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- Title
Implementation of Recommendations on the Use of Corticosteroids in Severe COVID-19.
- Authors
Camirand-Lemyre, Félix; Merson, Laura; Tirupakuzhi Vijayaraghavan, Bharath Kumar; Burrell, Aidan J. C.; Citarella, Barbara Wanjiru; Domingue, Marie-Pier; Lévesque, Simon; Usuf, Effua; Wils, Evert-Jan; Ohshimo, Shinichiro; Martin-Loeches, Ignacio; Sǎndulescu, Oana; Laake, Jon Henrik; Lamontagne, François
- Abstract
Key Points: Question: How did the percentage of patients with severe COVID-19 who received treatment with corticosteroids vary over time (January 2020-September 2022) and across World Health Organization geographic regions? Findings: In this cohort study of 434 851 patients with severe COVID-19, corticosteroid use increased over time but unequally across geographic regions. The statistical associations between increased corticosteroid use and publication of the Randomised Evaluation of COVID-19 Therapy trial and World Health Organization guidelines were significant only in Europe, where most of the trial recruitment occurred. Meaning: The findings of this study suggest that a lack of research representativeness may hinder guideline implementation. Importance: Research diversity and representativeness are paramount in building trust, generating valid biomedical knowledge, and possibly in implementing clinical guidelines. Objectives: To compare variations over time and across World Health Organization (WHO) geographic regions of corticosteroid use for treatment of severe COVID-19; secondary objectives were to evaluate the association between the timing of publication of the RECOVERY (Randomised Evaluation of COVID-19 Therapy) trial (June 2020) and the WHO guidelines for corticosteroids (September 2020) and the temporal trends observed in corticosteroid use by region and to describe the geographic distribution of the recruitment in clinical trials that informed the WHO recommendation. Design, Setting, and Participants: This prospective cohort study of 434 851 patients was conducted between January 31, 2020, and September 2, 2022, in 63 countries worldwide. The data were collected under the auspices of the International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC)–WHO Clinical Characterisation Protocol for Severe Emerging Infections. Analyses were restricted to patients hospitalized for severe COVID-19 (a subset of the ISARIC data set). Exposure: Corticosteroid use as reported to the ISARIC-WHO Clinical Characterisation Protocol for Severe Emerging Infections. Main Outcomes and Measures: Number and percentage of patients hospitalized with severe COVID-19 who received corticosteroids by time period and by WHO geographic region. Results: Among 434 851 patients with confirmed severe or critical COVID-19 for whom receipt of corticosteroids could be ascertained (median [IQR] age, 61.0 [48.0-74.0] years; 53.0% male), 174 307 (40.1%) received corticosteroids during the study period. Of the participants in clinical trials that informed the guideline, 91.6% were recruited from the United Kingdom. In all regions, corticosteroid use for severe COVID-19 increased, but this increase corresponded to the timing of the RECOVERY trial (time-interruption coefficient 1.0 [95% CI, 0.9-1.2]) and WHO guideline (time-interruption coefficient 1.9 [95% CI, 1.7-2.0]) publications only in Europe. At the end of the study period, corticosteroid use for treatment of severe COVID-19 was highest in the Americas (5421 of 6095 [88.9%]; 95% CI, 87.7-90.2) and lowest in Africa (31 588 of 185 191 [17.1%]; 95% CI, 16.8-17.3). Conclusions and Relevance: The results of this cohort study showed that implementation of the guidelines for use of corticosteroids in the treatment of severe COVID-19 varied geographically. Uptake of corticosteroid treatment was lower in regions with limited clinical trial involvement. Improving research diversity and representativeness may facilitate timely knowledge uptake and guideline implementation. This large cohort study assesses variations over time and across World Health Organization geographic regions for the use of corticosteroids in treating patients with severe or critical COVID-19.
- Subjects
STATISTICS; COVID-19; ADRENOCORTICAL hormones; CONFIDENCE intervals; MEDICAL protocols; DESCRIPTIVE statistics; CHI-squared test; DATA analysis software; DATA analysis; LOGISTIC regression analysis; LONGITUDINAL method
- Publication
JAMA Network Open, 2023, Vol 6, Issue 12, pe2346502
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.46502