Olivia C. Welter, PharmD
A new study published in JAMA investigated how various treatment interventions affected long-term outcomes in critically ill patients with COVID-19.
Since the beginning of the pandemic in 2020, patients and providers alike have had an interest in learning about how contracting the virus could impact an individual’s future health, even after recovering from infection.
“Long COVID,” formally known as post-acute SARS-CoV-2 infection, has since become recognized as a diagnosable condition. Long COVID is an illness in which patients previously diagnosed with COVID-19 continue to have symptoms—like fatigue and brain fog—for a month or longer.
While long COVID is certainly a concern for any patient recovering from COVID-19, researchers of the study focused on big-picture health endpoints specifically for patients with COVID-19 who had been admitted to an ICU. The study found that interleukin-6 (IL-6) receptor antagonists and antiplatelet agents yielded the most favorable results, while some antiviral agents were associated with potential patient harm.
Treatments assessed
Enrolled patients in the study could receive treatment interventions from several domains: corticosteroid, immune modulation, antiviral, immunoglobulin, anticoagulation, or antiplatelet. Each domain contained various intervention options patients could receive. For example, a patient who fell under the antiviral domain could receive either lopinavir/ritonavir, hydroxychloroquine, combination therapy, or no antiviral therapy. Eligible patients could also receive treatments from multiple domains.
The identified domains align with treatments that patients had been receiving throughout the pandemic for COVID-19 infection. While health care professionals were aware that these interventions may not have been effective in the short-term, they often didn’t have a chance to evaluate how they affected patients several months following hospitalization.
Outcomes evaluated
The primary outcome of the study was mortality status at 180 days. While researchers were most interested in learning whether certain treatments increased a patient’s chance of survival 6 months after infection, they also assessed mortality status at 90 days, health-related quality of life (HRQoL), and disability. HRQoL evaluation focused on each patient’s mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. These assessments give health care professionals insight into which treatment options are associated with
the best outcomes for critically ill patients with COVID-19.
Which treatments yielded the best outcomes?
Among all the potential treatments that patients could have received, the authors of the study determined that certain domains could be associated with lower mortality and greater HRQoL at the specified endpoints. IL-6 receptor antagonists, a medication class included under the immune modulators domain, were found to be the intervention that had the greatest probability of improving outcomes at 180 days. In fact, the probability of improved mortality was greater than 99.9%. IL-6 receptor antagonists were also correlated with higher HRQoL scores and lower instances of disability.
Closely following IL-6 receptor antagonists, the antiplatelet domain was found to have a 95% probability of improving mortality 6 months after treatment.
Conversely, researchers determined that hydroxychloroquine alone or in combination with lopinavir/ritonavir had high potential to cause harm. The probability of causing harm was a consistent finding for the antiviral domain across all evaluated outcomes: mortality, quality of life, and disability.
Based on the findings of this study, health care professionals should give careful consideration to the treatments they use for critically ill patients with COVID-19. The researchers commented that this study is likely the largest to be conducted investigating long-term outcomes of COVID-19 treatments, meaning the results have a higher level of credibility.
Throughout the pandemic, regulatory agencies including FDA have issued statements cautioning that taking medication like hydroxychloroquine to treat COVID-19 could be associated with negative effects such as an irregular heart rhythm. This study provides evidence that hydroxychloroquine should be avoided in patients with COVID-19 infection, particularly patients who are considered to be critically ill.
IL-6 receptor antagonists and antiplatelet agents were shown in the study to yield the most favorable outcomes; providers can consider using medications such as tocilizumab or clopidogrel in their critically ill patients with COVID-19. ■