Antiviral Combination Treatment for COVID-19 in Immunocompromised Patients: Towards Defining Its Place in Therapy.

IF 5.3 3区 医学 Q1 INFECTIOUS DISEASES
Chiara Sepulcri, Claudia Bartalucci, Elisa Balletto, Chiara Dentone, Federica Magné, Michele Mirabella, Silvia Dettori, Martina Bavastro, Carmen Di Grazia, Anna Maria Raiola, Massimiliano Gambella, Valentina Ricucci, Bianca Bruzzone, Sabrina Beltramini, Emanuele Angelucci, Matteo Bassetti, Malgorzata Mikulska
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引用次数: 0

Abstract

Introduction: Antiviral combinations have been successfully used to treat COVID-19 in immunocompromised patients, especially those with prolonged viral shedding or relapses. This study assessed outcomes of antiviral combination therapy, stratified by clinical indication.

Methods: In this retrospective single-center study (October 2022-March 2024), patients receiving antiviral combinations were stratified according to treatment indication: prolonged/relapsed infection (group 1), severe COVID-19 (group 2), or early treatment of non-severe COVID-19 (group 3). Outcomes included virological clearance at day 14, and success rate at days 30 and 100.

Results: Seventy-one patients were included (group 1: 43; group 2 and 3: 14 each); 52% had non-Hodgkin lymphoma, 39.4% prior anti-CD20 therapy, 32% transplant/CAR-T. Most (92.6%) were vaccinated (median three doses). Treatment consisted of two antivirals in 59 patients (82%), mainly 10 days of both remdesivir and nirmatrelvir/ritonavir (n = 52, 73%), two antivirals plus single-dose tixagevimab/cilgavimab in 11 (15%), and three antivirals in 1. Virological clearance by day 14 was achieved in 79% (52/66 evaluable patients): 85% (34/40) in group 1, 58% (7/12) in group 2, 78.6% (11/14) in group 3. In group 1, predictors of day 14 clearance were prior vaccination and combination treatment with ≥ 10 days of oral antiviral. Success rates at days 30 and 100 were 80% (57/71) and 79% (56/71), respectively, with no significant differences between groups. Five patients required further treatment courses. COVID-19-related mortality was 12.5% (9/71). Three grade 2 adverse events occurred.

Conclusions: Antiviral combination therapy was effective in prolonged/relapsed and severe COVID-19 while its role in early mild infections warrants further study. Stratifying patients by treatment indication facilitates outcome interpretation and comparisons.

免疫功能低下患者COVID-19抗病毒联合治疗:确定其在治疗中的地位
抗病毒药物组合已成功用于治疗免疫功能低下患者的COVID-19,特别是那些病毒长期脱落或复发的患者。本研究评估了抗病毒联合治疗的结果,并按临床指征分层。方法:在这项回顾性单中心研究中(2022年10月- 2024年3月),根据治疗适应证对接受抗病毒药物联合治疗的患者进行分层:长期/复发感染(1组),严重COVID-19(2组)或早期治疗的非严重COVID-19(3组)。结果包括第14天的病毒学清除率,以及第30天和第100天的成功率。结果:共纳入71例患者(1组43例,2组和3组各14例);52%患有非霍奇金淋巴瘤,39.4%既往抗cd20治疗,32%移植/CAR-T。大多数(92.6%)接种了疫苗(中位数为三剂)。治疗包括59例(82%)患者使用两种抗病毒药物,主要是10天内同时使用瑞德西韦和尼马特韦/利托那韦(n = 52, 73%), 11例(15%)患者使用两种抗病毒药物加单剂量替沙吉维单抗/西加维单抗,1例患者使用三种抗病毒药物。79%(52/66例可评估患者)在第14天达到病毒学清除率:1组为85%(34/40),2组为58%(7/12),3组为78.6%(11/14)。在第1组中,第14天清除率的预测因子是先前的疫苗接种和联合治疗≥10天的口服抗病毒药物。第30天和第100天的成功率分别为80%(57/71)和79%(56/71),组间差异无统计学意义。5例患者需要进一步治疗。与covid -19相关的死亡率为12.5%(9/71)。发生3例2级不良事件。结论:抗病毒联合治疗对延长/复发和重症COVID-19有效,但对早期轻度感染的作用有待进一步研究。根据治疗指征对患者进行分层有助于结果的解释和比较。
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来源期刊
Infectious Diseases and Therapy
Infectious Diseases and Therapy Medicine-Microbiology (medical)
CiteScore
8.60
自引率
1.90%
发文量
136
审稿时长
6 weeks
期刊介绍: Infectious Diseases and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of infectious disease therapies and interventions, including vaccines and devices. Studies relating to diagnostic products and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to, bacterial and fungal infections, viral infections (including HIV/AIDS and hepatitis), parasitological diseases, tuberculosis and other mycobacterial diseases, vaccinations and other interventions, and drug-resistance, chronic infections, epidemiology and tropical, emergent, pediatric, dermal and sexually-transmitted diseases.
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