Newest COVID-19 Surge Leads to Shortages in Therapeutics

The resurgence of COVID-19 because of the Delta variant has led to significant imbalances in the supply and demand of commonly used medications for hospitalized patients, including tocilizumab, dexamethasone, baricitinib, and remdesivir.

According to a report from Vizient, the average demand for these medications has dramatically increased over recent months, whereas fill rates for hospital orders have decreased. When analyzing utilization trends, the researchers found that more than 50% of inpatient COVID-19 patients received dexamethasone for an average of 6 days. Approximately 36% of cases received remdesivir, although a low percentage of these cases also underwent invasive ventilation.

For example, the average demand for tocilizumab in intravenous (IV) format increased by 279% between the weeks of June 14 to 25 and the weeks of August 2 to 13, 2021. During the same time frame, however, fill rates for orders by hospitals dropped from 99% to 45%.

The report said tocilizumab was used in 4.5% of hospitalized patients with COVID-19, more than 40% of whom also received invasive ventilation during their inpatient stay. Patients receiving tocilizumab tend to be higher acuity, based on data showing longer expected lengths of stay, rates of intensive care unit utilization, and expected mortality rates.

Interestingly, the researchers noted that utilization trends for tocilizumab varied by discharge month. As total inpatient COVID-19 cases trended downward between April and October of 2020, the percentage of cases receiving tocilizumab also trend downward. During peak months of November 2020 through January 2021, utilization remained low overall, approximately 1% of cases. However, despite the number of cases trending downward between February and June 2021, utilization of tocilizumab increased to approximately 13% of cases in June.

Dexamethasone and remdesivir saw similar trends throughout the pandemic. Dexamethasone utilization increased dramatically between April and July 2020, which the researchers said may be a result of shifting literature and recommendations. Inpatient utilization in COVID-19 cases has remained between 60% and 70% since October 2020. Similarly, remdesivir utilization steadily increased between April and November of 2020, with utilization rates remaining at or near 50% of inpatient COVID-19 cases since that time.

Despite these steady utilization rates, the most recent surge in cases over the summer months has limited access. Similarly to the decreasing fill rates for tocilizumab, the alternative drug baricitinib has seen fill rates decline from 99% for the weeks of June 14 to 25 to 89% for the weeks of August 2 to 13.

Dexamethasone has seen a similar decline, with demand increasing by 47.5% between early July and early August, and the fill rate declining from 97% to 93% during the same time. Interestingly, remdesivir demand increased by 632% during the same time frame, although the fill rate remained at approximately 99%.

Sedatives, analgesics, and neuromuscular drugs also saw increases in demand over the past 2 months, although these trends were more moderate. For example, average demand for sedatives increased by 9% from the week ending July 2 to the week ending August 6, while the fill rate decreased from 94% to 90%.

Demand for analgesic drugs increased by 13% during the same time frame and fill rates decreased from 93% to 81%. Finally, average demand for neuromuscular drugs increased by just 2% between early July and early August, and the fill rate remained at approximately 93%.

Based on the analysis, demand for commonly prescribed inpatient COVID-19 therapeutics has increased across the board since early July. However, some of the most common drugs have declining fill rates, which could limit availability for patients most in need of them.

REFERENCE

COVID-19 medication update. IQVIA; August 26, 2021. Accessed August 27, 2021.