(114) New Medication Use in Post-Acute Sequelae Of COVID-19 (PASC): An EHR-based Study From the RECOVER Program

Background: Little is known regarding real-world treatment or management of post-acute sequelae of COVID-19 (PASC).

Objectives: To characterize newly prescribed medications among individuals with PASC as well as non-PASC controls.

Methods: We performed a retrospective cohort study using the National Covid Cohort Collaborative (N3C), the largest electronic health records data on COVID-19 in the US. We included individuals 21 years or older diagnosed with COVID-19 between March 2020 and August 2023, and compared incident medication use among individuals with PASC (ICD-10-CM code: U09.9 or B94.8) with a non-PASC group of individuals without documented PASC diagnosis codes within 1 year after COVID-19 infection. We defined index date as PASC diagnosis date for PASC group, and the clinic visit closest to 2 months after COVID diagnosis (to identify visits not related to acute COVID-19 phase) for the non-PASC group. We defined incident medications as those prescribed 7 days before or 180 days after the index date, with no recorded medication use during the year before COVID. We calculated the incidence proportion, calculated as the percentage of individuals with medications use, in the PASC and non-PASC groups and identified the top 50 medications with the highest incidence proportion difference. For the top 10 medications, we performed logistic regression to determine the association of PASC with medication use, controlling for age, sex, and Charlson comorbidity score.

Results: We included 51,112 individuals diagnosed with PASC and 3,006,221 non-PASC controls. Individuals diagnosed with PASC were older (mean age 53.8 vs. 50.5 years) and had a higher comorbidity burden (56.8% with at least one comorbidity vs. 42.1%) compared to non-PASC controls. A significantly greater proportion of individuals with PASC initiated 2 medications (7.8% vs. 6.4%) or 3 or more medications (62.1% vs. 32.0%) compared to non-PASC controls. Among the top 10 medications with the highest incidence proportion difference, 6 medications (e.g. salbutamol, fluticasone, benzonatate) were used to treat respiratory conditions. After adjusting for covariates, the use of the top 10 medications was significantly higher in the PASC cohort than in the non-PASC cohort, with odds ratios ranging from 1.99 to 5.81.

Conclusions: The utilization of new medications was higher among individuals with PASC. This overall increase may reflect the adoption of novel treatments for a recently developed disease but the medications with the largest relative increase appeared to be related to PASC symptom management.