Early Adoption of Anti-SARS-CoV-2 Pharmacotherapies Among US Veterans With Mild to Moderate COVID-19, January and February 2022

Kristina L Bajema, Xiao Qing Wang, Denise M Hynes, Mazhgan Rowneki, Alex Hickok, Francesca Cunningham, Amy Bohnert, Edward J Boyko, Theodore J Iwashyna, Matthew L Maciejewski, Elizabeth M Viglianti, Elani Streja, Lei Yan, Mihaela Aslan, Grant D Huang, George N Ioannou, Kristina L Bajema, Xiao Qing Wang, Denise M Hynes, Mazhgan Rowneki, Alex Hickok, Francesca Cunningham, Amy Bohnert, Edward J Boyko, Theodore J Iwashyna, Matthew L Maciejewski, Elizabeth M Viglianti, Elani Streja, Lei Yan, Mihaela Aslan, Grant D Huang, George N Ioannou

Abstract

Importance: Older adults and individuals with medical comorbidities are at increased risk for severe COVID-19. Several pharmacotherapies demonstrated to reduce the risk of COVID-19-related hospitalization and death have been authorized for use.

Objective: To describe factors associated with receipt of outpatient COVID-19 pharmacotherapies in the Veterans Affairs (VA) health care system.

Design, settings, and participants: This cohort study assessed outpatient veterans with risk factors for severe COVID-19 who tested positive for SARS-CoV-2 during January and February 2022. The setting was the VA health care system, the largest integrated health care system in the US.

Exposures: Demographic characteristics, place of residence, underlying medical conditions, and COVID-19 vaccination.

Main outcomes and measures: The odds of receipt of any COVID-19 pharmacotherapy, including sotrovimab, nirmatrelvir boosted with ritonavir, molnupiravir, or remdesivir were estimated using multivariable logistic regression.

Results: Among 111 717 veterans included in this study (median [IQR] age, 60 [46-72] years; 96 482 [86.4%] male, 23 362 [20.9%] Black, 10 740 [9.6%] Hispanic, 75 973 [68.0%] White) who tested positive for SARS-CoV-2 during January to February 2022, 4233 (3.8%) received any COVID-19 pharmacotherapy, including 2870 of 92 396 (3.1%) in January and 1363 of 19 321 (7.1%) in February. Among a subset of 56 285 veterans with documented COVID-19-related symptoms in the 30 days preceding a positive SARS-CoV-2 test, 3079 (5.5%) received any COVID-19 pharmacotherapy. Untreated veterans had a median (IQR) age of 60 (46-71) years and a median (IQR) of 3 (2-5) underlying medical conditions. Veterans receiving any treatment were more likely to be older (aged 65 to 74 years vs 50 to 64 years: adjusted odds ratio [aOR], 1.66 [95% CI, 1.52-1.80]; aged at least 75 years vs 50 to 64 years: aOR, 1.67 [95% CI, 1.53-1.84]) and have a higher number of underlying conditions (at least 5 conditions vs 1 to 2 conditions: aOR, 2.17 [95% CI, 1.98-2.39]). Compared with White veterans, Black veterans (aOR, 0.65 [95% CI, 0.60-0.72]) were less likely to receive treatment; and compared with non-Hispanic veterans, Hispanic veterans (aOR, 0.88 [95% CI, 0.77-0.99]) were less likely to receive treatment. There were 16 546 courses of sotrovimab, nirmatrelvir, and molnupiravir allocated across the VA during this period.

Conclusions and relevance: In this cohort study of veterans who tested positive for SARS-CoV-2 during January and February when supply of outpatient COVID-19 pharmacotherapies was limited, prescription of these pharmacotherapies was underused, and many veterans with risk factors for severe COVID-19 did not receive treatment. Veterans from minority racial and ethnic groups were less likely to receive any pharmacotherapy.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Hickok reported receiving grants from the Department of Veterans Affairs to support his work outside the submitted work. Dr Maciejewski reported receiving Amgen stock ownership due to his spouse's employment. No other disclosures were reported.

Figures

Figure 1.. Study Flowchart
Figure 1.. Study Flowchart
Veterans with a first positive SARS-CoV-2 test from January 1-February 28, 2022, were included in the study. Eligible veterans had an inpatient or outpatient encounter in the VA health care system in the 18 months preceding January 1, 2022, were not hospitalized on or before the date of positive SARS-CoV-2 test, and had at least 1 risk factor for progression to severe COVID-19.
Figure 2.. Distribution of COVID-19 Pharmacotherapies by…
Figure 2.. Distribution of COVID-19 Pharmacotherapies by Veterans Integrated Services Networks
A, Percentage of veterans receiving any COVID-19 pharmacotherapy. B, Pharmacotherapies prescribed among treated veterans. Regions are based on VISNs. West includes VISNs 19 to 22; Midwest: 10, 12, 15, 23; Northeast: 1, 2, 4, 5; South: 6 to 9, 16, 17. Error bars indicate 95% CIs for proportions; VISN, Veterans Integrated Services Network.

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Source: PubMed

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