tetano
Editor, Senior Moderator
Open Forum Infect Dis
. 2022 Nov 22;9(12)
fac632.
doi: 10.1093/ofid/ofac632. eCollection 2022 Dec.
Real-world Evidence of the Effects of Novel Treatments for COVID-19 on Mortality: A Nationwide Comparative Cohort Study of Hospitalized Patients in the First, Second, Third, and Fourth Waves in the Netherlands
Marleen A Slim[SUP] 1 2 [/SUP], Brent Appelman[SUP] 1 [/SUP], Hessel Peters-Sengers[SUP] 1 3 [/SUP], Dave A Dongelmans[SUP] 2 4 [/SUP], Nicolette F de Keizer[SUP] 4 5 [/SUP], Rogier P Schade[SUP] 6 [/SUP], Mark G J de Boer[SUP] 7 [/SUP], Marcella C A Müller[SUP] 2 [/SUP], Alexander P J Vlaar[SUP] 2 [/SUP], W Joost Wiersinga[SUP] 1 8 [/SUP], Lonneke A van Vught[SUP] 1 2 [/SUP]; NICE COVID-19 Research Consortium and the COVIDPredict study group
Collaborators, Affiliations
Abstract
Background: Large clinical trials on drugs for hospitalized coronavirus disease 2019 (COVID-19) patients have shown significant effects on mortality. There may be a discrepancy with the observed real-world effect. We describe the clinical characteristics and outcomes of hospitalized COVID-19 patients in the Netherlands during 4 pandemic waves and analyze the association of the newly introduced treatments with mortality, intensive care unit (ICU) admission, and discharge alive.
Methods: We conducted a nationwide retrospective analysis of hospitalized COVID-19 patients between February 27, 2020, and December 31, 2021. Patients were categorized into waves and into treatment groups (hydroxychloroquine, remdesivir, neutralizing severe acute respiratory syndrome coronavirus 2 monoclonal antibodies, corticosteroids, and interleukin [IL]-6 antagonists). Four types of Cox regression analyses were used: unadjusted, adjusted, propensity matched, and propensity weighted.
Results: Among 5643 patients from 11 hospitals, we observed a changing epidemiology during 4 pandemic waves, with a decrease in median age (67-64 years; P < .001), in in-hospital mortality on the ward (21%-15%; P < .001), and a trend in the ICU (24%-16%; P = .148). In ward patients, hydroxychloroquine was associated with increased mortality (1.54; 95% CI, 1.22-1.96), and remdesivir was associated with a higher rate of discharge alive within 29 days (1.16; 95% CI, 1.03-1.31). Corticosteroids were associated with a decrease in mortality (0.82; 95% CI, 0.69-0.96); the results of IL-6 antagonists were inconclusive. In patients directly admitted to the ICU, hydroxychloroquine, corticosteroids, and IL-6 antagonists were not associated with decreased mortality.
Conclusions: Both remdesivir and corticosteroids were associated with better outcomes in ward patients with COVID-19. Continuous evaluation of real-world treatment effects is needed.
Keywords: COVID-19; SARS-CoV-2; antiviral; epidemiology; immunosuppressive treatments.
. 2022 Nov 22;9(12)
fac632.doi: 10.1093/ofid/ofac632. eCollection 2022 Dec.
Real-world Evidence of the Effects of Novel Treatments for COVID-19 on Mortality: A Nationwide Comparative Cohort Study of Hospitalized Patients in the First, Second, Third, and Fourth Waves in the Netherlands
Marleen A Slim[SUP] 1 2 [/SUP], Brent Appelman[SUP] 1 [/SUP], Hessel Peters-Sengers[SUP] 1 3 [/SUP], Dave A Dongelmans[SUP] 2 4 [/SUP], Nicolette F de Keizer[SUP] 4 5 [/SUP], Rogier P Schade[SUP] 6 [/SUP], Mark G J de Boer[SUP] 7 [/SUP], Marcella C A Müller[SUP] 2 [/SUP], Alexander P J Vlaar[SUP] 2 [/SUP], W Joost Wiersinga[SUP] 1 8 [/SUP], Lonneke A van Vught[SUP] 1 2 [/SUP]; NICE COVID-19 Research Consortium and the COVIDPredict study group
Collaborators, Affiliations
- PMID: 36519114
- PMCID: PMC9745783
- DOI: 10.1093/ofid/ofac632
Abstract
Background: Large clinical trials on drugs for hospitalized coronavirus disease 2019 (COVID-19) patients have shown significant effects on mortality. There may be a discrepancy with the observed real-world effect. We describe the clinical characteristics and outcomes of hospitalized COVID-19 patients in the Netherlands during 4 pandemic waves and analyze the association of the newly introduced treatments with mortality, intensive care unit (ICU) admission, and discharge alive.
Methods: We conducted a nationwide retrospective analysis of hospitalized COVID-19 patients between February 27, 2020, and December 31, 2021. Patients were categorized into waves and into treatment groups (hydroxychloroquine, remdesivir, neutralizing severe acute respiratory syndrome coronavirus 2 monoclonal antibodies, corticosteroids, and interleukin [IL]-6 antagonists). Four types of Cox regression analyses were used: unadjusted, adjusted, propensity matched, and propensity weighted.
Results: Among 5643 patients from 11 hospitals, we observed a changing epidemiology during 4 pandemic waves, with a decrease in median age (67-64 years; P < .001), in in-hospital mortality on the ward (21%-15%; P < .001), and a trend in the ICU (24%-16%; P = .148). In ward patients, hydroxychloroquine was associated with increased mortality (1.54; 95% CI, 1.22-1.96), and remdesivir was associated with a higher rate of discharge alive within 29 days (1.16; 95% CI, 1.03-1.31). Corticosteroids were associated with a decrease in mortality (0.82; 95% CI, 0.69-0.96); the results of IL-6 antagonists were inconclusive. In patients directly admitted to the ICU, hydroxychloroquine, corticosteroids, and IL-6 antagonists were not associated with decreased mortality.
Conclusions: Both remdesivir and corticosteroids were associated with better outcomes in ward patients with COVID-19. Continuous evaluation of real-world treatment effects is needed.
Keywords: COVID-19; SARS-CoV-2; antiviral; epidemiology; immunosuppressive treatments.