P-661. Treatment Patterns Observed Among Immunocompromised And Frail Hospitalized COVID-19 Patients In The US

TL;DR

This study analyzed treatment patterns for hospitalized immunocompromised and frail patients with COVID-19 in the US, finding that many received no specific treatments and that remdesivir use was limited.

Contribution

The study provides new insights into treatment disparities among immunocompromised and frail patients during the pandemic.

Findings

Most hospitalized patients with COVID-19 did not receive any specific treatments.

Immunocompromised patients were less likely to receive remdesivir compared to non-immunocompromised patients.

Frail older patients were less likely to receive remdesivir than robust patients.

Abstract

The treatment landscape for COVID-19 has evolved rapidly since the virus emerged in 2019. Immunocompromised, older and/or frail patients with COVID-19 are at higher risk of severe disease or death than the general population. This retrospective study examined treatment patterns in adults hospitalized with COVID-19 in the US from 12/1/2021 to 06/30/2024.Figure 1:A Sankey Plot illustrating the treatment pathways experienced by immunocompromised hospitalised patients with COVID-19

A Sankey Plot illustrating the treatment pathways experienced by immunocompromised hospitalised patients with COVID-19

Using linked claims and chargemaster data, adults hospitalized with COVID-19 and >6 months of baseline healthcare insurance enrolment were selected. Corticosteroids (CS), remdesivir (RDV), Janus kinase inhibitor (JAKi), interleukin-6 inhibitors (IL-6i), nirmatrelvir plus ritonavir, and molnupiravir use were assessed from admission until death, discharge/transfer, 28 days after admission, or end of data. Therapies initiated prior to admission were not counted. Key subgroups were defined by age, diagnosis codes, and a published frailty algorithm.

The main cohort included 73,555 patients (mean age 59 years; 44% male). Most (59%) patients did not receive any COVID-19 treatments. The most common first-regimen treatments were CS alone (23%), CS/RDV combination (12%), and RDV alone (4%). Second regimen and third regimen treatments were identified in 13% (9,483) and 5% (3,984) of patients, respectively.

Among the 27,355 immunocompromised patients included (Figure 1), 58% had no treatments of interest. The most common initial treatment regimens were CS alone (21%), CS/RDV combination (13%), and RDV alone (5%). Second regimens were observed in 12% of immunocompromised patients; 5% had a third regimen treatment.

In patients without RDV-contraindicated conditions, RDV was used by 22% (3,765/16,775) of immunocompromised patients and 27% (4,928/18,316) of patients aged >65 during the assessment period. In patients aged >65, RDV was more commonly used in robust patients (28%), compared to mildly frail (24%) and moderate/severely frail (23%) patients.

Many patients hospitalised with COVID-19 did not receive any COVID-19 indicated treatments. Less than 1 in 5 immunocompromised patients received RDV, indicating a potential treatment unmet need. Frail older patients were less likely to receive RDV than robust patients; further research is needed in this area.

Harriet Dickinson, PhD, Gilead Sciences: Employment|Gilead Sciences: Stocks/Bonds (Public Company) Mark Berry, PhD, Gilead Sciences, Inc.: Employee|Gilead Sciences, Inc.: Stocks/Bonds (Public Company) Amanda Kong, DrPH, Aetion: Employee|Aetion: Stocks/Bonds (Private Company) Alice Bersani, Masters, Aetion: Employment|Aetion: Stocks/Bonds (Private Company)|Boehringer ingelheim: Employment Isabella Lelis, BA, Aetion: Employment Anand Chokkalingam, PhD, Gilead Sciences: Employment|Gilead Sciences: Stocks/Bonds (Public Company)

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