Remdesivir or Nirmatrelvir/Ritonavir Therapy for Omicron SARS-CoV-2 Infection in Hematological Patients and Cell Therapy Recipients

Background: Scarce data exist that analyze the outcomes of hematological patients with SARS-CoV-2 infection during the Omicron variant period who received treatment with remdesivir or nirmatrelvir/ritonavir. Methods: This study aims to address this issue by using a retrospective observational regist...

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Detalhes bibliográficos
Autores: Piñana, JL, Heras, I, Aiello, TF, García-Cadenas, I, Vazquez, L, Lopez-Jimenez, J, Chorao, P, Aroca, C, García-Vidal, C, Arroyo, I, Soler-Espejo, E, López-Corral, L, Avendaño-Pita, A, Arrufat, A, Garcia-Gutierrez, V, Arellano, E, Hernández-Medina, L, González-Santillana, C, Morell, J, Hernández-Rivas, JA, Rodriguez-Galvez, P, Mico-Cerdá, M, Guerreiro, M, Campos, D, Navarro, D, Cedillo, A, Martino, R, Solano, C
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2023
País:España
Recursos:INCLIVA
Repositorio:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p17941
Acesso em linha:https://incliva.portalinvestigacion.com/publicaciones/17941
Access Level:acceso abierto
Palavra-chave:remdesivir
nirmatrelvir/ritonavir
molnupiravir SARS-CoV-2 vaccines
Omicron
respiratory virus
hematological malignancies
allogeneic stem cell transplantation
autologous stem cell transplantation
COVID-19
mRNA vaccine
immunocompromised patients
Descrição
Resumo:Background: Scarce data exist that analyze the outcomes of hematological patients with SARS-CoV-2 infection during the Omicron variant period who received treatment with remdesivir or nirmatrelvir/ritonavir. Methods: This study aims to address this issue by using a retrospective observational registry, created by the Spanish Hematopoietic Stem Cell Transplantation and Cell Therapy Group, spanning from 27 December 2021 to 30 April 2023. Results: This study included 466 patients, 243 (52%) who were treated with remdesivir and 223 (48%) with nirmatrelvir/ritonavir. Nirmatrelvir/ritonavir was primarily used for mild cases, resulting in a lower COVID-19-related mortality rate (1.3%), while remdesivir was preferred for moderate to severe cases (40%), exhibiting a higher mortality rate (9%). A multivariate analysis in the remdesivir cohort showed that male gender (odds ratio (OR) 0.35, p = 0.042) correlated with a lower mortality risk, while corticosteroid use (OR 9.4, p < 0.001) and co-infection (OR 2.8, p = 0.047) were linked to a higher mortality risk. Prolonged virus shedding was common, with 52% of patients shedding the virus for more than 25 days. In patients treated with remdesivir, factors associated with prolonged shedding included B-cell malignancy as well as underlying disease, severe disease, a later onset of and shorter duration of remdesivir treatment and a higher baseline viral load. Nirmatrelvir/ritonavir demonstrated a comparable safety profile to remdesivir, despite a higher risk of drug interactions. Conclusions: Nirmatrelvir/ritonavir proved to be a safe and effective option for treating mild cases in the outpatient setting, while remdesivir was preferred for severe cases, where corticosteroids and co-infection significantly predicted worse outcomes. Despite antiviral therapy, prolonged shedding remains a matter of concern.

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