Anti-SARS-CoV-2 Pharmacotherapies Among Nonhospitalized US Veterans, January 2022 to January 2023

Lei Yan, Elani Streja, Yuli Li, Nallakkandi Rajeevan, Mazhgan Rowneki, Kristin Berry, Denise M Hynes, Francesca Cunningham, Grant D Huang, Mihaela Aslan, George N Ioannou, Kristina L Bajema, Lei Yan, Elani Streja, Yuli Li, Nallakkandi Rajeevan, Mazhgan Rowneki, Kristin Berry, Denise M Hynes, Francesca Cunningham, Grant D Huang, Mihaela Aslan, George N Ioannou, Kristina L Bajema

Abstract

Importance: Several pharmacotherapies have been authorized to treat nonhospitalized persons with symptomatic COVID-19. Longitudinal information on the use of these therapies is needed.

Objective: To analyze trends and factors associated with prescription of outpatient COVID-19 pharmacotherapies within the Veterans Health Administration (VHA).

Design, setting, and participants: This cohort study evaluated nonhospitalized veterans in VHA care who tested positive for SARS-CoV-2 from January 2022 through January 2023 using VHA and linked Community Care and Medicare databases.

Exposures: Demographic characteristics, underlying medical conditions, COVID-19 vaccination, and regional and local systems of care, including Veterans Integrated Services Networks (VISNs).

Main outcomes and measures: Monthly receipt of any COVID-19 pharmacotherapy (nirmatrelvir-ritonavir, molnupiravir, sotrovimab, or bebtelovimab) was described. Multivariable logistic regression was used to identify factors independently associated with receipt of any vs no COVID-19 pharmacotherapy.

Results: Among 285 710 veterans (median [IQR] age, 63.1 [49.9-73.7] years; 247 358 males [86.6%]; 28 444 Hispanic [10.0%]; 61 269 Black [21.4%] and 198 863 White [69.6%]) who tested positive for SARS-CoV-2 between January 2022 and January 2023, the proportion receiving any pharmacotherapy increased from 3285 of 102 343 veterans (3.2%) in January 2022 to 5180 of 21 688 veterans (23.9%) in August 2022. The proportion declined to 2194 of 10 551 veterans (20.8%) by January 2023. Across VISNs, the range in proportion of patients who tested positive who received nirmatrelvir-ritonavir or molnupiravir during January 2023 was 41 of 692 veterans (5.9%) to 106 of 494 veterans (21.4%) and 2.1% to 120 of 1074 veterans (11.1%), respectively. Veterans receiving any treatment were more likely to be older (adjusted odds ratio [aOR] for ages 65-74 vs 50-64 years, 1.18; 95% CI, 1.14-1.22; aOR for ages ≥75 vs 50-64 years, 1.19; 95% CI, 1.15-1.23) and have a higher Charlson Comorbidity Index score (aOR for CCI ≥6 vs 0, 1.52; 95% CI, 1.44-1.59). Compared with White veterans, Black veterans (aOR, 1.06; 95% CI, 1.02-1.09) were more likely to receive treatment, and compared with non-Hispanic veterans, Hispanic veterans (aOR 1.06; 95% CI, 1.01-1.11) were more likely to receive treatment.

Conclusions and relevance: This study found that prescription of outpatient COVID-19 pharmacotherapies in the VHA peaked in August 2022 and declined thereafter. There were large regional differences in patterns of nirmatrelvir-ritonavir and molnupiravir use.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Hynes reported receiving grants from the US Department of Veterans Affairs (VA) paid to the VA Portland Healthcare System during the conduct of the study; grants from the VA paid to the VA Portland Healthcare System and Pacific Source Community Services, Inc and the David and Lucille Packard Foundation paid to Oregon State University outside the submitted work; consulting fees from Quality Insights paid to van Breemen and Hynes LLC, of which Dr Hynes is co-owner; and travel fees from the VA. Dr Ioannou reported receiving grants from the VA during the conduct of the study and outside the submitted work. No other disclosures were reported.

Figures

Figure 1.. Study Flowchart
Figure 1.. Study Flowchart
US Department of Veterans Affairs (VA) enrollees with a first positive SARS-CoV-2 test from January 1, 2022, to January 31, 2023, included in the study are presented. aA total of 5683 veterans who received remdesivir, bamlanivimab-etesevimab, and casirivimab-imdevimab were excluded from the treatment and no treatment groups.
Figure 2.. Distribution of Pharmacotherapies
Figure 2.. Distribution of Pharmacotherapies
COVID-19 pharmacotherapies administered among patients who tested positive for SARS-CoV-2 in the Veterans Health Administration January 2022 to January 2023 are presented.
Figure 3.. Distribution of Pharmacotherapies Across Veterans…
Figure 3.. Distribution of Pharmacotherapies Across Veterans Integrated Services Network (VISN)
COVID-19 pharmacotherapies across the 18 VISNs are presented by month. Boxes indicate IQRs; circles, outliers; horizontal lines, medians; squares, means; whiskers, 1.5 × the IQR. Outliers are shown in A and B but omitted in C.

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Source: PubMed

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