Early combination therapy of COVID-19 in high-risk patients

Infection, Год журнала: 2023, Номер 52(3), С. 877 - 889

Опубликована: Ноя. 29, 2023

Prolonged shedding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been observed in immunocompromised hosts. Early monotherapy with direct-acting antivirals or monoclonal antibodies, as recommended by the international guidelines, does not prevent this certainty. Dual therapies may therefore have a synergistic effect.

Язык: Английский

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Severe COVID-19 in Vaccinated Adults With Hematologic Cancers in the Veterans Health Administration

JAMA Network Open, Год журнала: 2024, Номер 7(2), С. e240288 - e240288

Опубликована: Фев. 23, 2024

Importance With SARS-CoV-2 transforming into an endemic disease and with antiviral treatments available, it is important to establish which patients remain at risk of severe COVID-19 despite vaccination. Objective To quantify the associations clinical demographic variables odds among hematologic cancers. Design, Setting, Participants This case-control study included all malignant neoplasms in national Veterans Health Administration (VHA) who had documented infection after Groups (cases) vs nonsevere (controls) were compared. Data collected between January 1, 2020, April 5, 2023, data on 2021, September 30, 2022. All diagnostic codes for vaccination followed by whom severity could be assessed included. analyzed from July 28 December 2023. Exposures Clinical (comorbidities, predominant viral variant, treatment neoplasm, booster vaccination, treatment) (age sex) shown prior studies associated higher or lower rates COVID-19. Comorbidities Alzheimer dementia, chronic kidney disease, obstructive pulmonary diabetes, heart failure, peripheral vascular disease. Main Outcome Measures The main outcome was compared infection. Severe defined as death within days, mechanical ventilation, hospitalization use dexamethasone evidence hypoxemia supplemental oxygen. Multivariable logistic regression used estimate COVID-19, expressed adjusted ratios (aORs) 95% CIs. Results Among 6122 (5844 [95.5%] male, mean [SD] age, 70.89 [11.57] years), 1301 (21.3%) Age (aOR per 1-year increase, 1.05; CI, 1.04-1.06), antineoplastic immune-suppressive drugs (eg, combination glucocorticoids: aOR, 2.32; 1.93-2.80), comorbidities comorbidity, 1.35; 1.29-1.43) whereas (aOR, 0.73; 0.62-0.86). After oral became widely March 2022, 20 538 (3.7%) during this period progression Conclusions Relevance In cancers, remained high through mid-2022 especially requiring treatment.

Язык: 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, Год журнала: 2024, Номер 65, С. 101180 - 101180

Опубликована: Фев. 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

Язык: Английский

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Effectiveness of early intervention and combination treatment with monoclonal antibodies and antivirals in oncohematological patients with SARS-CoV-2: a retrospective experience

Frontiers in Immunology, Год журнала: 2025, Номер 16

Опубликована: Март 28, 2025

Patients with acute SARS-CoV-2 and pre-existing oncohematological conditions challenge clinicians due to a heightened risk for severe COVID-19 forced deferral of cancer treatment. Different treatment approaches aim either prevent the progression mild disease ("early therapy") or treat more COVID-19. Currently, there is limited evidence supporting effectiveness tailored approach patients. We present real-world experience from two university hospitals. In this retrospective study we recruited patients hospitalized pneumonia between March 2020 June 2023 hospitals in Latium, Italy. received antiviral monoclonal antibodies (MoAb) alone, dual therapy (antiviral MoAb) triple (two different antivirals MoAb). The aimed evaluate practical management focused on impact related specific therapies, early treatment, tixagevimab-cilgavimab prophylaxis in-hospital mortality viral clearance time. Overall, 101 were recruited, 76 (75.24%) developed pneumonia, 16 (15.84%) died any cause. While most (75,25%) did not receive "early therapy", those who had higher chance survival (p=0.04). Furthermore, subgroup treated demonstrated rate as well (p=0.02). Out resulted lower (all survive group). This group also showed significant reduction time first day evaluated (6 days [IQR 4;9]), compared only remdesivir (17 8;37]) (p=0.03). Our findings demonstrate that significantly reduces mortality, while accelerates These results, line recent studies, underscore critical importance prompt multitargeted pharmacological optimizing outcomes SARS-CoV-2. Future research, involving larger cohorts, should delve deeper into strategies vulnerable population, particular emphasis elderly, continue high rates.

