Efficacy of oral antivirals and combination therapy with remdesivir in hematological patients with COVID-19

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy Pub Date : 2025-08-29 DOI:10.1016/j.jiac.2025.102805

Kaito Takikawa, Mana Sota, Yui Imai, Hirofumi Nakano, Tomoyuki Uchida, Morihiro Inoue, Masao Hagihara

{"title":"Efficacy of oral antivirals and combination therapy with remdesivir in hematological patients with COVID-19","authors":"Kaito Takikawa, Mana Sota, Yui Imai, Hirofumi Nakano, Tomoyuki Uchida, Morihiro Inoue, Masao Hagihara","doi":"10.1016/j.jiac.2025.102805","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with hematological malignancies are at a high risk of contracting COVID-19, developing severe disease, and experiencing antiviral treatment failure. The present study examined the effectiveness of oral antivirals, and assessed the efficacy of combination therapy with remdesivir (RDV) and oral antivirals.</div></div><div><h3>Methods</h3><div>All patients with hematological disorders in our institution between May 20, 2023 and October 31, 2024 who developed COVID-19 during this period were included. Patients were treated with RDV, nirmatrelvir/ritonavir (Nir/Rit), ensitrelvir (Ens), or combinations of these drugs. Antiviral combination therapy was selected for patients receiving chemotherapy, those with infections occurring prior to treatment for their underlying disease, and cases in which initial antiviral treatment was ineffective.</div></div><div><h3>Results</h3><div>Forty-six patients were included in this study. When used as 1st-line treatments, viral load reductions by the oral antivirals Nir/Rit or Ens (a significant reduction in the viral load was defined as achieving a Ct value ≥ 30; 50 or 44 %, respectively) were superior to that by intravenous RDV (0 %). Combination therapy with Rit/Nir or Ens plus RDV was effective in 12 out of 13 cases (92 %) when used as a 1st-line treatment, and in all 9 cases when used as 2nd<sup>−</sup> or 3rd-line treatment.</div></div><div><h3>Conclusions</h3><div>Nir/Rit and Ens may exhibit superior antiviral efficacy compared to RDV in COVID-19 patients with underlying hematological malignancies. Combination therapy needs to be considered for patients with high risk of severe disease or persistent infection, and in cases where a rapid therapeutic response is urgently required for the management of the underlying malignancy.</div></div>","PeriodicalId":16103,"journal":{"name":"Journal of Infection and Chemotherapy","volume":"31 10","pages":"Article 102805"},"PeriodicalIF":1.5000,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Infection and Chemotherapy","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1341321X25002028","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

Patients with hematological malignancies are at a high risk of contracting COVID-19, developing severe disease, and experiencing antiviral treatment failure. The present study examined the effectiveness of oral antivirals, and assessed the efficacy of combination therapy with remdesivir (RDV) and oral antivirals.

Methods

All patients with hematological disorders in our institution between May 20, 2023 and October 31, 2024 who developed COVID-19 during this period were included. Patients were treated with RDV, nirmatrelvir/ritonavir (Nir/Rit), ensitrelvir (Ens), or combinations of these drugs. Antiviral combination therapy was selected for patients receiving chemotherapy, those with infections occurring prior to treatment for their underlying disease, and cases in which initial antiviral treatment was ineffective.

Results

Forty-six patients were included in this study. When used as 1st-line treatments, viral load reductions by the oral antivirals Nir/Rit or Ens (a significant reduction in the viral load was defined as achieving a Ct value ≥ 30; 50 or 44 %, respectively) were superior to that by intravenous RDV (0 %). Combination therapy with Rit/Nir or Ens plus RDV was effective in 12 out of 13 cases (92 %) when used as a 1st-line treatment, and in all 9 cases when used as 2nd⁻ or 3rd-line treatment.

Conclusions

Nir/Rit and Ens may exhibit superior antiviral efficacy compared to RDV in COVID-19 patients with underlying hematological malignancies. Combination therapy needs to be considered for patients with high risk of severe disease or persistent infection, and in cases where a rapid therapeutic response is urgently required for the management of the underlying malignancy.

查看原文本刊更多论文

口服抗病毒药物联合瑞德西韦治疗血液系统COVID-19患者的疗效观察。

血液系统恶性肿瘤患者是感染COVID-19、发展为严重疾病、抗病毒治疗失败的高危人群。本研究检测了口服抗病毒药物的有效性，并评估了瑞德西韦（RDV）和口服抗病毒药物联合治疗的疗效。方法：纳入我院2023年5月20日至2024年10月31日期间发生COVID-19的所有血液病患者。患者接受RDV、尼马替韦/利托那韦（Nir/Rit）、恩司替韦（Ens）或这些药物的联合治疗。对接受化疗的患者、在治疗其基础疾病之前发生感染的患者以及最初抗病毒治疗无效的患者选择抗病毒联合治疗。结果：本研究纳入46例患者。当作为一线治疗时，口服抗病毒药物Nir/Rit或Ens（病毒载量的显著降低定义为达到Ct值≥30，分别为50%或44%）优于静脉注射RDV（0%）。Rit/Nir或Ens + RDV联合治疗作为一线治疗时，13例中有12例（92%）有效，作为二线或三线治疗时，所有9例均有效。结论：与RDV相比，Nir/Rit和Ens在COVID-19合并基础血液系统恶性肿瘤患者中可能具有更好的抗病毒效果。对于严重疾病或持续感染的高风险患者，以及迫切需要快速治疗反应以管理潜在恶性肿瘤的病例，需要考虑联合治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Infection and Chemotherapy INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY

CiteScore

4.10

自引率

4.50%

发文量

303

审稿时长

47 days

期刊介绍： The Journal of Infection and Chemotherapy (JIC) — official journal of the Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases — welcomes original papers, laboratory or clinical, as well as case reports, notes, committee reports, surveillance and guidelines from all parts of the world on all aspects of chemotherapy, covering the pathogenesis, diagnosis, treatment, and control of infection, including treatment with anticancer drugs. Experimental studies on animal models and pharmacokinetics, and reports on epidemiology and clinical trials are particularly welcome.