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- Title
Anti–SARS-CoV-2 Pharmacotherapies Among Nonhospitalized US Veterans, January 2022 to January 2023.
- Authors
Yan, Lei; Streja, Elani; Li, Yuli; Rajeevan, Nallakkandi; Rowneki, Mazhgan; Berry, Kristin; Hynes, Denise M.; Cunningham, Francesca; Huang, Grant D.; Aslan, Mihaela; Ioannou, George N.; Bajema, Kristina L.
- Abstract
This cohort study investigates monthly rates of receipt of COVID-19 pharmacotherapies among nonhospitalized patients in the VHA from January 2022 to January 2023. Key Points: Question: How have anti–SARS-CoV-2 pharmacotherapies been used among nonhospitalized US Veterans in the Veterans Affairs health care system? Findings: In this cohort study of 285 710 outpatient US veterans who tested positive for SARS-CoV-2 from January 2022 through January 2023, the proportion receiving any pharmacotherapy increased from 3.2% in January 2022 to 23.9% in August 2022 and declined to 20.8% by January 2023. Black, Hispanic, and older veterans with a higher number of underlying conditions were more likely to receive treatment. Meaning: These results suggest the need for continued support of infrastructure and education to facilitate treatment for individuals at highest risk of progression to severe COVID-19. Importance: Several pharmacotherapies have been authorized to treat nonhospitalized persons with symptomatic COVID-19. Longitudinal information on the use of these therapies is needed. Objective: To analyze trends and factors associated with prescription of outpatient COVID-19 pharmacotherapies within the Veterans Health Administration (VHA). Design, Setting, and Participants: This cohort study evaluated nonhospitalized veterans in VHA care who tested positive for SARS-CoV-2 from January 2022 through January 2023 using VHA and linked Community Care and Medicare databases. Exposures: Demographic characteristics, underlying medical conditions, COVID-19 vaccination, and regional and local systems of care, including Veterans Integrated Services Networks (VISNs). Main Outcomes and Measures: Monthly receipt of any COVID-19 pharmacotherapy (nirmatrelvir-ritonavir, molnupiravir, sotrovimab, or bebtelovimab) was described. Multivariable logistic regression was used to identify factors independently associated with receipt of any vs no COVID-19 pharmacotherapy. Results: Among 285 710 veterans (median [IQR] age, 63.1 [49.9-73.7] years; 247 358 males [86.6%]; 28 444 Hispanic [10.0%]; 61 269 Black [21.4%] and 198 863 White [69.6%]) who tested positive for SARS-CoV-2 between January 2022 and January 2023, the proportion receiving any pharmacotherapy increased from 3285 of 102 343 veterans (3.2%) in January 2022 to 5180 of 21 688 veterans (23.9%) in August 2022. The proportion declined to 2194 of 10 551 veterans (20.8%) by January 2023. Across VISNs, the range in proportion of patients who tested positive who received nirmatrelvir-ritonavir or molnupiravir during January 2023 was 41 of 692 veterans (5.9%) to 106 of 494 veterans (21.4%) and 2.1% to 120 of 1074 veterans (11.1%), respectively. Veterans receiving any treatment were more likely to be older (adjusted odds ratio [aOR] for ages 65-74 vs 50-64 years, 1.18; 95% CI, 1.14-1.22; aOR for ages ≥75 vs 50-64 years, 1.19; 95% CI, 1.15-1.23) and have a higher Charlson Comorbidity Index score (aOR for CCI ≥6 vs 0, 1.52; 95% CI, 1.44-1.59). Compared with White veterans, Black veterans (aOR, 1.06; 95% CI, 1.02-1.09) were more likely to receive treatment, and compared with non-Hispanic veterans, Hispanic veterans (aOR 1.06; 95% CI, 1.01-1.11) were more likely to receive treatment. Conclusions And Relevance: This study found that prescription of outpatient COVID-19 pharmacotherapies in the VHA peaked in August 2022 and declined thereafter. There were large regional differences in patterns of nirmatrelvir-ritonavir and molnupiravir use.
- Subjects
UNITED States; THERAPEUTIC use of monoclonal antibodies; COVID-19; COMBINATION drug therapy; CONFIDENCE intervals; SUBSTANCE abuse; ALCOHOLISM; CHRONIC diseases; COVID-19 vaccines; AGE distribution; ANTIVIRAL agents; RACE; PSYCHOLOGY of veterans; DRUG prescribing; RITONAVIR; RESEARCH funding; PHYSICIAN practice patterns; SOCIODEMOGRAPHIC factors; ODDS ratio; RESIDENTIAL patterns; SMOKING; OUTPATIENT services in hospitals; MEDICAL care of veterans; LONGITUDINAL method; COMORBIDITY
- Publication
JAMA Network Open, 2023, Vol 6, Issue 8, pe2331249
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.31249