During the height of the COVID-19 pandemic, new medications were constantly being touted as showing promise to ameliorate the symptoms—or even cure—the sometimes-deadly virus.

But what drugs were actually used in hospitals to combat the novel SARS-CoV-2 virus, which is responsible for more than 118 million cases of COVID-19 and more than 2.6 million deaths worldwide?

To help answer that question, a study in JAMA Network Open reviewed the therapeutic arsenal used in a California hospital system. Researchers from the University of California Irvine School of Pharmacy & Pharmaceutical Sciences looked at potential therapeutic options, including dexamethasone, remdesivir, enoxaparin, heparin, colchicine, hydrocortisone, tocilizumab, azithromycin, hydroxychloroquine, and medication classes of angiotensin-2 converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) and then measured daily and overall use percentages for hospitalized patients in 2020.

Data came from the University of California COVID Research Data Set (UC CORDS), which contains COVID-19 treatment information from all five UC Health medical centers in Davis, Irvine, Los Angeles, San Diego, and San Francisco.

The total data set included 22,896 patients with COVID-19; those patients had a mean age of 42.4 years and 53.1% were women. Slightly more than 15% ended up being hospitalized. A sample of 6,326 patients included 27.6% non-Hispanic Whites, 37% Hispanics, 6.8% Asians, and 5.7% Blacks.

In terms of therapeutics, the authors report the following:
• Dexamethasone use jumped up from 1.4% (95% CI, 1.4%-1.5%) of COVID-19-diagnosed patients per day on March 31 to 67.5% (95% CI, 62.6%-72.1%) of patients per day on December 31.
• Enoxaparin daily usage was 50.4% (95% CI, 45.7%-55.2%) on March 21 and remained above this percentage for the remainder of 2020.
• Remdesivir use shot up more than 12-fold from 4.9% (95% CI, 4.7%-5.1%) on June 1 to 62.5% (95% CI, 56.7%-68.0%) on December 31.
• Azithromycin was used in 45.5% (95% CI, 41.9%-49.1%) of the COVID-19 patients on April 1 but fell by more than half to 20.0% (95% CI, 19.0%-21.1%) by August 1.
• Use of ACEIs/ARBs moderately declined from 27.5% (95% CI, 25.0%-30.2%) on March 31 to 18.5% (95% CI, 16.1%-21.1%) on December 31.
• Heparin overall use was fairly stable over time, at approximately 40%.
• Two other drugs touted as being helpful, tocilizumab and colchicine, were used in 2.4% (95% CI, 2.3%-2.5%) and 2.9% (95% CI, 2.8%-3.0%) of cases, respectively, on April 15 but remained below these percentages for the remainder of 2020.

Among the most dramatic changes occurred with hydroxychloroquine, the malaria drug that became politicized during the pandemic. Researchers point out that, in early April 2020, more than 40% of patients up to that point had received hydroxychloroquine. By July, however, fewer than 10% of all patients had received it.

“A small study conducted early in the pandemic favored use of hydroxychloroquine, but later, larger controlled studies found no benefit,” they explain. 

The trend went the opposite way for corticosteroids, partly because the World Health Organization initially recommended against using them for COVID-19. Before May, dexamethasone was used in only 4% of all COVID-19 patients to that point, but the study notes that use accelerated and, by the end of 2020, nearly 40% of all patients received dexamethasone.

“This cohort study found that, early in the COVID-19 pandemic, antimicrobials azithromycin and hydroxychloroquine were each used in more than 40% of hospitalized patients. By June, use was below 30% and 5%, respectively,” the authors wrote.

They posited that steady rates of enoxaparin use, which remained above 50% throughout 2020, might have been because the drug can be used for both thrombosis prophylaxis and thrombophilia treatment triggered by COVID-19.

In another case, use of remdesivir grew substantially, at least partly because availability increased over time as trials were completed, researchers suggest.

The authors say their review was the first analysis of medication utilization for hospitalized patients with COVID-19 in a large, diverse, statewide health system.

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