ABSTRACT
Background. The use of remdesivir (RDV) in patients hospitalized with COVID-19 has resulted in a significantly shorter time to recovery, especially in patients receiving low flow oxygen. Despite the shortened time to recovery, concerns have been raised regarding the $3,120 cost of a five-day course. This price was originally justified by the suggestion that RDV would save hospitals approximately $12,000 per patient by shortening hospital length of stay (LOS) by four days, however, this has not been consistently demonstrated in clinical practice. A preliminary review of RDV orders at our facility revealed hospital discharges were being delayed to complete a five-day course of treatment in patients otherwise medically ready to discharge. Methods. This single-center, retrospective, comparative study was conducted at AdventHealth Orlando, a 1,368-bed community teaching hospital in central Florida. In January 2021, the campus stewardship committee devised a RDV stewardship strategy including targeted education and escalation of orders not meeting institutional criteria at time of order verification. This study compared pre-intervention patients who received RDV from December 1, 2020, to January 7, 2021, to post-intervention patients who received RDV from January 8, 2021, to February 28, 2022. The primary objective of this study was to assess the impact of a pharmacist-driven RDV stewardship initiative on the duration of therapy in hospitalized patients with COVID-19. Results. A total of 2104 remdesivir orders were included in the study (209 preintervention and 1895 post-intervention). Overall, patients had a median age of 59 years and 49% were male. Majority of patients in both groups required low flow supplemental oxygen at the time of RDV initiation. Significantly more orders in the intervention group aligned with institutional criteria at the time of order entry (47% vs 84%, p< .001). Patients completing the full 5-day course of remdesivir therapy decreased from 79 to 53% (p< .001). A decreased duration of therapy and length of stay were observed in the intervention group. Conclusion. Pharmacist-driven RDV stewardship increased adherence to the institutional algorithm and reduced duration of therapy.
ABSTRACT
INTRODUCTION: Incidence and pharmacotherapy of hypertriglyceridemia (HTG) in COVID-19 have not been well characterized. HTG could lead to added COVID-19 complications such as pancreatitis. We aimed to describe HTG in a COVID-19 cohort. METHODS: Triglyceride (TG) values for an observational cohort of consecutive mechanically ventilated patients with COVID-19 were reviewed in two cohort intensive care units between March 22 and April 15, 2020. Data was retrospectively reviewed for the first 30 days of admission on baseline demographics, concomitant lipid therapies, TG levels, treatment, and incidence of pancreatitis. RESULTS: Forty-eight patients were identified. Overall prevalence of moderate hyperTG (175-499 mg/dL) was 85%, severe hyperTG (>500 mg/dL) 35% and 10% had a TG value > 1000 mg/dL. Mean TG was 258 mg/dL, with a median maximum value of 371 mg/d and increase from baseline of 139 mg/dL. Most patients received propofol infusions (94%) for sedation over a mean of six days at a mean dose of 29 mcg/kg/min for a mean of 146 hours. The cohort received enteral nutrition (100%), tocilizumab (40%), insulin infusions (25%), statins (23%), omega-3 fatty acids (10%), fibrates (8%). All patients with TG levels >1000 utilized insulin infusions for rapid TG lowering along with at least one oral therapy. Mean hospital length of stay was 23 days. No episodes of acute pancreatitis were noted in this cohort in whom acute treatment was initiated. CONCLUSIONS: An elevated occurrence of moderate and severe HTG was seen in this COVID-19 cohort, potentially related to multiple underlying mechanisms and pharmacotherapy. Clinicians should be aware of this disease characteristic and monitor TG levels closely, with consideration to avoid lipid infusion.