tetano
Editor, Senior Moderator
Front Med (Lausanne)
. 2022 Apr 22;9:785785.
doi: 10.3389/fmed.2022.785785. eCollection 2022.
A Home-Treatment Algorithm Based on Anti-inflammatory Drugs to Prevent Hospitalization of Patients With Early COVID-19: A Matched-Cohort Study (COVER 2)
Elena Consolaro[SUP] 1 [/SUP], Fredy Suter[SUP] 2 [/SUP], Nadia Rubis[SUP] 3 [/SUP], Stefania Pedroni[SUP] 1 [/SUP], Chiara Moroni[SUP] 1 [/SUP], Elena Pastò[SUP] 1 [/SUP], Maria Vittoria Paganini[SUP] 1 [/SUP], Grazia Pravettoni[SUP] 4 [/SUP], Umberto Cantarelli[SUP] 5 [/SUP], Norberto Perico[SUP] 3 [/SUP], Annalisa Perna[SUP] 3 [/SUP], Tobia Peracchi[SUP] 3 [/SUP], Piero Ruggenenti[SUP] 2 3 [/SUP], Giuseppe Remuzzi[SUP] 3 [/SUP]
Affiliations
Abstract
Background and aim: While considerable success has been achieved in the management of patients hospitalized with severe coronavirus disease 2019 (COVID-19), far less progress has been made with early outpatient treatment. We assessed whether the implementation of a home treatment algorithm-designed based on a pathophysiologic and pharmacologic rationale-and including non-steroidal anti-inflammatory drugs, especially relatively selective cyclooxygenase-2 inhibitors and, when needed, corticosteroids, anticoagulants, oxygen therapy and antibiotics-at the very onset of mild COVID-19 symptoms could effectively reduce hospital admissions.
Methods: This fully academic, matched-cohort study evaluated outcomes in 108 consecutive consenting patients with mild COVID-19, managed at home by their family doctors between January 2021 and May 2021, according to the proposed treatment algorithm and in 108 age-, sex-, and comorbidities-matched patients on other therapeutic schedules (ClinicalTrials.gov: NCT04854824). The primary outcome was COVID-19-related hospitalization. Analyses were by intention-to-treat.
Results: One (0.9%) patient in the "recommended" cohort and 12 (11.1%) in the "control" cohort were admitted to hospital (P = 0.0136). The proposed algorithm reduced the cumulative length of hospital stays by 85% (from 141 to 19 days) as well as related costs (from €60.316 to €9.058). Only 9.8 patients needed to be treated with the recommended algorithm to prevent one hospitalization event. The rate of resolution of major symptoms was numerically-but not significantly-higher in the "recommended" than in the "control" cohort (97.2 vs. 93.5%, respectively; P = 0.322). Other symptoms lingered in a smaller proportion of patients in the "recommended" than in the "control" cohort (20.4 vs. 63.9%, respectively; P < 0.001), and for a shorter period.
Conclusion: The adoption of the proposed outpatient treatment algorithm during the early, mild phase of COVID-19 reduced the incidence of subsequent hospitalization and related costs.
Keywords: COVID-19; SARS-CoV-2; at home management; hospitalization; outpatients.
. 2022 Apr 22;9:785785.
doi: 10.3389/fmed.2022.785785. eCollection 2022.
A Home-Treatment Algorithm Based on Anti-inflammatory Drugs to Prevent Hospitalization of Patients With Early COVID-19: A Matched-Cohort Study (COVER 2)
Elena Consolaro[SUP] 1 [/SUP], Fredy Suter[SUP] 2 [/SUP], Nadia Rubis[SUP] 3 [/SUP], Stefania Pedroni[SUP] 1 [/SUP], Chiara Moroni[SUP] 1 [/SUP], Elena Pastò[SUP] 1 [/SUP], Maria Vittoria Paganini[SUP] 1 [/SUP], Grazia Pravettoni[SUP] 4 [/SUP], Umberto Cantarelli[SUP] 5 [/SUP], Norberto Perico[SUP] 3 [/SUP], Annalisa Perna[SUP] 3 [/SUP], Tobia Peracchi[SUP] 3 [/SUP], Piero Ruggenenti[SUP] 2 3 [/SUP], Giuseppe Remuzzi[SUP] 3 [/SUP]
Affiliations
- PMID: 35530041
- PMCID: PMC9073076
- DOI: 10.3389/fmed.2022.785785
Abstract
Background and aim: While considerable success has been achieved in the management of patients hospitalized with severe coronavirus disease 2019 (COVID-19), far less progress has been made with early outpatient treatment. We assessed whether the implementation of a home treatment algorithm-designed based on a pathophysiologic and pharmacologic rationale-and including non-steroidal anti-inflammatory drugs, especially relatively selective cyclooxygenase-2 inhibitors and, when needed, corticosteroids, anticoagulants, oxygen therapy and antibiotics-at the very onset of mild COVID-19 symptoms could effectively reduce hospital admissions.
Methods: This fully academic, matched-cohort study evaluated outcomes in 108 consecutive consenting patients with mild COVID-19, managed at home by their family doctors between January 2021 and May 2021, according to the proposed treatment algorithm and in 108 age-, sex-, and comorbidities-matched patients on other therapeutic schedules (ClinicalTrials.gov: NCT04854824). The primary outcome was COVID-19-related hospitalization. Analyses were by intention-to-treat.
Results: One (0.9%) patient in the "recommended" cohort and 12 (11.1%) in the "control" cohort were admitted to hospital (P = 0.0136). The proposed algorithm reduced the cumulative length of hospital stays by 85% (from 141 to 19 days) as well as related costs (from €60.316 to €9.058). Only 9.8 patients needed to be treated with the recommended algorithm to prevent one hospitalization event. The rate of resolution of major symptoms was numerically-but not significantly-higher in the "recommended" than in the "control" cohort (97.2 vs. 93.5%, respectively; P = 0.322). Other symptoms lingered in a smaller proportion of patients in the "recommended" than in the "control" cohort (20.4 vs. 63.9%, respectively; P < 0.001), and for a shorter period.
Conclusion: The adoption of the proposed outpatient treatment algorithm during the early, mild phase of COVID-19 reduced the incidence of subsequent hospitalization and related costs.
Keywords: COVID-19; SARS-CoV-2; at home management; hospitalization; outpatients.