Concerted and Multidisciplinary Management of COVID-19 Drug Therapies During the First Two Epidemic Waves in a Tertiary Hospital in Marseille, France: Results of the Pharma-Covid Study
Matthieu Peretti, Stanislas Rebaudet, Laurent Chiche , Hervé Pegliasco, Emilie Coquet
Abstract
Objectives
To evaluate the impact of local therapeutic recommendation updates made by the COVID multidisciplinary consultation meeting (RCP) at the Hôpital Européen Marseille (HEM) through the description of the drug prescriptions for COVID-19 during the first two waves of the epidemic.
Introduction
In 2020, the SARS-CoV-2 pandemic was a unique health event that caused the health care system to be overwhelmed in several French regions [1]. The initial "shock" was followed by a rapid reorganization of the management of patients suffering from a new pathology, COVID-19, for which the medical teams had very little data, particularly in terms of medication. The Hôpital Européen Marseille (HEM) is a 610-bed private non-profit hospital located in the heart of Marseille’s impoverished districts and having, in particular, emergency, infectious diseases, pneumology and intensive care wards (ICU). From February 2020 onwards, HEM was committed by the regional public health authorities in the response to the COVID-19 pandemic, and played a major role in the care of COVID-19 patients in the Marseille area. At the peak of the first epidemic wave (April 1, 2020), HEM was taking care of up to 75 hospitalized patients, thanks to the involvement of a large part of the establishment’s medical community.
Materials and Methods
In order to evaluate the impact of local therapeutic recommendation updates made by the COVID RCP, we retrospectively included all patients hospitalized for COVID-19 between February 1, 2020 and January 21, 2021. We extracted specific anti-COVID-19 therapies (ST) from computerized patient record, including those administered in clinical trials in which the hospital participated, as well as patients’ demographic characteristics, comorbidities (including BMI, modified Charlson index [6]), and outcome (ICU admission, death). The evolution of ST prescriptions during the study period was described and put into perspective with the updates of local recommendations. We performed a comparative analysis between patients who did (ST+) or did not (ST-) receive specific anti-COVID-19 therapies, excluding anticoagulation, and between patients of the first (W1, from 2/24/2020 to 7/27/2020), and second (W2, from 7/28/2020 to 1/21/2021) epidemic waves in France.
Results
The overall average length of hospital stay was 13.3 days. A total of 134 inpatients (22%) were admitted to the ICU, and the overall mortality rate was 15% (Table 1). The proportion of patients admitted to the ICU and the mortality rate were similar during W1 and W2 (Table 1). The length of hospital stay was longer in the ST+ group than in the ST- group (16.8 vs 7.9 days, P-value<0.001). Finally, the proportion of patients admitted to the ICU was higher in the ST+ group than in the ST- group (32% vs 6%, P-value < 0.001) (S1 Table).
Discussion
Hydroxychloroquine, azithromycin and lopinavir-ritonavir were the most used repurposed drugs in different centres around the world for treatment of COVID-19 patients in 2020 [15]. In comparison, in our centre, hydroxychloroquine and lopinavir-ritonavir were administered to a very small group of patients and only at the very start of the pandemic, while azithromycin prescription dramatically dropped after the first pandemic wave. Remdesivir was never prescribed to our COVID-19 inpatients during our study period because: this specific drug was not available in our hospital at the beginning the pandemic; it was not judged clinically meaningful according to our implementation process based on the continuous critical reviewing of the available medical literature; and the French drug authorities (Haute Autorité de Santé) eventually considered in September 2020 that remdesivir did not bring any improvement in medical benefit in the cure of inpatients with moderate illness, and brought an insufficient medical benefit for those with severe or critical illness [16].
Citation: Peretti M, Rebaudet S, Chiche L, Pegliasco H, Coquet E (2023) Concerted and multidisciplinary management of COVID-19 drug therapies during the first two epidemic waves in a tertiary hospital in Marseille, France: Results of the PHARMA-COVID study. PLoS ONE 18(3): e0283165. https://doi.org/10.1371/journal.pone.0283165
Editor: Robert Jeenchen Chen, Stanford University School of Medicine, UNITED STATES
Received: July 7, 2022; Accepted: February 21, 2023; Published: March 17, 2023
Copyright: © 2023 Peretti et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: According to the European Data Protection Regulation (General Data Protection Regulation, GDPR), data including individual patient characteristics which support the findings of the present study could not be deposited in any integrated repository. However, the full pseudo-anonymised database is available upon reasonable request to Miss Cecile Berthelier (Clinical Research Department) at [email protected] and Miss Margaux Garreau (Ethic Committee) at [email protected].
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
