Does early combination vs. Monotherapy improve clinical outcomes of clinically extremely vulnerable patients with COVID-19? Results from a retrospective propensity-weighted analysis.

Autor: Maria M; Infectious and Tropical Diseases Unit, Padua University Hospital, 35128, Padua, Italy. m.mazzitelli88@gmail.com., Maraolo AE; Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples 'Federico II', 80131, Naples, Italy., Cozzolino C; Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35131, Padua, Italy., Sasset L; Infectious and Tropical Diseases Unit, Padua University Hospital, 35128, Padua, Italy., Ferrari A; Infectious and Tropical Diseases Unit, Padua University Hospital, 35128, Padua, Italy., Basso M; Infectious and Tropical Diseases Unit, Padua University Hospital, 35128, Padua, Italy., Vania E; Infectious and Tropical Diseases Unit, Padua University Hospital, 35128, Padua, Italy., Bonadiman N; Infectious and Tropical Diseases Unit, Padua University Hospital, 35128, Padua, Italy., Scaglione V; Infectious and Tropical Diseases Unit, Padua University Hospital, 35128, Padua, Italy., Cattelan AM; Infectious and Tropical Diseases Unit, Padua University Hospital, 35128, Padua, Italy.
Jazyk: angličtina
Zdroj: European journal of medical research [Eur J Med Res] 2024 Oct 04; Vol. 29 (1), pp. 484. Date of Electronic Publication: 2024 Oct 04.
DOI: 10.1186/s40001-024-02062-5
Abstrakt: Background: The potential efficacy of early combination therapy, based on an antiviral plus a monoclonal antibody, for COVID-19 in severely immunocompromised patients is matter of debate.
Objectives: Our aim was to describe the impact on clinical outcomes of COVID-19 treatments in severely immunocompromised individuals, evaluating differences between a combination and a monotherapy.
Methods: We included severely immunocompromised outpatients with mild-to-moderate COVID-19 who received an early treatment (either monotherapy with nirmatrelvir/ritonavir or remdesivir or the combination of an antiviral plus sotrovimab). We then assessed differences between the two treatment strategies on three main outcomes (30-day mortality, access to emergency department, hospitalization), separately and as a composite by using a propensity score weighted (PSW) approach.
Results: Eighty one severely immunocompromised patients were included, 39 receiving early combination therapy and 42 receiving monotherapy. No significant difference was observed in the 30-day mortality rate and hospitalization rate between subjects in the two groups, while access to the emergency department following treatment administration was significantly higher in people who received a combination therapy. After applying the PSW, it was observed that combination therapy impacted favourably on the composite outcome, in a statistically significant fashion. In addition, PSW approach for mortality showed that age was the only significant factor influencing the death as stand-alone outcome.
Conclusions: Early combination therapy showed a favourable impact on a composite outcome (including mortality, hospitalizations and access to emergency department) in severely immunocompromised hosts who were all vaccinated. However, further studies are needed to support our results.
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz: