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Different COVID-19 treatments' impact on hospital length of stay
Satori Iwamoto1, Bahaar Kaur Muhar1, Hao Chen2
1California Northstate University College of Medicine, Elk Grove, USA.
Insights
The combination of remdesivir, dexamethasone, and tocilizumab may reduce hospital length of stay for severe COVID-19 patients but does not impact mortality. Remdesivir may not be beneficial for mild COVID-19 cases.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pharmacology
Background:
- COVID-19 has significantly impacted global healthcare systems since 2019.
- Limited large-scale data exists on the efficacy of combination therapies for COVID-19.
Purpose of the Study:
- To evaluate if a combination therapy of dexamethasone, remdesivir, and tocilizumab is superior to other treatments in hospitalized COVID-19 patients.
- To assess the impact of different treatment regimens on hospital length of stay and mortality.
Main Methods:
- Retrospective, comparative effectiveness study.
- Analysis of 1233 hospitalized COVID-19 patients from 2020-2021.
- Patients categorized as mild, moderate, or severe based on oxygen requirements.
Main Results:
- No significant decrease in hospital length of stay (LOS) for mild COVID-19 patients across treatment groups.
- Remdesivir and dexamethasone combination showed a slight decrease in LOS for moderate COVID-19 patients (p=0.007).
- The three-drug combination (remdesivir, dexamethasone, tocilizumab) decreased LOS by 8 days in severe COVID-19 patients compared to nonviable treatments (p=0.0034), but not significantly compared to two-drug regimens (p=0.116).
- No treatment arm demonstrated a statistically significant decrease in mortality for severe COVID-19 patients.
Conclusions:
- The three-drug combination may reduce LOS in severe COVID-19 patients compared to two-drug therapy, though not statistically significant.
- Remdesivir may not offer clinical benefits for mild hospitalized COVID-19 patients, suggesting its use be reserved for moderate to severe cases.
- Triple drug therapies did not affect overall mortality in severe COVID-19 patients; further data is needed to increase statistical power.
Importance:
COVID-19 has adversely affected global healthcare infrastructure since 2019. Currently, there are no large-scale published reports on the efficacy of combination therapy of dexamethasone, remdesivir, and tocilizumab on COVID-19 patients.
Objectives:
Is the combination therapy of dexamethasone, remdesivir, and tocilizumab superior to other treatments on hospitalized COVID-19 patients?
Design:
This is a retrospective, comparative effectiveness study.
Setting:
Single-center study PARTICIPANTS/INTERVENTIONS: We analyzed different inpatient COVID-19 treatment options available in the United States and their impact on hospital length of stay (LOS) and mortality. Hospitalized COVID-19 were categorized as "mild," "moderate" and "severe'' based on the highest level of oxygen required; room air, nasal cannula, or high flow/PAP/intubation, respectively. Patients were treated in accordance with the availability of medications and the latest treatment guidelines.
Main Outcomes:
The endpoints of the study are hospital discharges and death during hospitalization.
Results:
1233 COVID-19 patients were admitted from 2020 to 2021. No treatment combinations showed a statistically significant decrease in hospital LOS in mild COVID-19 patients (p = 0.186). In moderate patients, the combination of remdesivir and dexamethasone slightly decreased LOS by 1 day (p = 0.007). In severe patients, the three-drug combination of remdesivir, dexamethasone, and tocilizumab decreased LOS by 8 days (p = 0.0034) when compared to nonviable treatments, such as hydroxychloroquine and convalescent plasma transfusion. However, it did not show any statistically significant benefit when compared to two-drug regimens (dexamethasone plus remdesivir) in severe COVID-19 (p = 0.116). No treatment arm appeared to show a statistically significant decrease in mortality for severe COVID-19 patients.
Conclusions:
Our findings suggest that three-drug combination may decrease LOS in severe COVID-19 patients when compared to two-drug therapy. However, the trend was not supported by statistical analysis. Remdesivir may not be clinically beneficial for mild hospitalized COVID-19 patients; considering its cost, one could reserve it for moderate and severe patients. Triple drug therapies, while potentially reducing LOS for severe patients, do not affect overall mortality. Additional patient data may increase statistical power and solidify these findings.
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