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Abstract: FR-PO008

Use of Non-Approved and Approved Treatments for COVID-19 by CKD Status in Medicare

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Roetker, Nicholas S., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • St. Peter, Wendy L., University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
  • Hoover, Madison, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Wetmore, James B., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Johansen, Kirsten L., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
Background

Hydroxychloroquine, chloroquine, and ivermectin gained popularity for treatment of COVID-19 in 2020. Remdesivir was approved for treating hospitalized COVID-19 in late 2020. We studied the uptake of these drugs early in the pandemic in a 5% sample of Medicare fee-for-service beneficiaries with and without CKD.

Methods

We examined the percentage of beneficiaries receiving ≥1 Part D covered prescription for hydroxychloroquine or chloroquine and ivermectin in each month of 2020. Among first COVID-19 hospitalizations from November 2020-June 2021, we examined the percentage receiving remdesivir using ICD-10-PCS. Analyses included those aged ≥66 years without ESRD; CKD was defined by ≥1 inpatient or ≥2 outpatient diagnoses.

Results

Use of hydroxychloroquine and chloroquine increased in March 2020 and then subsided in the ensuing months, remaining slightly elevated though 2020 (Figure A). Receipt of these drugs was higher in patients with CKD than in those without. Ivermectin use was uncommon in both groups before spiking in December 2020 (Figure B). Among COVID-19 inpatients, 55% without CKD and 44% with CKD received remdesivir, which was used more often in men than in women, less often in Blacks than in Whites or Hispanics, and less often in those with the low-income subsidy than in those without.

Conclusion

In 2020, Medicare beneficiaries with and without CKD showed similar spiking patterns in use of the approval-revoked or non-approved drugs hydroxychloroquine/chloroquine (in March) and ivermectin (in December). Through June 2021, remdesivir was used less in patients with CKD than in those without for hospitalized COVID-19, likely because the FDA recommends not using remdesivir if eGFR is <30 mL/min. Lower income and Black patients were less likely to receive remdesivir than others.

Funding

  • NIDDK Support