Risk of Underlying Diseases and Effectiveness of Drugs on COVID-19 Inpatients Assessed Using Medical Claims in Japan: Retrospective Observational Study
Mitsushima et al.
, Risk of Underlying Diseases and Effectiveness of Drugs on COVID-19 Inpatients Assessed Using Medical Claims in..
, International Journal of General Medicine, doi:10.2147/IJGM.S394413
Retrospective 18,566 hospitalized patients in Japan, showing higher mortality with remdesivir treatment.[Gérard, Wu, Zhou]
show significantly increased risk of acute kidney injury with remdesivir.
risk of death, 44.0% higher, OR 1.44, p < 0.01, adjusted per study, multivariable, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Mitsushima et al., 21 Feb 2023, retrospective, Japan, peer-reviewed, 3 authors.
Abstract: International Journal of General Medicine
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Open Access Full Text Article
Risk of Underlying Diseases and Effectiveness of
Drugs on COVID-19 Inpatients Assessed Using
Medical Claims in Japan: Retrospective Observational
, Hiromasa Horiguchi 2 , Kiyosu Taniguchi
Center for Field Epidemic Intelligence, Research and Professional Development, National Institute of Infectious Diseases, Shinjuku-ku, Tokyo, Japan;
Department of Clinical Data Management and Research, Clinical Research Center, National Hospital Organization Headquarters, Meguro-ku, Tokyo,
Japan; 3Director-General, National Hospital Organization Mie National Hospital, Tsu, Mie, Japan; 4Research Director, The Tokyo Foundation for
Policy Research, Minato-ku, Tokyo, Japan
Correspondence: Shingo Mitsushima, Center for Field Epidemic Intelligence, Research and Professional Development, National Institute of Infectious
Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan, Tel +81-3-5285-1111, Fax +81-3-5285-1150, Email email@example.com
Background: Results of earlier studies have demonstrated underlying diseases such as cancer, diabetes mellitus, immunodeficiency,
hypertension and heart failure to be risk factors for severe outcomes and mortality. Furthermore, clinical trials have shown that drugs
such as antiviral drugs, antibody cocktails, steroids and anti-inflammatory drugs can be expected to prevent severe COVID-19
outcomes and death.
Methods: This study, using inpatient records from the Medical Information Analysis Databank covering national hospital organiza
tions in Japan, was conducted to evaluate the effects of underlying diseases and/or administered drugs on mortality. Subjects were all
inpatients receiving oxygen administration and inpatients using respiratory ventilators, categorized by three age classes: all ages,
patients 65 years old or older, and patients younger than 65 years old. We used logistic regression to analyze outcomes for underlying
diseases, administered drugs, age, sex, the proportion of the mutated strains, and vaccine coverage.
Results: Patients with hypertension, except for younger inpatients, have a lower risk of mortality (estimated coefficient 0.67 among all
inpatients (p < 0.01): 0.77 among inpatients with oxygen therapy (p = 0.02) and 0.57 among inpatients with respiratory ventilation
w (p = 0.01)). Except for younger inpatients, antibody cocktail (casirivimab/imdevimab or sotrovimab) administration was associated
with a higher probability of survival (estimated coefficient 0.27 among all inpatients (p < 0.01)). It raised the survival probability
consistently, although other drugs might have reduced the probability of survival.
Conclusion: These findings suggest that antiviral drugs (remdesivir, estimated coefficient 1.44 (p < 0.01)), steroids (dexamethasone,
estimated coefficient 1.85 (p < 0.01)), and anti-inflammatory drugs (baricitinib, estimated coefficient 1.62 (p < 0.01), and tocilizumab,
estimated coefficient 2.73 (p < 0.01)) might not contribute to survival. These results have not been reported from earlier studies. More
sophisticated estimation procedures, such as treatment effect models, are necessary to obtain conclusive results.
Keywords: antibody cocktail, anti-inflammatory drug,..
is less effective
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