Remdesivir or Nirmatrelvir/Ritonavir Therapy for Omicron SARS-CoV-2 Infection in Hematological Patients and Cell Therapy Recipients
2023
José Luis Piñana | Inmaculada Heras | Tommaso Francesco Aiello | Irene García-Cadenas | Lourdes Vazquez | Javier Lopez-Jimenez | Pedro Chorão | Cristina Aroca | Carolina García-Vidal | Ignacio Arroyo | Eva Soler-Espejo | Lucia López-Corral | Alejandro Avendaño-Pita | Anna Arrufat | Valentín Garcia-Gutierrez | Elena Arellano | Lorena Hernández-Medina | Clara González-Santillana | Julia Morell | José Ángel Hernández-Rivas | Paula Rodriguez-Galvez | Mireia Mico-Cerdá | Manuel Guerreiro | Diana Campos | David Navarro | Ángel Cedillo | Rodrigo Martino | Carlos Solano
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, <i>p</i> = 0.042) correlated with a lower mortality risk, while corticosteroid use (OR 9.4, <i>p</i> < 0.001) and co-infection (OR 2.8, <i>p</i> = 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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