目的:分析大流行期间住院患者COVID-19治疗的处方趋势。
方法:多中心,生态,在巴塞罗那五家急性护理医院接受治疗的所有COVID-19成年患者的汇总数据的时间序列研究,西班牙,2020年3月至2021年5月。通过Mantel-Haenszel检验分析了针对COVID-19的药物每月流行趋势。
结果:参与的医院在研究期间收治了22,277例COVID-19患者,报告总死亡率为10.8%.在大流行的头几个月,洛匹那韦/利托那韦和羟氯喹是最常用的抗病毒药物,但这些被废弃了,并于2020年7月被remdesivir取代。相比之下,托珠单抗的使用趋势各不相同,首次在2020年4月和5月达到峰值,下降至2021年1月,此后呈现离散上升趋势。关于皮质类固醇的使用,从2020年7月起,我们观察到每天6mg地塞米松的使用量呈显著上升趋势.最后,抗生素的使用率很高,尤其是阿奇霉素,前三个月,但此后下降了。
结论:在大流行期间,随着科学证据的变化,对COVID-19住院患者的治疗也在发展。最初,根据经验使用了多种药物,但这些药物随后无法显示出临床获益.在未来的大流行中,利益相关者应努力促进适应性随机临床试验的早期实施.
OBJECTIVE: To analyze trends in the prescription of COVID-19 treatments for hospitalized patients during the pandemic.
METHODS: Multicenter, ecological, time-series
study of aggregate data for all adult patients with COVID-19 treated in five acute-care hospitals in Barcelona, Spain, between March 2020 and May 2021. Trends in the monthly prevalence of drugs used against COVID-19 were analyzed by the Mantel-Haenszel test.
RESULTS: The participating hospitals admitted 22,277 patients with COVID-19 during the
study period, reporting an overall mortality of 10.8%. In the first months of the pandemic, lopinavir/ritonavir and hydroxychloroquine were the most frequently used antivirals, but these fell into disuse and were replaced by remdesivir in July 2020. By contrast, the trend in tocilizumab use varied, first peaking in April and May 2020, declining until January 2021, and showing a discrete upward trend thereafter. Regarding corticosteroid use, we observed a notable upward trend in the use of dexamethasone 6 mg per day from July 2020. Finally, there was a high prevalence of antibiotics use, especially azithromycin, in the first three months, but this decreased thereafter.
CONCLUSIONS: Treatment for patients hospitalized with COVID-19 evolved with the changing scientific evidence during the pandemic. Initially, multiple drugs were empirically used that subsequently could not demonstrate clinical benefit. In future pandemics, stakeholders should strive to promote the early implementation of adaptive randomized clinical trials.