Prescribers Switch to Remdesivir for COVID-19 Treatment

Although COVID-19 treatments azithromycin and hydroxychloroquine were often used in patients early in the pandemic, use decreased significantly by the end of 2020. But for drugs such as remdesivir and dexamethasone, use in patients dramatically increased.
 

The JAMA Network Open study looked at 22,896 patients with COVID-19 from March 2020 to December 2020. Data was taken from the University of California COVID Research Data Set, which contained information from all five UC Health medical centers.

Researchers found that hydroxychloroquine and azithromycin were each used in over 40 percent of hospitalized patients at the beginning of 2020. But by early June, use was below 30 percent and 5 percent, respectively. 

The hydroxychloroquine decrease is likely due to the numerous studies that found no real benefit from use of the drug in COVID-19 patients.

For example, a clinical trial published in the New England Journal of Medicine in June 2020 found that new illness compatible with COVID-19 did not differ substantially between participants receiving hydroxychloroquine (11.8 percent) and those receiving a placebo (14.3 percent).

New COVID-19 developed in 107 of 821 participants, or 13 percent, during the 14 days of follow-up. 

FDA then revoked the emergency use authorization for hydroxychloroquine based on the newly gathered information.  And shortly after FDA’s decision, the World Health Organization (WHO) paused the use of hydroxychloroquine in its Solidarity trial. 

Additionally, azithromycin, which is used to treat chest infections like pneumonia, was used in 45.5 percent of COVID-19 patients in April 2020. This number fell to 20 percent by August. 

The use of ACEs/ARBs also moderately declined from 27.5 percent in March to 18.5 percent in December. 

Although ACEs were associated with a significantly reduced risk of COVID-19 requiring hospital admission at the beginning of the pandemic, they were not substantially associated with risk of ICU care. 

Tocilizumab and colchicine uses were 2.4 percent and 2.9 percent, respectively, in April 2020 and remained below these percentages for the remainder of 2020.

In contrast, dexamethasone was used in only four percent of all COVID-19 patients before May. But by close of 2020, nearly 40 percent of all patients received the drug. 

Dexamethasone elicited positive outcomes in 2020 clinical trials. For example, a June clinical trial found that dexamethasone improved survival in hospitalized COVID-19 patients and reduced the 28-day mortality rate in one-third of patients (17 percent). 

Remdesivir use in patients also grew significantly, from 4.9 percent in June 2020 to 62.5 percent by December. Researchers stated the increased use could be due to the fact that remdesivir was so readily available early in the pandemic. 

Developed by Gilead, remdesivir was previously used to treat Ebola back in 2013.

But in September 2020, FDA expanded remdesivir use to all hospitalized adults and pediatric patients with COVID-19. 

The decision to expand the use of remdesivir stemmed from the agency’s ongoing review of the May 2020 emergency use authorization of the drug, which showed that it may be effective for the treatment of suspected or laboratory-confirmed COVID-19 in severely ill patients. 

Just one month later, FDA approved remdesivir as the first COVID-19 treatment. 

For drugs such as enoxaparin and heparin (which is used to prevent blood clots), use in patients stayed the same throughout 2020, at about 50 percent and 40 percent, respectively. 

Steady use of enoxaparin throughout the pandemic could be due to the fact that the drug serves use both for thrombosis prophylaxis and thrombophilia treatment, which are triggered by COVID-19.