Evidence map›Paper›PMID 33975825›Full record

ArticleBMJ (Clinical research ed.)2021

Use of repurposed and adjuvant drugs in hospital patients with covid-19: multinational network cohort study.

Albert Prats-Uribe, Anthony G Sena, Lana Yin Hui Lai, Waheed-Ul-Rahman Ahmed, Heba Alghoul, Osaid Alser, Thamir M Alshammari, Carlos Areia, William Carter, Paula Casajust and 33 more

Erratum issuedOpen access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ (Clinical research ed.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 38 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
38citing papers in PubMed, 2 pooled it
4.2field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

38 citing papers in PubMed, 2 syntheses or guidelines pooled it, 70 citations in OpenAlex.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

43 authors at 20 institutions in 12 countries.

Albert Prats-UribePharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Anthony G SenaJanssen Research and Development, Titusville, NJ, USA.
Lana Yin Hui LaiDivision of Cancer Sciences, School of Medical Sciences, University of Manchester, Manchester, UK.
Waheed-Ul-Rahman AhmedNuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Heba AlghoulFaculty of Medicine, Islamic University of Gaza, Gaza City, Palestine.
Osaid AlserMassachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Thamir M AlshammariCollege of Pharmacy, Riyadh Elm University, Riyadh, Saudi Arabia.
Carlos AreiaCritical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
William CarterUniversity of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Paula CasajustReal-World Evidence, Trial Form Support, Barcelona, Spain.
Dalia DawoudFaculty of Pharmacy, Cairo University, Cairo, Egypt.
Asieh GolozarRegeneron Pharmaceuticals, Tarrytown, NY, US.
Jitendra JonnagaddalaSchool of Population Health, UNSW Sydney, Sydney, Australia.
Paras P MehtaCollege of Medicine, University of Arizona, Tucson, AZ, USA.
Mengchun GongDHC Technologies, Beijing, China.
Daniel R MoralesDivision of Population Health and Genomics, University of Dundee, Dundee, UK.
Fredrik NybergSchool of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Jose D PosadaDepartment of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Martina RecaldeFundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
Elena RoelFundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
Karishma ShahNuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Nigam H ShahDepartment of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Lisa M SchillingUniversity of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Vignesh SubbianCollege of Engineering, University of Arizona Tucson, AZ, USA.
David VizcayaBayer Pharmaceuticals, Sant Joan Despí, Spain.
Lin ZhangSchool of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ying ZhangDHC Technologies, Beijing, China.
Hong ZhuNanfang University, Southern Medical University, Guangzhou, China.
Li LiuNanfang University, Southern Medical University, Guangzhou, China.
Jaehyeong ChoDepartment of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea.
Kristine E LynchVA Informatics and Computing Infrastructure, VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
Michael E MathenyVA Informatics and Computing Infrastructure, Tennessee Valley Healthcare System, VA Medical Center, Nashville, TN, USA.
Seng Chan YouDepartment of Preventive Medicine and Public Health, Yonsei University College of Medicine, Seoul, South Korea.
Peter R RijnbeekDepartment of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands.
George HripcsakDepartment of Biomedical Informatics, Columbia University, New York, NY, USA.
Jennifer Ce LaneNuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Edward BurnPharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Christian ReichIQVIA, Cambridge, MA, USA.
Marc A SuchardDepartment of Biostatistics, UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA.
Talita Duarte-SallesFundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
Kristin KostkaIQVIA, Cambridge, MA, USA.
Patrick B RyanJanssen Research and Development, Titusville, NJ, USA ryan@ohdsi.org.ORCID 0000-0002-9727-2138
Daniel Prieto-AlhambraPharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Nuffield Orthopaedic Centre · GBErasmus MC · NLNanfang Hospital · CNStanford University · USUniversitat Autònoma de Barcelona · ESUniversity of Arizona · USUniversity of Colorado Anschutz Medical Campus · USAjou University · KRCairo University · EGColumbia University · USColumbia University Irving Medical Center · USHarvard University · USInstitut Universitari d'Investigació en Atenció Primària Jordi Gol · ESIQVIA (United States) · USIslamic University of Gaza · PSJohns Hopkins University · USNortheastern University · USRiyadh Elm University · SAThe University of Melbourne · AUUniversity of California, Los Angeles · US

Funding

DISCOVERING AND APPLYING KNOWLEDGE IN CLINICAL DATABASESR01LM006910 · NLM · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI HRIPCSAK, GEORGE M · 2000 to 2023
$10.6M
NLM NIH HHS R01 LM006910
6 · The paper itself

Abstract

objectiveTo investigate the use of repurposed and adjuvant drugs in patients admitted to hospital with covid-19 across three continents.

designMultinational network cohort study.

settingHospital electronic health records from the United States, Spain, and China, and nationwide claims data from South Korea.

participants303 264 patients admitted to hospital with covid-19 from January 2020 to December 2020.

main outcome measuresPrescriptions or dispensations of any drug on or 30 days after the date of hospital admission for covid-19.

resultsOf the 303 264 patients included, 290 131 were from the US, 7599 from South Korea, 5230 from Spain, and 304 from China. 3455 drugs were identified. Common repurposed drugs were hydroxychloroquine (used in from <5 (<2%) patients in China to 2165 (85.1%) in Spain), azithromycin (from 15 (4.9%) in China to 1473 (57.9%) in Spain), combined lopinavir and ritonavir (from 156 (<2%) in the VA-OMOP US to 2,652 (34.9%) in South Korea and 1285 (50.5%) in Spain), and umifenovir (0% in the US, South Korea, and Spain and 238 (78.3%) in China). Use of adjunctive drugs varied greatly, with the five most used treatments being enoxaparin, fluoroquinolones, ceftriaxone, vitamin D, and corticosteroids. Hydroxychloroquine use increased rapidly from March to April 2020 but declined steeply in May to June and remained low for the rest of the year. The use of dexamethasone and corticosteroids increased steadily during 2020.

conclusionsMultiple drugs were used in the first few months of the covid-19 pandemic, with substantial geographical and temporal variation. Hydroxychloroquine, azithromycin, lopinavir-ritonavir, and umifenovir (in China only) were the most prescribed repurposed drugs. Antithrombotics, antibiotics, H2 receptor antagonists, and corticosteroids were often used as adjunctive treatments. Research is needed on the comparative risk and benefit of these treatments in the management of covid-19.

Indexed as

COVID-19 Drug TreatmentAdministrative Claims, HealthcareAdolescentAdrenal Cortex HormonesAdultAgedAged, 80 and overAzithromycinCeftriaxoneChemotherapy, AdjuvantChildChild, PreschoolChinaCohort StudiesCOVID-19Drug CombinationsAdrenal Cortex HormonesAzithromycinCeftriaxoneDrug CombinationsEnoxaparinFluoroquinolonesHydroxychloroquineLopinavirlopinavir-ritonavir drug combinationRitonavirVitamin D

Identifiers

PMID33975825
PMCPMC8111167
OpenAlexW3159981122

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.