Triple Combination Therapy With 2 Antivirals and Monoclonal Antibodies for Persistent or Relapsed Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Immunocompromised Patients

Clinical Infectious Diseases, Journal Year: 2023, Volume and Issue: 77(2), P. 280 - 286

Published: March 28, 2023

Severely immunocompromised patients are at risk for prolonged or relapsed Coronavirus Disease 2019 (COVID-19), leading to increased morbidity and mortality. We aimed evaluate efficacy safety of combination treatment in COVID-19 patients.We included all with prolonged/relapsed treated therapy 2 antivirals (remdesivir plus nirmatrelvir/ritonavir, molnupiravir case renal failure) plus, if available, anti-spike monoclonal antibodies (mAbs), between February October 2022. The main outcomes were virological response day 14 (negative Severe Acute Respiratory Syndrome [SARS-CoV-2] swab) clinical (alive, asymptomatic, negative SARS-CoV-2 30 the last follow-up.Overall, 22 (Omicron variant 17/18) included: 18 received full mAbs 4 only; 20 (91%) patients, nirmatrelvir/ritonavir remdesivir. Nineteen (86%) had hematological malignancy, 15 (68%) anti-CD20 therapy. All symptomatic; 8 (36%) required oxygen. Four a second course treatment. rate 14, 30, follow-up was 75% (15/20 evaluable), 73% (16/22), 82% (18/22), respectively. Day rates significantly higher when mAbs. Higher number vaccine doses associated better final outcome. Two (9%) developed severe side effects (bradycardia remdesivir discontinuation myocardial infarction).Combination including (mainly nirmatrelvir/ritonavir) high COVID-19.

Language: Английский

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Case report: Sotrovimab, remdesivir and nirmatrelvir/ritonavir combination as salvage treatment option in two immunocompromised patients hospitalized for COVID-19

Frontiers in Medicine, Journal Year: 2023, Volume and Issue: 9

Published: Jan. 9, 2023

COVID-19 in immunocompromised patients is difficult to treat. SARS-CoV-2 interaction with the host immune system and role of therapy still remains only partly understood. There are no data regarding use monoclonal antibodies combination two antivirals fighting viral replication disease progression. We report cases patients, both treated rituximab for non-Hodgkin lymphoma granulomatosis polyangiitis, respectively, hospitalized positive RNAemia, who were successfully a salvage sotrovimab, remdesivir nirmatrelvir/ritonavir.

Language: Английский

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Dual combined antiviral treatment with remdesivir and nirmatrelvir/ritonavir in patients with impaired humoral immunity and persistent SARS‐CoV‐2 infection

Hematological Oncology, Journal Year: 2023, Volume and Issue: 41(5), P. 904 - 911

Published: July 15, 2023

Despite global vaccination efforts, immunocompromized patients remain at high risk for COVID-19-associated morbidity. In particular, with impaired humoral immunity have shown a of persistent infection. We report case series adult B cell malignancies and/or undergoing targeting therapies persisting SARS-CoV-2 infection and treated combination antiviral therapy remdesivir nirmatrelvir/ritonavir, in three Italian tertiary academic hospitals. A total 14 adaptive prolonged were the dual therapy. The median age was 60 (IQR 56-68) years, 11 male. Twelve had lymphoma, one patient chronic lymphocytic leukemia multiple sclerosis. Thirteen out received prior cell-targeting therapies, consisting anti-CD20 monoclonal antibodies patients, chimeric antigen receptor T 2 patients. time between diagnosis start 42.0 35-46) days. Seven mild, 6 moderate severe disease. Nine signs interstitial pneumonitis on chest computed tomography scans before treatment. duration nirmatrelvir/ritonavir 10 All showed resolution COVID-19-related symptoms after 4-11) days viral clearance 9 5-11) Combination is promising treatment option COVID-19 impairment, worthy prospective comparative trials.

Language: Английский

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Persistent COVID-19 in immunocompromised patients—Israeli society of infectious diseases consensus statement on diagnosis and management

Clinical Microbiology and Infection, Journal Year: 2024, Volume and Issue: 30(8), P. 1012 - 1017

Published: April 18, 2024

Language: Английский

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B-cell-depleted patients with persistent SARS-CoV-2 infection: combination therapy or monotherapy? A real-world experience

Frontiers in Medicine, Journal Year: 2024, Volume and Issue: 11

Published: Feb. 29, 2024

Objectives The aim of the study was to describe a cohort B-cell-depleted immunocompromised (IC) patients with prolonged or relapsing COVID-19 treated monotherapy combination therapy. Methods This is multicenter observational retrospective conducted on IC consecutively hospitalized SARS-CoV-2 infection from November 2020 January 2023. subjects were stratified according anti-SARS-CoV-2 therapy received. Results Eighty-eight enrolled, 19 under and 69 population had history immunosuppression (median 2 B-cells/mm 3 , IQR 1–24 cells), residual hypogammaglobulinemia observed in 55 patients. A reduced length hospitalization time negative molecular nasopharyngeal swab (NPS) versus group observed. In univariable multivariable analyses, percentage change rate days NPS negativity showed significant reduction receiving compared those monotherapy. Conclusion persistent patients, it essential explore new therapeutic strategies such as multi-target (antiviral double antiviral plus antibody-based therapies) avoid viral shedding and/or severe infection.

