Convalescent plasma treatment for SARS-CoV-2 infected high-risk patients: a matched pair analysis to the LEOSS cohort.

Establishing the optimal treatment for COVID-19 patients remains challenging. Specifically, immunocompromised and pre-diseased patients are at high risk for severe disease course and face limited therapeutic options. Convalescent plasma (CP) has been considered as therapeutic approach, but reliable data are lacking, especially for high-risk patients. We performed a retrospective analysis of 55 hospitalized COVID-19 patients from University Hospital Duesseldorf (UKD) at high risk for disease progression, in a substantial proportion due to immunosuppression from cancer, solid organ transplantation, autoimmune disease, dialysis. A matched-pairs analysis (1:4) was performed with 220 patients from the Lean European Open Survey on SARS-CoV-2-infected Patients (LEOSS) who were treated or not treated with CP. Both cohorts had high mortality (UKD 41.8%, LEOSS 34.1%). A matched-pairs analysis showed no significant effect on mortality. CP administration before the formation of pulmonary infiltrates showed the lowest mortality in both cohorts (10%), whereas mortality in the complicated phase was 27.8%. CP administration during the critical phase revealed the highest mortality: UKD 60.9%, LEOSS 48.3%. In our cohort of COVID-19 patients with severe comorbidities CP did not significantly reduce mortality in a retrospective matched-pairs analysis. However, our data supports the concept that a reduction in mortality is achievable by early CP administration.

[Medication Plans at Hospital Admission - a Multicentre Analysis Using Statutory Health Insurance Data]. / Medikationspläne bei Krankenhausaufnahme ­ eine multizentrische Analyse unter Nutzung von Routinedaten einer gesetzlichen Krankenversicherung.

INTRODUCTION: Changes in drug therapy at intersectoral interfaces can lead to clinically relevant drug-related problems. This study aimed, therefore, at comparing the drug prescription continuity of patients with and without a medication plan at hospital admission. METHODS: After ethical approval, patients of a health insurance company in 6 hospitals in Saxony were consecutively assigned to this study from November 2011 to January 2012 after written informed consent. We assessed the following drug-related data for patients with and without medication plan at hospital admission: (i) the medication prescribed by the hospital physician on the day of hospital admission and (ii) the medication of the hospital discharge letter. Patient-individual claims data were assigned to the inpatient data for a period of 6 months before and after inpatient treatment (data linkage). RESULTS: Of the 279 study participants, 173 (62 %) used a medication plan at hospital admission. Patients with a medication plan had a statistically significantly older age, higher numbers of drugs and diagnoses and fewer emergency admissions. At admission 53 % of the drugs were continued in patients with medication plan and 40 % in patients without a medication plan (p < 0.001). At hospital discharge 66 % and 64 % were continued after discharge (n. s.). Medication plans were mostly written by their GP (38 %) and in 12 % by the patients themselves. DISCUSSION: Even before implementation of the national medication plan, nearly two third of the patients had a medication plan at hospital admission. However, in many cases it had been prepared by the patients themselves. The existence of a medication plan can have an impact on the continuity of the drug prescription during hospitalisation but not after discharge.

[Utilising statutory health insurance data to evaluate pharmaceutical interventions in secondary care - a pilot study]. / Verwendung von Routinedaten der gesetzlichen Krankenkasse in einer Pilotstudie zur Evaluation pharmazeutischer Interventionen im Krankenhaus.

BACKGROUND: Intensive pharmaceutical and medical care can lead to fewer drug-related problems (DRPs) in hospitals. Currently available methods to track drug changes after transition from inpatient to outpatient care are susceptible to systemic bias. Therefore we analysed the feasibility of a data linkage between prescription data extracted from hospital medical records and claims data from a health insurance company. METHODS: At six Saxonian hospitals, patients with a written informed consent were consecutively assigned to a control (CG) or intervention group (IG) depending on the time of admission. Clinical pharmacists documented predetermined DRPs and prescribed medication on the day of hospital admission and in the discharge letter. In case of DRP (IG) or potentially life-threatening DRPs (CG), drug changes were recommended to the hospital physician. These data were patient-individually linked to claims data from a health insurance company comprising a period of six months before and six months after hospitalisation (data linkage). We analysed data consistency within the data linkage and the post-hospital prevalence of DRPs identified in the hospital setting. RESULTS: We enrolled 532 patients (CG/IG 280/252). The data linkage was feasible for 97.0% (CG) and 96.6% (IG) of the patients, respectively. A total of 318 DRPs (CG/IG 176/142) was detected. Because of restrictions in the reimbursement of drugs in the outpatient setting, 22 (12.5%, CG) and 13 (9.2%, IG) DRPs were not analysable. Insurance claims data during a 6-month follow-up showed no statistically significant difference between the CG (without intervention) and in the IG (with intervention) with respect to DRPs (43.4% vs 38.1%; p = 0.472). CONCLUSIONS: The linkage of inpatient and outpatient data was feasible for the majority of enrolled patients. Compared to similar studies, the risk for systemic bias decreased because fewer patients were lost to follow-up. Within this feasibility study the expected difference between IG and CG could not be demonstrated statistically.