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Drug prescription patterns and their association with mortality and hospitalization duration in COVID-19 patients: insights from big data

Mehrizi et al., Frontiers in Public Health, doi:10.3389/fpubh.2023.1280434
Dec 2023  
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Mortality 19% Improvement Relative Risk Famotidine  Mehrizi et al.  LATE TREATMENT Is late treatment with famotidine beneficial for COVID-19? Retrospective 917,198 patients in Iran (February 2020 - March 2022) Lower mortality with famotidine (p<0.000001) c19early.org Mehrizi et al., Frontiers in Public He.., Dec 2023 Favorsfamotidine Favorscontrol 0 0.5 1 1.5 2+
Famotidine for COVID-19
26th treatment shown to reduce risk in October 2021
 
*, now with p = 0.00026 from 30 studies, recognized in 2 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,400+ studies for 79 treatments. c19early.org
Retrospective study of 917,198 hospitalized COVID-19 cases covered by the Iran Health Insurance Organization over 26 months showing that antithrombotics, corticosteroids, and antivirals reduced mortality while diuretics, antibiotics, and antidiabetics increased it. Confounding makes some results very unreliable. For example, diuretics like furosemide are often used to treat fluid overload, which is more likely in ICU or advanced disease requiring aggressive fluid resuscitation. Hospitalization length has increased risk of significant confounding, for example longer hospitalization increases the chance of receiving a medication, and death may result in shorter hospitalization. Mortality results may be more reliable.
Confounding by indication is likely to be significant for many medications. Authors adjustments have very limited severity information (admission type refers to ward vs. ER department on initial arrival). We can estimate the impact of confounding from typical usage patterns, the prescription frequency, and attenuation or increase of risk for ICU vs. all patients.
risk of death, 19.0% lower, OR 0.81, p < 0.001, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Mehrizi et al., 18 Dec 2023, retrospective, Iran, peer-reviewed, 10 authors, study period 1 February, 2020 - 20 March, 2022. Contact: rdaroudi@sina.tums.ac.ir.
This PaperFamotidineAll
Drug prescription patterns and their association with mortality and hospitalization duration in COVID-19 patients: insights from big data
Reza Mehrizi, Ali Golestani, Mohammad-Reza Malekpour, Hossein Karami, Mohammad Mahdi Nasehi, Mohammad Effatpanah, Hossein Ranjbaran, Zahra Shahali, Ali Akbari Sari, Rajabali Daroudi
Frontiers in Public Health, doi:10.3389/fpubh.2023.1280434
Background: Different medication prescription patterns have been associated with varying course of disease and outcomes in COVID-19. Health claims data is a rich source of information on disease treatment and outcomes. We aimed to investigate drug prescription patterns and their association with mortality and hospitalization via insurance data for a relatively long period of the pandemic in Iran. Methods: We retrieved hospitalized patients' data from Iran Health Insurance Organization (IHIO) spanning 26 months (2020-2022) nationwide. Included were patients with ICD-10 codes U07.1/U07.2 for confirmed/suspected COVID-19. A case was defined as a single hospitalization event for an individual patient. Multiple hospitalizations of a patient within a 30-day interval were aggregated into a single case, while hospitalizations with intervals exceeding 30 days were treated as independent cases. The Anatomical Therapeutic Chemical (ATC) was used for medications classification. The two main study outcomes were general and intensive care unit (ICU) hospitalization periods and mortality. Besides, various demographic and clinical associate factors were analyzed to derive the associations with medication prescription patterns and study outcomes using accelerated failure time (AFT) and logistic regression models. Results: During the 26 months of the study period, 1,113,678 admissions with COVID-19 diagnosis at hospitals working in company with IHIO were recorded. 917,198 cases were detected from the database, among which 51.91% were females and 48.09% were males. Among the main groups of medications, antithrombotics (55. ), corticosteroids (54.14% [54.04-54.24]), and antibiotics (42.22% [42.12-42.32]) were the top used medications among cases with COVID-19. Investigation of the duration of hospitalization based on main medication groups showed antithrombotics (adjusted median ratio = 0.94 [0.94-0.95]) were significantly associated with shorter periods of overall hospitalization. Also, antithrombotics (adjusted odds ratio = 0.74 [95%CI,
Ethics statement This study was approved by the ethical committee at the School of Public Health, Tehran University of Medical Sciences (code: IR.TUMS. SPH.REC.1401.120). The provided data by IHIO in this study were de-identified and data holder and study investigators were responsible to save the privacy of the patients and users of the IHIO insurance services. The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation was not required from the participants or the participants' legal guardians/next of kin in accordance with the national legislation and institutional requirements. Author contributions Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Publisher's note All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Supplementary material The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpubh.2023.1280434/ full#supplementary-material
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We aimed to ' 'investigate drug prescription patterns and their association with mortality and ' 'hospitalization via insurance data for a relatively long period of the pandemic in ' 'Iran.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We retrieved ' 'hospitalized patients’ data from Iran Health Insurance Organization (IHIO) spanning 26\u2009' 'months (2020–2022) nationwide. Included were patients with ICD-10 codes U07.1/U07.2 for ' 'confirmed/suspected COVID-19. A case was defined as a single hospitalization event for an ' 'individual patient. Multiple hospitalizations of a patient within a 30-day interval were ' 'aggregated into a single case, while hospitalizations with intervals exceeding 30\u2009days ' 'were treated as independent cases. The Anatomical Therapeutic Chemical (ATC) was used for ' 'medications classification. The two main study outcomes were general and intensive care unit ' '(ICU) hospitalization periods and mortality. Besides, various demographic and clinical ' 'associate factors were analyzed to derive the associations with medication prescription ' 'patterns and study outcomes using accelerated failure time (AFT) and logistic regression ' 'models.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>During the ' '26\u2009months of the study period, 1,113,678 admissions with COVID-19 diagnosis at hospitals ' 'working in company with IHIO were recorded. 917,198 cases were detected from the database, ' 'among which 51.91% were females and 48.09% were males. Among the main groups of medications, ' 'antithrombotics (55.84% [95% CI: 55.74–55.94]), corticosteroids (54.14% [54.04–54.24]), and ' 'antibiotics (42.22% [42.12–42.32]) were the top used medications among cases with COVID-19. ' 'Investigation of the duration of hospitalization based on main medication groups showed ' 'antithrombotics (adjusted median ratio\u2009=\u20090.94 [0.94–0.95]) were significantly ' 'associated with shorter periods of overall hospitalization. Also, antithrombotics (adjusted ' 'odds ratio\u2009=\u20090.74 [95%CI, 0.73–0.76]), corticosteroids (0.97 [0.95–0.99]), ' 'antivirals (0.82 [0.80–0.83]), and ACE inhibitor/ARB (0.79 [0.77–0.80]) were significantly ' 'associated with lower ' 'mortality.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Over ' '2\u2009years of investigation, antithrombotics, corticosteroids, and antibiotics were the top ' 'medications for hospitalized patients with COVID-19. Trends in medication prescription varied ' 'based on various factors across the country. 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Late treatment
is less effective
Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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