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

Fecha de publicación: 01/10/2023 Fecha Ahead of Print: 08/10/2023

Autores de IIS La Fe

• José Luis Piñana Sánchez

  Autor

• Pedro Miguel Aparicio Chorao

  Autor

• Manuel Nuno Direito De Morais Guerreiro

  Autor

Participantes ajenos a IIS La Fe

• Heras, Inmaculada
• Aiello, Tommaso Francesco
• Garcia-Cadenas, Irene
• Vazquez, Lourdes
• Lopez-Jimenez, Javier
• Aroca, Cristina
• Garcia-Vidal, Carolina
• Arroyo, Ignacio
• Soler-Espejo, Eva
• Lopez-Corral, Lucia
• Avendano-Pita, Alejandro
• Arrufat, Anna
• Garcia-Gutierrez, Valentin
• Arellano, Elena
• Hernandez-Medina, Lorena
• Gonzalez-Santillana, Clara
• Morell, Julia
• Hernandez-Rivas, Jose Angel
• Rodriguez-Galvez, Paula
• Mico-Cerda, Mireia
• Campos, Diana
• Navarro, David
• Cedillo, Angel
• Martino, Rodrigo
• Solano, Carlos
• Infect Complications Subcomm Spa

Grupos

• Hematología y Hemoterapia

  

  Investigador Principal

  Javier De La Rubia Comos

Abstract

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.

Keywords

• 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