Prats-Uribe Albert, Sena Anthony G, Lai Lana Yin Hui, Ahmed Waheed-Ul-Rahman, Alghoul Heba, Alser Osaid, Alshammari Thamir M, Areia Carlos, Carter William, Casajust Paula, Dawoud Dalia, Golozar Asieh, Jonnagaddala Jitendra, Mehta Paras P, Gong Mengchun, Morales Daniel R, Nyberg Fredrik, Posada Jose D, Recalde Martina, Roel Elena, Shah Karishma, Shah Nigam H, Schilling Lisa M, Subbian Vignesh, Vizcaya David, Zhang Lin, Zhang Ying, Zhu Hong, Liu Li, Cho Jaehyeong, Lynch Kristine E, Matheny Michael E, You Seng Chan, Rijnbeek Peter R, Hripcsak George, Lane Jennifer Ce, Burn Edward, Reich Christian, Suchard Marc A, Duarte-Salles Talita, Kostka Kristin, Ryan Patrick B, Prieto-Alhambra Daniel
Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Janssen Research and Development, Titusville, NJ, USA.
BMJ. 2021 May 11;373:n1038. doi: 10.1136/bmj.n1038.
To investigate the use of repurposed and adjuvant drugs in patients admitted to hospital with covid-19 across three continents.
Multinational network cohort study.
Hospital electronic health records from the United States, Spain, and China, and nationwide claims data from South Korea.
303 264 patients admitted to hospital with covid-19 from January 2020 to December 2020.
Prescriptions or dispensations of any drug on or 30 days after the date of hospital admission for covid-19.
Of 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.
Multiple 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.
调查三大洲因新冠肺炎住院患者中重新利用药物和辅助药物的使用情况。
跨国网络队列研究。
来自美国、西班牙和中国的医院电子健康记录，以及来自韩国的全国索赔数据。
2020年1月至2020年12月因新冠肺炎住院的303264名患者。
新冠肺炎住院日期当天或之后30天内任何药物的处方或配药情况。
在纳入的303264名患者中，290131名来自美国，7599名来自韩国，5230名来自西班牙，304名来自中国。共识别出3455种药物。常见的重新利用药物有羟氯喹（在中国使用的患者不到5人（<2%），在西班牙为2165人（85.1%））、阿奇霉素（在中国为15人（4.9%），在西班牙为1473人（57.9%））、洛匹那韦和利托那韦联合使用（在美国VA-OMOP中为156人（<2%），在韩国为2652人（34.9%），在西班牙为1285人（50.5%））以及乌米芬诺韦（在美国、韩国和西班牙为0%，在中国为238人（78.3%））。辅助药物的使用差异很大，使用最多的五种治疗药物为依诺肝素、氟喹诺酮类、头孢曲松、维生素D和皮质类固醇。羟氯喹的使用在2020年3月至4月迅速增加，但在5月至6月急剧下降，且在该年剩余时间一直保持在低水平。地塞米松和皮质类固醇的使用在2020年期间稳步增加。
在新冠肺炎疫情的头几个月使用了多种药物，存在显著的地域和时间差异。羟氯喹、阿奇霉素、洛匹那韦-利托那韦和乌米芬诺韦（仅在中国）是处方最多的重新利用药物。抗血栓药、抗生素、H2受体拮抗剂和皮质类固醇常被用作辅助治疗。需要对这些治疗方法在新冠肺炎管理中的相对风险和益处进行研究。
