '2022102203230152355_j_cipms-2022-0020_ref_004', 'doi-asserted-by': 'crossref', 'unstructured': '4. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical ' 'characteristics of 138 hospitalized patients with 2019 novel ' 'coronavirus-infected pneumonia in Wuhan, China. JAMA. ' '2020;323(11):1061-9.10.1001/jama.2020.1585704288132031570', 'DOI': '10.1001/jama.2020.1585'}, { 'key': '2022102203230152355_j_cipms-2022-0020_ref_005', 'doi-asserted-by': 'crossref', 'unstructured': '5. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, ' 'Davidson KW, et al. Presenting characteristics, comorbidities, and ' 'outcomes among 5700 patients hospitalized with COVID-19 in the New York ' 'City area. JAMA. ' '2020;323(20):2052-9.10.1001/jama.2020.6775717762932320003', 'DOI': '10.1001/jama.2020.6775'}, { 'key': '2022102203230152355_j_cipms-2022-0020_ref_006', 'doi-asserted-by': 'crossref', 'unstructured': '6. Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB. Pharmacologic ' 'treatments for Coronavirus Disease 2019 (COVID-19): A review. JAMA. ' '2020;323(18):1824-36.10.1001/jama.2020.601932282022', 'DOI': '10.1001/jama.2020.6019'}, { 'key': '2022102203230152355_j_cipms-2022-0020_ref_007', 'doi-asserted-by': 'crossref', 'unstructured': '7. Bajwah S, Wilcock A, Towers R, Costantini M, Bausewein C, Simon ST, ' 'et al. Managing the supportive care needs of those affected by COVID-19. ' 'Eur Respir J. ' '2020;55(4):2000815.10.1183/13993003.00815-2020714426832269090', 'DOI': '10.1183/13993003.00815-2020'}, { 'key': '2022102203230152355_j_cipms-2022-0020_ref_008', 'doi-asserted-by': 'crossref', 'unstructured': '8. Campos DM de O, Fulco UL, de Oliveira CBS, Oliveira JIN. SARSCoV-2 ' 'virus infection: Targets and antiviral pharmacological strategies. J ' 'Evid Based Med. 2020;13(4):255-60.10.1111/jebm.12414767531533058394', 'DOI': '10.1111/jebm.12414'}, { 'key': '2022102203230152355_j_cipms-2022-0020_ref_009', 'doi-asserted-by': 'crossref', 'unstructured': '9. Sahebnasagh A, Avan R, Saghafi F, Mojtahedzadeh M, Sadremomtaz A, ' 'Arasteh O, et al. Pharmacological treatments of COVID-19. Pharmacol Rep. 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WHO; 2021.[https://www.who.int/] (access: 28 June 2021)'}, { 'key': '2022102203230152355_j_cipms-2022-0020_ref_013', 'doi-asserted-by': 'crossref', 'unstructured': '13. Best JH, Kong AM, Kaplan-Lewis E, Brawley OW, Baden R, Zazzali JL, ' 'et al. Treatment patterns in US patients hospitalized with COVID-19 and ' 'pulmonary involvement. J Med Virol. 2021;93:5367-75.10.1002/jmv.27049', 'DOI': '10.1002/jmv.27049'}, { 'key': '2022102203230152355_j_cipms-2022-0020_ref_014', 'doi-asserted-by': 'crossref', 'unstructured': '14. Chibber P, Haq SA, Ahmed I, Andrabi NI, Singh G. Advances in the ' 'possible treatment of COVID-19: A review. Eur J Pharmacol. ' '2020;883:173372.10.1016/j.ejphar.2020.173372', 'DOI': '10.1016/j.ejphar.2020.173372'}, { 'key': '2022102203230152355_j_cipms-2022-0020_ref_015', 'doi-asserted-by': 'crossref', 'unstructured': '15. Lin KJ, Schneeweiss S, Tesfaye H, D’Andrea E, Liu J, Lii J, et al. ' 'Pharmacotherapy for hospitalized patients with COVID-19: Treatment ' 'patterns by disease severity. Drugs. ' '2020;80(18):1961-72.10.1007/s40265-020-01424-7', 'DOI': '10.1007/s40265-020-01424-7'}, { 'key': '2022102203230152355_j_cipms-2022-0020_ref_016', 'unstructured': '16. Centers for Disease Control and Prevention. Guidance for COVID-19. ' '[https://www.cdc.gov/coronavirus/2019-ncov/communication/guidance.html] ' '(access: 27 June 0 2021).'}, { 'key': '2022102203230152355_j_cipms-2022-0020_ref_017', 'doi-asserted-by': 'crossref', 'unstructured': '17. Watanabe JH, Kwon J, Nan B, Abeles SR, Jia S, Mehta SR. Medication ' 'use patterns in hospitalized patients with COVID-19 in California During ' 'the pandemic. JAMA Netw Open. ' '2021;4(5):e2110775.10.1001/jamanetworkopen.2021.10775', 'DOI': '10.1001/jamanetworkopen.2021.10775'}, { 'key': '2022102203230152355_j_cipms-2022-0020_ref_018', 'doi-asserted-by': 'crossref', 'unstructured': '18. 