Sequential or Combination Treatments as Rescue Therapies in Immunocompromised Patients with Persistent SARS-CoV-2 Infection in the Omicron Era: A Case Series.

Autor: Longo BM; Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, 'Amedeo di Savoia' Hospital, ASL 'Città di Torino', 10060 Turin, Italy., Venuti F; Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, 'Amedeo di Savoia' Hospital, ASL 'Città di Torino', 10060 Turin, Italy., Gaviraghi A; Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, 'Amedeo di Savoia' Hospital, ASL 'Città di Torino', 10060 Turin, Italy., Lupia T; Unit of Infectious Diseases, Cardinal Massaia Hospital, 14100 Asti, Italy., Ranzani FA; Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, 'Amedeo di Savoia' Hospital, ASL 'Città di Torino', 10060 Turin, Italy., Pepe A; Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, 'Amedeo di Savoia' Hospital, ASL 'Città di Torino', 10060 Turin, Italy., Ponzetta L; Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, 'Amedeo di Savoia' Hospital, ASL 'Città di Torino', 10060 Turin, Italy., Vita D; Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, 'Amedeo di Savoia' Hospital, ASL 'Città di Torino', 10060 Turin, Italy., Allice T; Microbiology and Molecular Biology Laboratory, 'Amedeo di Savoia' Hospital, ASL 'Città di Torino', 10060 Turin, Italy., Gregorc V; Unit of Oncology and Haematology, Candiolo Cancer Institute, FPO-IRCCS, 10060 Candiolo, Italy., Frascione PMM; Unit of Oncology and Haematology, Candiolo Cancer Institute, FPO-IRCCS, 10060 Candiolo, Italy., De Rosa FG; Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, 'Amedeo di Savoia' Hospital, ASL 'Città di Torino', 10060 Turin, Italy.; Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy., Calcagno A; Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, 'Amedeo di Savoia' Hospital, ASL 'Città di Torino', 10060 Turin, Italy., Bonora S; Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, 'Amedeo di Savoia' Hospital, ASL 'Città di Torino', 10060 Turin, Italy.
Jazyk: angličtina
Zdroj: Antibiotics (Basel, Switzerland) [Antibiotics (Basel)] 2023 Sep 19; Vol. 12 (9). Date of Electronic Publication: 2023 Sep 19.
DOI: 10.3390/antibiotics12091460
Abstrakt: Prolonged SARS-CoV-2 infections are widely described in immunosuppressed patients, but safe and effective treatment strategies are lacking. We aimed to outline our approach to treating persistent COVID-19 in patients with immunosuppression from different causes. In this case series, we retrospectively enrolled all immunosuppressed patients with persistent SARS-CoV-2 infections treated at our centers between March 2022 and February 2023. Patients received different sequential or combination regimens, including antivirals (remdesivir, nirmatrelvir/ritonavir, or molnupiravir) and/or monoclonal antibodies (mAbs) (tixagevimab/cilgavimab or sotrovimab). The main outcome was a complete virological response (negative SARS-CoV-2 RT-PCR on nasopharyngeal swabs) at the end of treatment. Fifteen patients were included as follows: eleven (11/15; 73%) with hematological disease and four (4/15; 27%) with recently diagnosed HIV/AIDS infection. Six patients (6/15; 40%) received a single antiviral course, four patients (4/15; 27%) received an antiviral and mAbs sequentially, and two patients (13%) received three lines of treatment (a sequence of three antivirals or two antivirals and mAbs). A combination of two antivirals or one antiviral plus mAbs was administered in three cases (3/15, 20%). One patient died while still positive for SARS-CoV-2, while fourteen (14/15; 93%) tested negative within 16 days after the end of treatment. The median time to negativization since the last treatment was 2.5 days. Both sequential and combination regimens used in this study demonstrated high efficacy and safety in the high-risk group of immunosuppressed patients.
Databáze: MEDLINE
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