The objective of this preliminary, exploratory analysis was to evaluate medication use patterns of commonly used drugs, which might have found use for the treatment and/or prevention of COVID-19 in New Jersey during the past two years.
Introduction
Concern about the use of ivermectin for COVID-19 treatment led to a joint statement from the American Pharmacists Association, the American Society of Health-System Pharmacists and the American Medical Association strongly opposing the ordering, prescribing or dispensing of ivermectin to prevent or treat COVID-19 outside of a clinical trial.1 Although limited data exists regarding the use of other unproven medications for possible treatments,2 there has been a great deal of discussion on social media about other forms of therapy. We hypothesized that, in addition to the use of ivermectin, there are other medications also being used to prevent and/or treat COVID-19.
Methods
Sixteen medications were selected for analysis, in anticipation of changes in use due to the stress of the pandemic (i.e., antianxiety, antidepressants), reports of earlier therapeutic use (i.e., azithromycin, hydroxychloroquine), theoretical indications (i.e., interferons, ivermectin, blockers of cytokine storms) and more recent product introductions (i.e., IL-6 inhibitors, anti-retrovirals, lopinavir-ritonavir).
We reviewed Medicaid New Jersey pharmacy data from chain and independent pharmacies, reflecting approximately 3.2 million deidentified claims per year for the selected medications. These totals also include New Jersey patients using mail-order pharmacies, which are subject to the same rules and regulations as non-mail-order pharmacies; claims data are collected in the same manner as non-mail order pharmacies.
Results
Data showing the use of selected medications between July 1, 2019, and June 30, 2021, are presented in Table 1. Of interest is that although the number of claims remained essentially static, far fewer individuals were using azithromycin or the inhaled steroids in 2021 than in 2019. However, the absolute quantity of the studied medications increased overall, indicating that the individuals receiving the medications received more units. Among our selected medications, a few others also had at least a 20 percent decrease in use (i.e., the interferons and lopinavir-ritonavir). On the other hand, there was a doubling in the number of recipients treated with ivermectin and a consequent almost tripling of the number of units of ivermectin dispensed. Also, there were more than 20 percent increases in the use of dexamethasone, famotidine, sarilumab, tocilizumab and zinc, although the absolute numbers of the two IL-6 inhibitors (sarilumab and tocilizumab) were so small as to be insignificant.
Discussion
These data demonstrated an apparent surge in ivermectin prescription dispensing, likely due to off-label prescriptions for COVID-19 because of the touting of its effectiveness by some individuals in the public eye. The drop in azithromycin prescriptions implies a response to the negative publicity about this treatment. However, as the data shows, there has been a major increase not only in ivermectin use, but also in the absolute use of dexamethasone, famotidine and zinc. While the dexamethasone increase was expected, given the positive published results,3 there is little evidence that famotidine4 or zinc5 are effective in treating COVID-19.
Our data does not include any data regarding adverse reactions to any of these medications. Given the potential toxicity, however, this analysis raises the question about the need for further warnings to be issued regarding the use of these medications, and we would encourage further use of drug utilization data for this purpose.
“It was difficult for the practicing physician to balance the requests of their patients with the lack of evidence of efficacy.”
While the scientific literature does not support the use of many of these medications, our data suggest that use of some medications was fostered by discussion in the lay media/literature rather than scientifically based reports. Physicians have been hampered by the relative paucity of scientific information regarding the off-label use of these medications in preventing or treating COVID-19. On the other hand, the public was faced with many anecdotal reports regarding the use of these medications. It was difficult for the practicing physician to balance the requests of their patients with the lack of evidence of efficacy. The use of these medications is considered “off label”; therefore, it is important for physicians to understand the risks and benefits of such use. More effective education of providers is needed to deal with this important issue.
Table 1.
