Optimizing COVID-19 treatment in immunocompromised patients: early combination therapy with remdesivir, nirmatrelvir/ritonavir and sotrovimab

Autor: Ivan Gentile, Maria Foggia, Maria Silvitelli, Alessia Sardanelli, Letizia Cattaneo, Giulio Viceconte
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: Virology Journal, Vol 20, Iss 1, Pp 1-5 (2023)
Druh dokumentu: article
ISSN: 1743-422X
DOI: 10.1186/s12985-023-02269-8
Popis: Abstract Background Morbidity and mortality are higher in immunocompromised patients affected by COVID-19 than in the general population. Some authors have successfully used antiviral combination, but never in the early phase of the infection. Methods We conducted a retrospective cohort study to determine the efficacy and safety of the combination of two antivirals, with and without a monoclonal antibody (mAb), in both the early (within 10 days of symptoms) and in a later phase (after 10 days) of SARS-CoV-2 infection in immunocompromised patients admitted to our Facility. Results We treated 11 patients (seven in an early phase and four in a late phase of COVID-19) with 10 days of intravenous remdesivir plus five days of oral nirmatelvir/ritonavir, also combined with sotrovimab in 10/11 cases. Notably, all the “early” patients reached virological clearance at day 30 from the end of the therapy and were alive and well at follow-up, whereas the corresponding numbers in the “late” patients were 50% and 75%. Patients in the “late” group more frequently needed oxygen supplementation (p = 0.015) and steroid therapy (p = 0.045) during admission and reached higher COVID-19 severity (p = 0.017). Discussion The combination of antiviral and sotrovimab in the early phase of COVID-19 is well tolerated by immunocompromised patients and is associated with 100% of virological clearance. Patients treated later have lower response rates and higher disease severity, but whether therapy plays a causative role in such findings has yet to be determined.
Databáze: Directory of Open Access Journals
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