A study of more than 285,000 nonhospitalized US veterans who tested positive for COVID-19 in 2022 and early 2023 reveals low rates of prescribing of antivirals and monoclonal antibodies (mAbs), with a higher likelihood of treatment for Black, Hispanic, and older patients with more chronic conditions.
For the study, published yesterday in JAMA Network Open, a Veterans Affairs (VA)-led research team mined Veterans Health Administration (VHA) and linked Community Care and Medicare databases on the number of prescriptions each month for the antiviral medications nirmatrelvir-ritonavir (Paxlovid), molnupiravir (Lagevrio) and the mAbs sotrovimab (Xevudy) and bebtelovimab from January 2022 through January 2023.
Median age of the 285,710 enrollees was 63.1 years, 86.6% were men, 69.6% were White, 21.4% were Black, and 10.0% were Hispanic.
84% received no COVID treatment
Of all COVID-19 patients, 9.3% were prescribed nirmatrelvir-ritonavir, 3.2% were given molnupiravir, 1.7% received sotrovimab or bebtelovimab, and 83.8% received no treatment. The remaining 2.0% received other COVID-19 drugs such as remdesivir (1.8%) or other monoclonal antibodies (0.3%) and weren't included in the any-treatment or no-treatment groups.
The proportion of veterans receiving any COVID-19 treatment rose from 3.2% in January 2022 to 23.9% in August 2022 and then fell to 20.8% in January 2023. Veterans most likely to receive any treatment were older (adjusted odds ratio [aOR] for ages 65 to 74 vs 50 to 64 years, 1.18) and had a higher Charlson Comorbidity Index (CCI) score (aOR for CCI score of 6 or higher vs 0, 1.52).
A more recent decline has not been widely reported in nonveteran populations.
Black veterans were more likely than their White peers to be prescribed a COVID-19 drug (aOR, 1.06), and Hispanic veterans had greater odds of receiving treatment than their non-Hispanic counterparts (aOR, 1.06).
"Although trends in early uptake of COVID-19 pharmacotherapies within the VHA mirrored other settings, a more recent decline has not been widely reported in nonveteran populations," the study authors wrote. "These results suggest the need for continued support of infrastructure and education to facilitate treatment for individuals at highest risk of progression to severe COVID-19."