Early administration of nirmatrelvir/ritonavir leads to faster negative SARS-CoV-2 nasal swabs than monoclonal antibodies in COVID 19 patients at high-risk for severe disease.
COVID-19
Immunosuppression
Monoclonal antibodies
Nirmatrelvir/Ritonavir
Time to negativization
Journal
Virology journal
ISSN: 1743-422X
Titre abrégé: Virol J
Pays: England
ID NLM: 101231645
Informations de publication
Date de publication:
20 Mar 2024
20 Mar 2024
Historique:
received:
07
09
2023
accepted:
28
02
2024
medline:
21
3
2024
pubmed:
21
3
2024
entrez:
21
3
2024
Statut:
epublish
Résumé
Besides the well-established efficacy in preventing severe COVID-19, the impact of early treatments, namely antivirals and monoclonal antibodies (mAbs), on the time length to negativization of SARS-CoV-2 nasal swabs is still unclear. The aim of this study was to compare the efficacy of different early treatments in reducing the SARS-CoV-2 viral shedding, identifying a single drug that might potentially lead to a more rapid negativization of SARS-CoV-2 nasal swab. This was a single-centre, retrospective, observational study conducted at Ospedale Luigi Sacco in Milan. Data of high-risk COVID-19 patients who received early treatments between 23 December 2021 and March 2023 were extracted. The comparison across treatments was conducted using the Kruskall-Wallis test for continuous variables. Dunn's test with Bonferroni adjustment was performed for post-hoc comparisons of days to negativization. Secondly, a negative binomial regression adjusted for age, sex, number of comorbidities, immunosuppression, and SARS-CoV-2 vaccination status was implemented. Data from 428 patients receiving early treatments were collected. The majority were treated with Nirmatrelvir/Ritonavir and were affected by SARS-CoV-2 Omicron infection with BA.2 sublineage. The median length time to SARS-CoV-2 nasal swab negativization was 9 days [IQR 7-13 days]. We found that Nirmatrelvir/Ritonavir determined a significant decrease of the length time to SARS-CoV-2 nasal swab negativization compared to mAbs (p = 0.003), but not compared to Remdesivir (p = 0.147) and Molnupiravir (p = 0.156). Our findings highlight the importance of promptly treating high-risk COVID-19 patients with Nirmatrelvir/Ritonavir, as it also contributes to achieving a faster time to negative SARS-CoV-2 nasal swabs.
Identifiants
pubmed: 38509536
doi: 10.1186/s12985-024-02333-x
pii: 10.1186/s12985-024-02333-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
68Informations de copyright
© 2024. The Author(s).
Références
Clark A, et al. Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study. Lancet Glob Health. Aug. 2020;8(8):e1003–17. https://doi.org/10.1016/S2214-109X(20)30264-3 .
Cohen MS, Wohl DA, Fischer WA, Smith DM, Eron JJ. Outpatient Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 Infection to Prevent Coronavirus Disease 2019 Progression., Clin Infect Dis, vol. 73, no. 9, pp. 1717–1721, Nov. 2021, https://doi.org/10.1093/cid/ciab494 .
Wong CKH, Au ICH, Lau KTK, Lau EHY, Cowling BJ, Leung GM. Real-world effectiveness of molnupiravir and nirmatrelvir plus ritonavir against mortality, hospitalisation, and in-hospital outcomes among community-dwelling, ambulatory patients with confirmed SARS-CoV-2 infection during the omicron wave in Hong Kong: an observational study., Lancet, vol. 400, no. 10359, pp. 1213–1222, Oct. 2022, https://doi.org/10.1016/S0140-6736(22)01586-0 .
Corey L, Beyrer C, Cohen MS, Michael NL, Bedford T, Rolland M. SARS-CoV-2 Variants in Patients with Immunosuppression, New England Journal of Medicine, vol. 385, no. 6, pp. 562–566, Aug. 2021, https://doi.org/10.1056/NEJMsb2104756 .
Farmaci utilizzabili per il trattamento della malattia COVID-19 | Agenzia Italiana del Farmaco. https://www.aifa.gov.it/aggiornamento-sui-farmaci-utilizzabili-per-il-trattamento-della-malattia-covid19 (accessed Jul. 13, 2023).
Butler CC, et al. Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes (PANORAMIC): an open-label, platform-adaptive randomised controlled trial. Lancet. Jan. 2023;401(10373):281–93. https://doi.org/10.1016/S0140-6736(22)02597-1 .
Sung A, et al. Isolation of SARS-CoV-2 in viral cell culture in immunocompromised patients with persistently positive RT-PCR results. Front Cell Infect Microbiol. 2022;12:804175. https://doi.org/10.3389/fcimb.2022.804175 .
doi: 10.3389/fcimb.2022.804175
pubmed: 35186791
pmcid: 8847756
Martin-Blondel G et al. Apr., Time to negative PCR conversion amongst high-risk patients with mild-to-moderate Omicron BA.1 and BA.2 COVID-19 treated with sotrovimab or nirmatrelvir., Clin Microbiol Infect, vol. 29, no. 4, pp. 543.e5-543.e9, 2023, https://doi.org/10.1016/j.cmi.2022.12.016 .
Gentile I et al. Oct., Nirmatrelvir/Ritonavir and Molnupiravir in the Treatment of Mild/Moderate COVID-19: Results of a Real-Life Study., Vaccines (Basel), vol. 10, no. 10, 2022, https://doi.org/10.3390/vaccines10101731 .