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' '[https://doi.org/10.1101/2020.06.24.20133249]10.1101/2020.06.24.20133249', 'DOI': '10.1101/2020.06.24.20133249'}, { 'key': '2022102203230152355_j_cipms-2022-0020_ref_021', 'doi-asserted-by': 'crossref', 'unstructured': '21. Salazar E, Christensen PA, Graviss EA, Nguyen DT, Castillo B, Chen ' 'J, et al. Treatment of Coronavirus Disease 2019 patients with ' 'convalescent plasma reveals a signal of significantly decreased ' 'mortality. Am J Pathol. ' '2020;190(11):2290-303.10.1016/j.ajpath.2020.08.001741790132795424', 'DOI': '10.1016/j.ajpath.2020.08.001'}, { 'key': '2022102203230152355_j_cipms-2022-0020_ref_022', 'doi-asserted-by': 'crossref', 'unstructured': '22. Alsharidah S, Ayed M, Ameen RM, Alhuraish F, Rouheldeen NA, ' 'Alshammari FR, et al. COVID-19 convalescent plasma treatment of moderate ' 'and severe cases of SARS-CoV-2 infection: A multicenter interventional ' 'study. Int J Infect Dis. ' '2021;103:439-46.10.1016/j.ijid.2020.11.198771777233285283', 'DOI': '10.1016/j.ijid.2020.11.198'}, { 'key': '2022102203230152355_j_cipms-2022-0020_ref_023', 'doi-asserted-by': 'crossref', 'unstructured': '23. Arshad S, Kilgore P, Chaudhry ZS, Jacobsen G, Wang DD, Huitsing K, ' 'et al. Treatment with hydroxychloroquine, azithromycin, and combination ' 'in patients hospitalized with COVID-19. Int J Infect Dis. ' '2020;97:396-403.10.1016/j.ijid.2020.06.099733057432623082', 'DOI': '10.1016/j.ijid.2020.06.099'}, { 'key': '2022102203230152355_j_cipms-2022-0020_ref_024', 'doi-asserted-by': 'crossref', 'unstructured': '24. Freedberg DE, Conigliaro J, Wang TC, Tracey KJ, Callahan MV, Abrams ' 'JA, et al. Famotidine use is associated with improved clinical outcomes ' 'in hospitalized COVID-19 patients: A propensity score matched ' 'retrospective cohort study. Gastroenterol. ' '2020;159(3):1129-31.e3.10.1053/j.gastro.2020.05.053724219132446698', 'DOI': '10.1053/j.gastro.2020.05.053'}, { 'key': '2022102203230152355_j_cipms-2022-0020_ref_025', 'doi-asserted-by': 'crossref', 'unstructured': '25. Padhy BM, Mohanty RR, Das S, Meher BR. Therapeutic potential of ' 'ivermectin as add on treatment in COVID 19: A systematic review and ' 'meta-analysis. J Pharm Pharm Sci. ' '2020;23:462-9.10.18433/jpps3145733227231', 'DOI': '10.18433/jpps31457'}, { 'key': '2022102203230152355_j_cipms-2022-0020_ref_026', 'doi-asserted-by': 'crossref', 'unstructured': '26. Zanasi A, Mazzolini M, Kantar A. A reappraisal of the mucoactive ' 'activity and clinical efficacy of bromhexine. Multidiscip Respir Med. ' '2017;12(1):1-14.10.1186/s40248-017-0088-1535981728331610', 'DOI': '10.1186/s40248-017-0088-1'}], 'container-title': 'Current Issues in Pharmacy and Medical Sciences', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://www.sciendo.com/pdf/10.2478/cipms-2022-0020', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2022, 10, 22]], 'date-time': '2022-10-22T03:23:54Z', 'timestamp': 1666409034000}, 'score': 1, 'resource': {'primary': {'URL': 'https://www.sciendo.com/article/10.2478/cipms-2022-0020'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2022, 10, 21]]}, 'references-count': 26, 'journal-issue': {'issue': '0', 'published-online': {'date-parts': [[2022, 10, 21]]}}, 'alternative-id': ['10.2478/cipms-2022-0020'], 'URL': 'http://dx.doi.org/10.2478/cipms-2022-0020', 'relation': {}, 'ISSN': ['2300-6676'], 'subject': ['Pharmacology', 'Molecular Biology', 'General Medicine', 'Biochemistry'], 'published': {'date-parts': [[2022, 10, 21]]}}
Late treatment
is less effective
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