04 Nov Patterns of steroid utilization in COVID-19 patients (Q21-02)
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Patterns of steroid utilization in COVID-19 patients (Q21-02)
Q21-02_CDM
Overview
What is the issue?
- National Institute of Health COVID-19 Treatment Guidelines recommend that systemic dexamethasone not be used in outpatients with mild to moderate COVID-19, or in hospitalized patients not requiring supplemental oxygen. However, a recent study from the United States showed that 15% of outpatients were prescribed systemic corticosteroids (CS) within 14 days of COVID-19 infection.
What was the aim of the study?
- Our main objective was to describe the clinical and demographic characteristics and outcomes of Canadians infected with SARS-CoV-2 as outpatients, according to whether they initiated outpatient systemic CS therapy during the 14 days following diagnosis with COVID-19.
How was the study conducted?
- This was a population-based cohort study using administrative health data from three Canadian provinces (British Columbia, BC; Manitoba, MB; and Ontario, ON [over age 65]) during the first year of the pandemic: April 1, 2020, to January 31, 2021.
- The cohort included residents with a first instance of COVID-19 (positive SARS-CoV-2 nucleic acid laboratory test) in an outpatient setting.
- Follow-up was 30 days from the date of the positive test or date of dispensing of a systemic CS during the 14 days following COVID-19 diagnosis. Patients were censored if they died or were hospitalized during the 14-day exposure ascertainment window.
- We determined the percentage of patients newly dispensed systemic CS therapy by province, overall and by month; the demographic and clinical characteristics of patients; and the 30-day rates of hospitalization, COVID-19-related hospitalization, and death according to whether patients initiated CS therapy, overall and by long-term care (LTC) residence.
What did the study find?
- We studied 108,338 eligible COVID-19 outpatients: 50,869 in BC; 23,545 in MB; and 33,924 in ON.
- Mean age: 40 years in MB and BC; 70 years in ON
- LTC residents: 5% in MB and BC; 39% in ON
- Newly prescribed CS: 1.8% of MB and BC; 6% in ON
- CS recipients were older and more likely to reside in LTC, had a greater prevalence of comorbidities and concomitant medications, and were more likely to use health services than non-recipients.
- CS recipients had higher 30-day rates of hospitalization, COVID-19-related hospitalization, and death, compared with non-recipients.
Implications
- Further research is needed to continue to monitor CS prescribing in outpatients with mild to moderate COVID-19, and to study its safety, particularly in LTC settings where it is most frequently prescribed.
Key messages
- This population-based study of COVID-19 outpatients in three Canadian provinces, demonstrated that use of systemic CS therapy as a treatment for COVID-19 was limited during the first year of the pandemic.