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 RESEARCH ARTICLE 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 PHARMACOVID study a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 Matthieu Peretti ID1, Stanislas Rebaudet2,3, Laurent Chiche ID2*, Hervé Pegliasco4, Emilie Coquet ID1 1 Service de Pharmacie, Hôpital Européen, Marseille, France, 2 Service d’Infectiologie et de Médecine Interne, Hôpital Européen, Marseille, France, 3 UMR1252 SESSTIM, Aix-Marseille Univ, Inserm, IRD, ISSPAM, Marseille, France, 4 Service de Pneumologie, Hôpital Européen, Marseille, France * OPEN ACCESS 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 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0283165 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 Statement: According to the European Data Protection Regulation (General Data 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. Methods This retrospective observational study analysed data from the hospital’s pharmaceutical file. We included all patients hospitalized for COVID-19 between February 1, 2020 and January 21, 2021 and extracted specific anti-COVID-19 therapies (ST) from computerized patient record, as well as patients’ demographic characteristics, comorbidities and outcome. The evolution of ST prescriptions during the study period was described and put into perspective with the updates of local recommendations made during the first (V1, from 2/24/2020 to 7/ 27/2020), and second (V2, from 7/28/2020 to 1/21/2021) epidemic waves. Results A total of 607 COVID-19 hospitalized patients, 197 during V1 and 410 during V2. Their mean age was 65 years-old, and they presented frequent comorbidities. In total, 93% of hospitalized patients received ST: anticoagulants (90%), glucocorticoids (39%) mainly during V2 (49% vs 17%, P<0.001), and azithromycin (30%) mainly during V1 (71% vs 10%, P<0.001). Lopinavir/ritonavir and hydroxychloroquine were prescribed to 17 and 7 inpatients, respectively, and only during V1. Remdesivir was never administered. A total of 22 inpatients were enrolled into clinical trials. PLOS ONE | https://doi.org/10.1371/journal.pone.0283165 March 17, 2023 1/7 PLOS ONE 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 c. and Miss Margaux Garreau (Ethic Committee) at . Funding: The author(s) received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Management of COVID-19 drug therapies during the first two epidemic waves Conclusions The effective dissemination of evidence-based and concerted recommendations seems to have allowed an optimized management of COVID-19 drug therapies in the context of this emerging infection with rapidly evolving therapeutic questions. 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, COVID19, 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. As early as March 16, a COVID multidisciplinary consultation meeting (RCP) was set up, bringing together infectiologists, respirologists, internists, ICU physicians, cardiologists, radiologists, biologists, immunologists, epidemiologists and pharmacists. RCP objectives were: (1) to ensure a permanent monitoring of the published literature and guidelines concerning the management of COVID patients; (2) to share observations or difficulties from the field (lack of staff, drugs in short supply. . .); (3) to propose a regular update of local management recommendations; and (4) to organize daily medical discussions of specific COVID patients, not only to homogenize and rationalize rapidly evolving practices, but also to reassure clinicians in a context of off-label prescriptions. Digital tools (WhatsApp group, hospital COVID-19 therapeutic guide on smartphone, webinars) facilitated the real-time dissemination of updated recommendations, as well as advice requests from clinicians and feedback. Pharmacists also had a role in informing about the availability of certain off-label treatments and monitoring the stock status of life-saving drugs. In order to evaluate the impact of local therapeutic recommendation updates made by the COVID RCP in this context of great initial uncertainty, the objective of the present study was to describe the drug prescriptions for COVID-19 at HEM during the first two waves of the epidemic. Methods The main aim of the COVID multidisciplinary consultation meeting (RCP) at Hôpital Européen Marseille (HEM) was to develop evidence-based, rapid, living guidelines intended to support our clinicians in their decisions about manag (...truncated)