Clinical Outcome and 7-Day Virological Clearance in High-Risk Patients with Mild–Moderate COVID-19 Treated with Molnupiravir, Nirmatrelvir/Ritonavir, or Remdesivir

Autor: Francesca Bai, Tomaso Beringheli, Virginia Vitaletti, Andrea Santoro, Francesco Molà, Alessandro Copes, Nicole Gemignani, Sofia Pettenuzzo, Roberto Castoldi, Benedetta Varisco, Riccardo Nardo, Lorenzo Brando Lundgren, Riccardo Ligresti, Matteo Sala, Lorenzo Albertini, Matteo Augello, Lorenzo Biasioli, Valeria Bono, Roberta Rovito, Teresa Bini, Sabrina Passarella, Nicola Vincenzo Orfeo, Antonella d’Arminio Monforte, Giulia Marchetti
Jazyk: angličtina
Rok vydání: 2024
Předmět:
Zdroj: Infectious Diseases and Therapy, Vol 13, Iss 7, Pp 1589-1605 (2024)
Druh dokumentu: article
ISSN: 2193-8229
2193-6382
DOI: 10.1007/s40121-024-00994-3
Popis: Abstract Introduction We compared the effectiveness and virological clearance (VC) at day 7 (T7) post-treatment with molnupiravir, nirmatrelvir/ritonavir, and remdesivir in SARS-CoV-2-infected patients at high risk (HR) for clinical progression. Methods We conducted a retrospective study enrolling HR patients with mild-to-moderate COVID-19 (Jan–Oct 2022) treated with nirmatrelvir/ritonavir or molnupiravir or 3 days of remdesivir. We investigated clinical recovery at T7 (resolution of symptoms for ≥ 72 h or all-cause death), VC at T7 (PCR/antigenic negative nasopharyngeal swab), and median time to VC (days from symptom onset to the first negative swab). Factors associated with VC were investigated by logistic regression. Results In the study, 92/376 (43.8%) patients received molnupiravir, 150/376 (24.7%) nirmatrelvir/ritonavir, and 134/376 (31.5%) remdesivir. Forty-nine (13%) patients were unvaccinated or incompletely vaccinated. Patients treated with nirmatrelvir/ritonavir were younger and presented immunodeficiencies more frequently; remdesivir was used more commonly in patients hospitalized for other diseases. A high proportion of patients obtained clinical recovery without differences among the therapies (97.5% for molnupiravir, 98.3% for nirmatrelvir/ritonavir, and 93.6% for remdesivir); 12 (3.7%) patients died. Nirmatrelvir/ritonavir was associated with a higher proportion of T7 VC and a shorter time to VC compared to molnupiravir/remdesivir, also after adjustment for age and immunodeficiency (AOR 0.445 RDV vs. NMV-r, 95% CI 0.240–0.826, p = 0.010; AOR 0.222 MNP vs. NMV-r, 95% CI 0.105–0.472, p
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