Real-world treatment patterns and clinical outcomes for inpatients with COVID-19 in the US from September 2020 to February 2021

PLoS One. 2021 Dec 28;16(12):e0261707. doi: 10.1371/journal.pone.0261707. eCollection 2021.

Abstract

The objective of this retrospective cohort study was to describe pre-treatment characteristics, treatment patterns, health resource use, and clinical outcomes among adults hospitalized with COVID-19 in the United States (US) who initiated common treatments for COVID-19. The Optum® COVID-19 electronic health records database was used to identify patients >18 years, diagnosed with COVID-19, who were admitted to an inpatient setting and received treatments of interest for COVID-19 between September 2020 and January 2021. Patients were stratified into cohorts based on index treatment use. Patient demographics, medical history, care setting, medical procedures, subsequent treatment use, patient disposition, clinical improvement, and outcomes were summarized descriptively. Among a total of 26,192 patients identified, the most prevalent treatments initiated were dexamethasone (35.4%) and dexamethasone + remdesivir (14.9%), and dexamethasone was the most common subsequent treatment. At day 14 post-index, <10% of patients received any treatments of interest. Mean (standard deviation [SD]) patient age was 65.6 (15.6) years, and the most prevalent comorbidities included hypertension (44.8%), obesity (35.4%), and diabetes (25.7%). At the end of follow-up, patients had a mean (SD) 8.1 (6.6) inpatient days and 1.4 (4.1) days with ICU care. Oxygen supplementation, non-invasive, or invasive ventilation was required by 4.5%, 3.0%, and 3.1% of patients, respectively. At the end of follow-up, 84.2% of patients had evidence of clinical improvement, 3.1% remained hospitalized, 83.8% were discharged, 4% died in hospital, and 9.1% died after discharge. Although the majority of patients were discharged alive, no treatments appeared to alleviate the inpatient morbidity and mortality associated with COVID-19. This highlights an unmet need for effective treatment options for patients hospitalized with COVID-19.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenosine Monophosphate / analogs & derivatives*
  • Adenosine Monophosphate / therapeutic use
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Alanine / analogs & derivatives*
  • Alanine / therapeutic use
  • Anti-Inflammatory Agents / therapeutic use*
  • Antiviral Agents / therapeutic use*
  • COVID-19 / diagnosis
  • COVID-19 / epidemiology
  • COVID-19 / virology
  • COVID-19 Drug Treatment*
  • Comorbidity
  • Dexamethasone / therapeutic use*
  • Drug Therapy, Combination / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Hypertension / epidemiology*
  • Male
  • Middle Aged
  • Obesity / epidemiology*
  • Patient Discharge*
  • RNA, Viral / genetics
  • Retrospective Studies
  • SARS-CoV-2 / genetics*
  • SARS-CoV-2 / immunology*
  • Treatment Outcome
  • United States / epidemiology
  • Young Adult

Substances

  • Anti-Inflammatory Agents
  • Antiviral Agents
  • RNA, Viral
  • remdesivir
  • Adenosine Monophosphate
  • Dexamethasone
  • Alanine

Grants and funding

This study was sponsored by Takeda Development Center Americas Inc.: study design, data collection and analysis, decision to publish, and preparation of the manuscript; Amgen Inc.: study design, interpretation of analyses, decision to publish, and preparation of the manuscript; and Bristol-Myers Squibb Co.: study design, interpretation of analyses, decision to publish, and preparation of the manuscript.