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Machine Learning as a Precision-Medicine Approach to Prescribing COVID-19 Pharmacotherapy with Remdesivir or Corticosteroids.
Lam, Carson; Siefkas, Anna; Zelin, Nicole S; Barnes, Gina; Dellinger, R Phillip; Vincent, Jean-Louis; Braden, Gregory; Burdick, Hoyt; Hoffman, Jana; Calvert, Jacob; Mao, Qingqing; Das, Ritankar.
  • Lam C; Dascena Inc, Houston, Texas.
  • Siefkas A; Dascena Inc, Houston, Texas. Electronic address: asiefkas@dascena.com.
  • Zelin NS; Dascena Inc, Houston, Texas.
  • Barnes G; Dascena Inc, Houston, Texas.
  • Dellinger RP; Division of Critical Care Medicine, Cooper University Hospital/Cooper Medical School, Rowan University, Camden, New Jersey.
  • Vincent JL; Department of Intensive Care, Erasme University Hospital, Université Libre, Brussels, Belgium.
  • Braden G; Kidney Care and Transplant Associates of New England, Springfield, Massachusetts.
  • Burdick H; Cabell Huntington Hospital, Huntington, West Virginia; School of Medicine, Marshall University, Huntington, West Virginia.
  • Hoffman J; Dascena Inc, Houston, Texas.
  • Calvert J; Dascena Inc, Houston, Texas.
  • Mao Q; Dascena Inc, Houston, Texas.
  • Das R; Dascena Inc, Houston, Texas.
Clin Ther ; 43(5): 871-885, 2021 05.
Article in English | MEDLINE | ID: covidwho-1188425
ABSTRACT

PURPOSE:

Coronavirus disease-2019 (COVID-19) continues to be a global threat and remains a significant cause of hospitalizations. Recent clinical guidelines have supported the use of corticosteroids or remdesivir in the treatment of COVID-19. However, uncertainty remains about which patients are most likely to benefit from treatment with either drug; such knowledge is crucial for avoiding preventable adverse effects, minimizing costs, and effectively allocating resources. This study presents a machine-learning system with the capacity to identify patients in whom treatment with a corticosteroid or remdesivir is associated with improved survival time.

METHODS:

Gradient-boosted decision-tree models used for predicting treatment benefit were trained and tested on data from electronic health records dated between December 18, 2019, and October 18, 2020, from adult patients (age ≥18 years) with COVID-19 in 10 US hospitals. Models were evaluated for performance in identifying patients with longer survival times when treated with a corticosteroid versus remdesivir. Fine and Gray proportional-hazards models were used for identifying significant findings in treated and nontreated patients, in a subset of patients who received supplemental oxygen, and in patients identified by the algorithm. Inverse probability-of-treatment weights were used to adjust for confounding. Models were trained and tested separately for each treatment.

FINDINGS:

Data from 2364 patients were included, with men comprising slightly more than 50% of the sample; 893 patients were treated with remdesivir, and 1471 were treated with a corticosteroid. After adjustment for confounding, neither corticosteroids nor remdesivir use was associated with increased survival time in the overall population or in the subpopulation that received supplemental oxygen. However, in the populations identified by the algorithms, both corticosteroids and remdesivir were significantly associated with an increase in survival time, with hazard ratios of 0.56 and 0.40, respectively (both, P = 0.04). IMPLICATIONS Machine-learning methods have the capacity to identify hospitalized patients with COVID-19 in whom treatment with a corticosteroid or remdesivir is associated with an increase in survival time. These methods may help to improve patient outcomes and allocate resources during the COVID-19 crisis.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Antiviral Agents / Adenosine Monophosphate / Adrenal Cortex Hormones / Alanine / Machine Learning / COVID-19 Drug Treatment Type of study: Experimental Studies / Prognostic study Limits: Adolescent / Adult / Aged / Female / Humans / Male / Middle aged / Young adult Language: English Journal: Clin Ther Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Antiviral Agents / Adenosine Monophosphate / Adrenal Cortex Hormones / Alanine / Machine Learning / COVID-19 Drug Treatment Type of study: Experimental Studies / Prognostic study Limits: Adolescent / Adult / Aged / Female / Humans / Male / Middle aged / Young adult Language: English Journal: Clin Ther Year: 2021 Document Type: Article