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Medication Patterns and Disease Progression Among 165 Patients with Coronavirus Disease 2019 (COVID-19) in Wuhan, China: A Single-Centered, Retrospective, Observational Study
37 Pages Posted: 17 Mar 2020More...
Background: The epidemic of coronavirus disease 2019 (COVID-19) has been lasting for nearly three months. Although several treatments have been introduced to the clinical practice, the information on medication patterns and disease progression of patients is still limited. We aimed to describe medication patterns and disease progression of COVID-19 and to explore a potential therapeutic time window for preventing the deterioration of non-severe patients.
Methods: A retrospective, single-center case series study enrolled consecutive hospitalized COVID-19 patients from a designated hospital in Wuhan who were followed up until February 12, 2020. Patients were grouped on a baseline degree of severity: non-severe group (mild and general condition) and severe group (severe and critical severe condition). The medication patterns and potential 72 hours therapeutic time window were linked to disease progression (unchanged/improved vs deteriorated), and were further compared across the two groups.
Findings: Of 165 COVID-19 cases included, the median age was 55 years, 84 (50·9%) had comorbidity, and 26 (15·2%) were in the severe subgroup at admission. Antivirals, antibacterials, glucocorticoids, and traditional Chinese medicine were administered to 92·7%, 98·8%, 68·5% and 55·2% of patients, respectively. A median of 17 (IQR, 10-27) kinds of drugs were prescribed to each patient, and combination patterns were quite diverse. During the follow-up, 11·5% (19/165) died and 32·4% (45/139) non-severe cases deteriorated. Compared with the unchanged/improved group, the deteriorated group was less likely to take medications within 72 hours since the onset of the first symptoms and signs, especially antivirals (8·9% vs 21·3%, P = 0·07). Only 24 patients took antivirals within 72 hours, in which 4 (16·7%) deteriorated. After adjusting age, sex and number of comorbidities, administering medications within 72 hours still significantly decreased the risk of death or deterioration with an odds ratio of 0·3 (95% CI 0·1-0·9; P = 0·04). Besides, 12 patients (7·3%) had a high level of myocardial enzymes, and seven patients (4·2%) presented worsen kidney function.
Interpretation: Medication patterns for COVID-19 were diverse but generally complied with the existing guideline. A potential therapeutic time window of 72 hours might exist in non-severe patients, especially for antiviral drugs. Additionally, the safety issue should not be ignored. Funding National Natural Science Foundation of China.
Funding Statement: This study was supported by the National Natural Science Foundation of China (grant 81973146 to Prof. Zhan).
Declaration of Interests: The authors declare no competing interests.
Ethics Approval Statement: This study was approved by the institutional ethics board of Zhongnan Hospital of Wuhan University (No. 2020014). Written informed consent was waived for emerging infectious diseases.
Keywords: Coronavirus disease 2019 (COVID-19); Medication pattern; Disease progression; Therapeutic time window
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