“At the start of the pandemic, when we knew little about COVID-19 and how to treat it, there were many differences between hospitals around the world on how health professionals were treating it,” said study co-lead Albert Prats-Uribe, a DPhil candidate and Research Assistant in Clinical Epidemiology at the University of Oxford.
“This was also influenced by political and social media pressures that spread misinformation,” said senior author Dani Prieto-Alhambra, Professor of Pharmaco- and Device Epidemiology at the University of Oxford. “Once reliable evidence from well-designed and performed studies came in, the situation quickly improved, and hospitals stopped using the ineffective treatments and turned to more effective ones.”
Deidentified patient data from 11 databases across three continents (Asia, Europe and North America) showed that more than 3,400 different medicines were used in the treatment of COVID-19 patients. Among the most popular in the earliest stages of the pandemic was hydroxychloroquine, which was heavily promoted without the backing of reliable evidence and later revoked from emergency approval status following both randomized controlled trials (RCTs) and related studies, including an OHDSI study showing dangerous risk of combining hydroxychloroquine with another early popular prescribed COVID-19 therapeutic, azithromycin.
Heterogeneity in drug therapy choice was dramatic across databases around the world. For example, lopinavir-ritonavir was used 50% of the time in one Spanish setting (HM Hospitals), 35% of the time in a South Korean setting (HIRA), and 0% of the time in a U.S. setting (Department of Veterans Affairs).
Adjunctive therapies developed into popular forms of management for supportive care, with the most recognized being corticosteroids and anti-cytokines, both of which have been shown to reduce mortality in more serious cases. While these were lightly used early in the pandemic, results from the RECOVERY RCT showed efficacy in reducing death on hospitalized patients with severe respiratory disease.