韩国大流行早期 COVID-19 无效抗病毒候选药物处方的风险因素。

Risk Factors for the Prescription of Ineffective Antiviral Candidates for COVID-19 During the Early Pandemic Period in Korea.

机构信息

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.

出版信息

J Korean Med Sci. 2023 Sep 11;38(36):e280. doi: 10.3346/jkms.2023.38.e280.

DOI:10.3346/jkms.2023.38.e280

PMID:37698205

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10497349/

Abstract

BACKGROUND

Although the evidence of treatment for coronavirus disease 2019 (COVID-19) changed rapidly, little is known about the patterns of potential pharmacological treatment during the early period of the COVID-19 pandemic in Korea and the risk factors for ineffective prescription.

METHODS

Using claims data from the Korean National Health Insurance System, this retrospective cohort study included admission episodes for COVID-19 from February to December 2020. Ineffective antiviral prescriptions for COVID-19 were defined as lopinavir/ritonavir (LPN/r) and hydroxychloroquine (HCQ) prescribed after July 2020, according to the revised National Institute of Health COVID-19 treatment guidelines. Factors associated with ineffective prescriptions, including patient and hospital factors, were identified by multivariate logistic regression analysis.

RESULTS

Of the 15,723 COVID-19 admission episodes from February to June 2020, 4,183 (26.6%) included prescriptions of LPN/r, and 3,312 (21.1%) included prescriptions of HCQ. Of the 48,843 admission episodes from July to December 2020, after the guidelines were revised, 2,258 (4.6%) and 182 (0.4%) included prescriptions of ineffective LPN/r and HCQ, respectively. Patient factors independently associated with ineffective antiviral prescription were older age (adjusted odds ratio [aOR] per 10-year increase, 1.17; 95% confidence interval [CI], 1.14-1.20) and severe condition with an oxygen requirement (aOR, 2.49; 95% CI, 2.24-2.77). The prescription of ineffective antiviral drugs was highly prevalent in primary and nursing hospitals (aOR, 40.58; 95% CI, 31.97-51.50), public sector hospitals (aOR, 15.61; 95% CI, 12.76-19.09), and regions in which these drugs were highly prescribed before July 2020 (aOR, 10.65; 95% CI, 8.26-13.74).

CONCLUSION

Ineffective antiviral agents were prescribed to a substantial number of patients during the first year of the COVID-19 pandemic in Korea. Treatment with these ineffective drugs tended to be prolonged in severely ill patients and in primary and public hospitals.

摘要

背景

尽管针对 2019 年冠状病毒病（COVID-19）的治疗证据变化迅速，但对于 COVID-19 大流行早期韩国潜在药物治疗模式以及无效处方的风险因素知之甚少。

方法

本回顾性队列研究使用了韩国国家健康保险系统的索赔数据，纳入了 2020 年 2 月至 12 月期间因 COVID-19 住院的病例。根据修订后的美国国立卫生研究院 COVID-19 治疗指南，将 2020 年 7 月以后开具的洛匹那韦/利托那韦（LPN/r）和羟氯喹（HCQ）定义为无效的抗病毒药物。通过多变量逻辑回归分析确定了与无效处方相关的因素，包括患者和医院因素。

结果

在 2020 年 2 月至 6 月的 15723 例 COVID-19 住院病例中，4183 例（26.6%）处方了 LPN/r，3312 例（21.1%）处方了 HCQ。在 2020 年 7 月至 12 月指南修订后，48843 例住院病例中，分别有 2258 例（4.6%）和 182 例（0.4%）处方了无效的 LPN/r 和 HCQ。与无效抗病毒处方相关的患者因素是年龄较大（每增加 10 岁，调整后的优势比[OR]为 1.17；95%置信区间[CI]为 1.14-1.20）和需要吸氧的严重病情（OR，2.49；95%CI，2.24-2.77）。在初级和护理医院（OR，40.58；95%CI，31.97-51.50）、公立医疗机构（OR，15.61；95%CI，12.76-19.09）以及这些药物在 2020 年 7 月之前大量开具的地区（OR，10.65；95%CI，8.26-13.74），无效抗病毒药物的处方率很高。