Comparative Effectiveness of Outpatient COVID-19 Therapies in Solid Organ Transplant Recipients.

IF 2.6 4区医学 Q3 IMMUNOLOGY

Transplant Infectious Disease Pub Date : 2025-01-10 DOI:10.1111/tid.14436

Zachary A Yetmar, Viengneesee Thao, David A Helfinstine, Kelly M Pennington, Raymund R Razonable

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引用次数: 0

Abstract

Background: Multiple outpatient therapies have been developed for COVID-19 in high-risk individuals, but solid organ transplant (SOT) recipients were not well represented in controlled clinical trials. To date, few comparative studies have evaluated outcomes between outpatient therapies in this population.

Methods: We performed a retrospective cohort study using de-identified administrative claims data from OptumLabs Data Warehouse. Patients were included if they were age ≥ 18 years, diagnosed with COVID-19 between January 2022 and December 2023, and underwent SOT prior to COVID-19. The primary outcome was 30-day hospitalization. Stabilized inverse probability of treatment weighting was used to account for potential confounding variables.

Results: 4192 SOT recipients with COVID-19 were identified. 1403 received an outpatient COVID-19 therapy, including anti-spike monoclonal antibodies (N = 748, 53.3%), molnupiravir (N = 327, 23.3%), ritonavir-boosted nirmatrelvir (N = 217, 15.5%), or remdesivir (N = 141, 10.0%). In weighted analysis compared to no treatment, anti-spike monoclonal antibodies (hazard ratio [HR] 0.39, 95% confidence interval [CI] 0.28-0.55; p < 0.001), molnupiravir (HR 0.56, 95% CI 0.36-0.89; p = 0.013), and nirmatrelvir (HR 0.47, 95% CI 0.25-0.89; p = 0.020) were associated with reduced hospitalization risk, while remdesivir (HR 1.00, 95% CI 0.50-1.98; p = 0.992) was not. Hospitalization rates were similar between the treatment agents, apart from remdesivir showing a higher risk compared to anti-spike monoclonal antibodies.

Conclusions: Outpatient COVID-19 therapies were largely associated with improved outcomes among SOT recipients. These treatment agents showed similar rates of 30-day hospitalization, except for remdesivir. The choice of outpatient COVID-19 therapy in SOT recipients should primarily account for patients' individual circumstances and drug-drug interactions rather than differential therapeutic efficacy.

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实体器官移植受者门诊COVID-19治疗效果比较

背景：针对高危人群的COVID-19，已经开发了多种门诊治疗方法，但实体器官移植（SOT）接受者在对照临床试验中并未得到很好的代表。迄今为止，很少有比较研究评估门诊治疗在这一人群中的效果。方法：我们使用来自OptumLabs数据仓库的去识别行政索赔数据进行了回顾性队列研究。纳入的患者年龄≥18岁，在2022年1月至2023年12月期间被诊断为COVID-19，并在COVID-19之前接受了SOT。主要终点为住院30天。使用稳定的处理加权逆概率来解释潜在的混杂变量。结果：共有4192例SOT接受者感染COVID-19。1403例患者接受了门诊COVID-19治疗，包括抗刺突单克隆抗体（N = 748, 53.3%）、莫努匹拉韦（N = 327, 23.3%）、利托那韦增强的尼马特利韦（N = 217, 15.5%）或瑞德西韦（N = 141, 10.0%）。在加权分析中，与未治疗相比，抗刺突单克隆抗体(风险比[HR] 0.39, 95%可信区间[CI] 0.28-0.55；p < 0.001)，莫那匹拉韦(HR 0.56, 95% CI 0.36-0.89；p = 0.013)，尼马特利韦(HR 0.47, 95% CI 0.25-0.89；p = 0.020)与住院风险降低相关，而瑞德西韦(HR 1.00, 95% CI 0.50-1.98；P = 0.992)。两种治疗药物之间的住院率相似，除了瑞德西韦显示出比抗刺突单克隆抗体更高的风险。结论：门诊COVID-19治疗在很大程度上与SOT患者预后改善相关。除瑞德西韦外，这些治疗药物的30天住院率相似。SOT接受者选择门诊COVID-19治疗应主要考虑患者的个体情况和药物-药物相互作用，而不是治疗效果的差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.