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Real-world Evidence of the Effects of Novel Treatments for COVID-19 on Mortality: A Nationwide Comparative Cohort Study of Hospitalized Patients in the First, Second, Third, and Fourth Waves in the Netherlands.
Slim, Marleen A; Appelman, Brent; Peters-Sengers, Hessel; Dongelmans, Dave A; de Keizer, Nicolette F; Schade, Rogier P; de Boer, Mark G J; Müller, Marcella C A; Vlaar, Alexander P J; Wiersinga, W Joost; van Vught, Lonneke A.
  • Slim MA; Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers-Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands.
  • Appelman B; Department of Intensive Care, Amsterdam University Medical Centers-Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands.
  • Peters-Sengers H; Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers-Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands.
  • Dongelmans DA; Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers-Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands.
  • de Keizer NF; Department of Epidemiology and Data Science, Amsterdam University Medical Centers-Location AMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
  • Schade RP; Department of Intensive Care, Amsterdam University Medical Centers-Location AMC, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands.
  • de Boer MGJ; National Intensive Care Evaluation (NICE) Foundation, Amsterdam, the Netherlands.
  • Müller MCA; National Intensive Care Evaluation (NICE) Foundation, Amsterdam, the Netherlands.
  • Vlaar APJ; Department of Medical Informatics, Amsterdam University Medical Centers, University of Amsterdam-Location AMC, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
  • Wiersinga WJ; Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers-Location AMC, University of Amsterdam, Amsterdam, the Netherlands.
  • van Vught LA; Department of Infectious Diseases and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
Open Forum Infect Dis ; 9(12): ofac632, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2161132
ABSTRACT

Background:

Large clinical trials on drugs for hospitalized coronavirus disease 2019 (COVID-19) patients have shown significant effects on mortality. There may be a discrepancy with the observed real-world effect. We describe the clinical characteristics and outcomes of hospitalized COVID-19 patients in the Netherlands during 4 pandemic waves and analyze the association of the newly introduced treatments with mortality, intensive care unit (ICU) admission, and discharge alive.

Methods:

We conducted a nationwide retrospective analysis of hospitalized COVID-19 patients between February 27, 2020, and December 31, 2021. Patients were categorized into waves and into treatment groups (hydroxychloroquine, remdesivir, neutralizing severe acute respiratory syndrome coronavirus 2 monoclonal antibodies, corticosteroids, and interleukin [IL]-6 antagonists). Four types of Cox regression analyses were used unadjusted, adjusted, propensity matched, and propensity weighted.

Results:

Among 5643 patients from 11 hospitals, we observed a changing epidemiology during 4 pandemic waves, with a decrease in median age (67-64 years; P < .001), in in-hospital mortality on the ward (21%-15%; P < .001), and a trend in the ICU (24%-16%; P = .148). In ward patients, hydroxychloroquine was associated with increased mortality (1.54; 95% CI, 1.22-1.96), and remdesivir was associated with a higher rate of discharge alive within 29 days (1.16; 95% CI, 1.03-1.31). Corticosteroids were associated with a decrease in mortality (0.82; 95% CI, 0.69-0.96); the results of IL-6 antagonists were inconclusive. In patients directly admitted to the ICU, hydroxychloroquine, corticosteroids, and IL-6 antagonists were not associated with decreased mortality.

Conclusions:

Both remdesivir and corticosteroids were associated with better outcomes in ward patients with COVID-19. Continuous evaluation of real-world treatment effects is needed.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Journal: Open Forum Infect Dis Year: 2022 Document Type: Article Affiliation country: Ofid

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Journal: Open Forum Infect Dis Year: 2022 Document Type: Article Affiliation country: Ofid