Language: Английский

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Intravenous immunoglobulin therapy for COVID-19 in immunocompromised patients: A retrospective cohort study

International Journal of Infectious Diseases, Journal Year: 2024, Volume and Issue: 144, P. 107046 - 107046

Published: April 12, 2024

ObjectivesTo investigate the effectiveness of intravenous immunoglobulin (IVIG) as treatment for COVID-19 in immunocompromised patients.MethodsThis retrospective study investigated outcomes immunocompromised, vaccine non-responsive, patients that between September 2022 and April 2023 received IVIG region Västerbotten, Sweden. We analyzed clinical data, viral load, anti-SARS-CoV-2 IgG binding neutralization levels patient serum samples production batches. Primary secondary were cure clearance, respectively.ResultsSixteen analyzed. After a median duration four weeks, 60g infusion increased SARS-CoV-2 neutralizing antibody levels, with broad vitro activity against tested variants. The resulted abrogation viremia all general improvement 15 survivors met primary endpoint. Thirteen endpoint at follow-up after months. Two subjects persistent carriage relapsed but successfully retreated IVIG.ConclusionsAntibodies efficiently neutralized several Treatment was associated clearance patients. Our data suggests could be novel alternative this category.

Language: Английский

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

Virology Journal, Journal Year: 2023, Volume and Issue: 20(1)

Published: Dec. 15, 2023

Abstract Background Morbidity and mortality are higher in immunocompromised patients affected by COVID-19 than the general population. Some authors have successfully used antiviral combination, but never early phase of infection. Methods We conducted a retrospective cohort study to determine efficacy safety combination two antivirals, with without monoclonal antibody (mAb), both (within 10 days symptoms) later (after days) SARS-CoV-2 infection admitted our Facility. Results treated 11 (seven an four late COVID-19) intravenous remdesivir plus five oral nirmatelvir/ritonavir, also combined sotrovimab 10/11 cases. Notably, all “early” reached virological clearance at day 30 from end therapy were alive well follow-up, whereas corresponding numbers “late” 50% 75%. Patients group more frequently needed oxygen supplementation (p = 0.015) steroid 0.045) during admission severity 0.017). Discussion The is tolerated associated 100% clearance. lower response rates disease severity, whether plays causative role such findings has yet be determined.

Language: Английский

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Combination treatment of persistent COVID-19 in immunocompromised patients with remdesivir, nirmaltrevir/ritonavir and tixegavimab/cilgavimab

Journal of Microbiology Immunology and Infection, Journal Year: 2023, Volume and Issue: 57(1), P. 189 - 194

Published: Sept. 27, 2023

We present a retrospective study on the treatment outcomes of severely immunocompromised patients with persistent COVID-19. The analyzed data from 14 who received combination tixegavimab/cilgavimab and antiviral medications. Response was evaluated based symptom improvement, PCR cycle-threshold values, C-responsive protein levels. Eleven achieved complete clinical virological resolution, while three showed partial responses. suggests potential association between non-response neutralization. findings underscore need for tailored approaches further research optimal strategies managing COVID-19, as well development antivirals variant-specific monoclonal antibodies.

Language: Английский

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Prevention and management of infectious complications in patients with chronic lymphocytic leukemia (CLL) treated with BTK and BCL-2 inhibitors, focus on current guidelines

Blood Reviews, Journal Year: 2024, Volume and Issue: 65, P. 101180 - 101180

Published: Feb. 2, 2024

CLL is associated with an increased risk of infectious complications. Treatment BTK or BCL-2 inhibitors does not seem to increase significantly the opportunistic infections, but role combination therapies including and/or remains be established. Various complications can successfully prevented appropriate management strategies. In this paper we reviewed international guidelines on prevention and in patients treated inhibitors. Universal pharmacological anti-herpes, antibacterial antifungal prophylaxis warranted. Reactivation HBV should HBsAg-positive subjects. For HBsAg-negative/HBcAb-positive recommendations differ, case treatment follow those for other, particularly anti-CD20, agent. Immunization provided preferably before onset treatment. Immunoglobulin therapy has favourable impact morbidity mortality hypogammaglobulinemia severe recurrent infections. Lack high-quality data heterogeneity protocols included studies might explain differences among main guidelines. Better collection

Language: Английский

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Sequential or Combination Treatments as Rescue Therapies in Immunocompromised Patients with Persistent SARS-CoV-2 Infection in the Omicron Era: A Case Series

Antibiotics, Journal Year: 2023, Volume and Issue: 12(9), P. 1460 - 1460

Published: Sept. 19, 2023

Prolonged SARS-CoV-2 infections are widely described in immunosuppressed patients, but safe and effective treatment strategies lacking. We aimed to outline our approach treating persistent COVID-19 patients with immunosuppression from different causes. In this case series, we retrospectively enrolled all treated at centers between March 2022 February 2023. Patients received sequential or combination regimens, including antivirals (remdesivir, nirmatrelvir/ritonavir, molnupiravir) and/or monoclonal antibodies (mAbs) (tixagevimab/cilgavimab sotrovimab). The main outcome was a complete virological response (negative RT-PCR on nasopharyngeal swabs) the end of treatment. Fifteen were included as follows: eleven (11/15; 73%) hematological disease four (4/15; 27%) recently diagnosed HIV/AIDS infection. Six (6/15; 40%) single antiviral course, an mAbs sequentially, two (13%) three lines (a sequence mAbs). A one plus administered cases (3/15, 20%). One patient died while still positive for SARS-CoV-2, fourteen (14/15; 93%) tested negative within 16 days after median time negativization since last 2.5 days. Both regimens used study demonstrated high efficacy safety high-risk group patients.

Language: Английский

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