Comparison of Drug Groups, SFY 2019-2020-2021
Managed Care Organizations (MCO) and Fee-for-Service (FFS) Claims for Service Dates in SFY 2019 (July 2018-Jun 2019), SFY 2020 (July 2019-June 2020), and SFY 2021 (July 2020-June 2021)| Claims | ||||
|---|---|---|---|---|
| Drug Group | SFY 2019 | SFY 2020 | SFY 2021 | SFY'19 to SFY'21 Chg |
| Antianxiety | 464,321 | 464,834 | 486,901 | +5% |
| Antidepressants | 1,411,634 | 1,430,703 | 1,518,077 | +8% |
| Azithromycin | 269,469 | 242,089 | 158,583 | -41% |
| Chloroquine | 146 | 101 | 67 | -54% |
| Colchicine | 15,313 | 15,069 | 15,411 | +1% |
| Dexamethasone | 11,850 | 10,706 | 16,385 | +38% |
| Famotidine | 133,539 | 143,070 | 174,619 | +31% |
| Hydroxychloroquine | 28,448 | 30,103 | 29,132 | +2% |
| InhaledCorticosteroids | 760,986 | 732,292 | 672,100 | -12% |
| Interferons | 895 | 765 | 609 | -32% |
| Ivermectin | 1,042 | 931 | 2,645 | +154% |
| Lopinavir-Ritonavir | 1,528 | 948 | 693 | -55% |
| Sarilumab | 246 | 523 | 590 | +140% |
| SedativeHypnotics | 156,287 | 144,693 | 144,655 | -7% |
| Tocilizumab | 563 | 719 | 772 | +37% |
| Zinc | 2,262 | 3,695 | 20,591 | +810% |
| Totals | 3,258,529 | 3,221,241 | 3,241,830 | -1% |
| Recipients (unduplicated) | ||||
|---|---|---|---|---|
| Drug Group | SFY2019 | SFY2020 | SFY2021 | SFY'19 to SFY' 21 Chg |
| Antianxiety | 88,301 | 85,453 | 88,172 | 0% |
| Antidepressants | 194,435 | 191,660 | 202,174 | +4% |
| Azithromycin | 199,813 | 181,212 | 118,863 | -41% |
| Chloroquine | 67 | 45 | 35 | -48% |
| Colchicine | 4,740 | 4,693 | 5,180 | +9% |
| Dexamethasone | 7,188 | 6,300 | 11,272 | +57% |
| Famotidine | 46,175 | 51,139 | 62,198 | +35% |
| Hydroxychloroquine | 5,548 | 7,721 | 6,810 | +23% |
| Inhaled Corticosteroids | 254,245 | 227,635 | 196,510 | -23% |
| Interferons | 116 | 93 | 68 | -41% |
| Ivermectin | 691 | 655 | 2,075 | +200% |
| Lopinavir-Ritonavir | 203 | 132 | 94 | -54% |
| Sarilumab | 61 | 89 | 96 | +57% |
| Sedative Hypnotics | 29,844 | 26,983 | 26,316 | -12% |
| Tocilizumab | 107 | 128 | 140 | +31% |
| Zinc | 685 | 1,816 | 11,247 | +1542% |
| Totals | 832,219 | 785,754 | 731,250 | -12% |
| Quantity | ||||
|---|---|---|---|---|
| Drug Group | SFY2019 | SFY2020 | SFY2021 | SFY'19 to SFY' 21 Chg |
| Antianxiety | 26,374,478 | 26,803,755 | 28,369,652 | +8% |
| Antidepressants | 53,504,036 | 54,742,090 | 59,550,564 | +11% |
| Azithromycin | 2,934,316 | 2,464,324 | 1,438,675 | -51% |
| Chloroquine | 3,376 | 2,421 | 1,341 | -60% |
| Colchicine | 617,142 | 611,436 | 619,576 | 0% |
| Dexamethasone | 330,877 | 298,610 | 401,857 | +21% |
| Famotidine | 5,823,585 | 6,606,390 | 8,743,547 | +50% |
| Hydroxychloroquine | 1,860,199 | 1,849,469 | 1,887,421 | +1% |
| Inhaled Corticosteroids | 18,467,309 | 17,452,492 | 15,253,398 | -17% |
| Interferons | 4,399 | 3,574 | 2,836 | -36% |
| Ivermectin | 7,574 | 6,350 | 29,839 | +294% |
| Lopinavir-Ritonavir | 201,551 | 125,750 | 96,638 | -52% |
| Sarilumab | 565 | 1,186 | 1,350 | +139% |
| Sedative Hypnotics | 4,688,128 | 4,356,136 | 4,404,036 | -6% |
| Tocilizumab | 2,069 | 2,556 | 2,776 | +34% |
| Zinc | 83,951 | 128,104 | 776,099 | +824% |
| Totals | 114,903,554 | 115,454,643 | 121,579,603 | +6% |