Язык: Английский

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Outcomes of targeted treatment in immunocompromised patients with asymptomatic or mild COVID-19: a retrospective study

Scientific Reports, Год журнала: 2023, Номер 13(1)

Опубликована: Сен. 16, 2023

The aim of this study was to describe the outcomes targeted COVID-19 treatments in immunocompromised patients with asymptomatic or mild during period expansion different Omicron subvariants France. A retrospective monocentric observational performed. All aged 18 more, SARS-CoV-2 infection COVID-19, and who had received a treatment sotrovimab, tixagevimab/cilgavimab, nirmatrelvir/ritonavir remdesivir at Bordeaux University Hospital from 1st January 2022 31st December were eligible. primary interest defined as composite either (i) progression moderate (WHO-Clinical Progression Scale 4 5) severe (WHO-CPS ≥ 6), (ii) occurrence COVID-19-related death. secondary components outcome. Outcomes collected until day 30 after administration discharge for still hospitalised relation 30. 223 COVID-19: 114 50 49 nirmatrelvir/ritonavir, 10 remdesivir. Among treated patients, (4.5%) progressed disease: three (1.3%) 7 (3.1%) disease. them, (1.8%) died COVID-19. More than 95% by therapies era did not progress

Язык: Английский

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Antibody Response to the SARS-CoV-2 Vaccine and COVID-19 Vulnerability during the Omicron Pandemic in Patients with CLL: Two-Year Follow-Up of a Multicenter Study

Cancers, Год журнала: 2023, Номер 15(11), С. 2993 - 2993

Опубликована: Май 30, 2023

High morbidity and mortality due to COVID-19 were described in the pre-vaccination era patients with chronic lymphocytic leukemia (CLL). To evaluate after SARS-CoV-2 vaccine, we carried out a prospective study 200 CLL patients. The median age of was 70 years; 35% showed IgG levels ≤ 550 mg/dL, 61% unmutated IGHV, 34% TP53 disruption. Most patients, 83.5%, previously treated, including 36% ibrutinib 37.5% venetoclax. serologic response rates second third dose vaccine 39% 53%, respectively. With follow-up 23.4 months, 41% experienced COVID-19, 36.5% during Omicron pandemic, 10% had subsequent events. Severe requiring hospitalization recorded 26% 4% died. Significant independent factors associated vulnerability (OR: 0.93; HR: 0.97) less than 18 months between start targeted agents 0.17; 0.31). mutation ≥two prior treatments also emerged as significant an increased risk developing (HR: 1.85; 2.08). No statistical difference found or without antibody (47.5% vs. 52.5%; p = 0.21). Given persistent infection continuous emergence variants, our results support importance new vaccines protective measures prevent mitigate

Язык: Английский

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Oral anti‐viral therapy for early COVID‐19 infection in patients with haematological malignancies: A multicentre prospective cohort

British Journal of Haematology, Год журнала: 2023, Номер 202(5), С. 928 - 936

Опубликована: Май 31, 2023

High rates of lung failure have been reported in haematological patients after SARS-CoV2 infection. An early administration monoclonal antibodies or anti-virals may improve the prognosis. Oral a wider use independently genetic variations virus. Prospective data on malignancies (HMs) are still lacking. Outpatients diagnosed with HM and COVID-19 infection were prospectively treated oral nirmatrelvir/ritonavir molnupiravir. Incidence failure, deaths adverse events was analysed. Long-term outcome at third month evaluated. Eighty-two outpatients evaluable for study objectives. All had their within 12 months. COVID-19-related 23.1%. Active (aOR = 4.42; p 0.038) prolonged viral shedding 1.04; 0.022) resulted independent predictors severe The vaccination three to four doses 0.02; 0.001) two 0.06; 0.006) protective. 28 days 6.1%. All-cause mortality 90-day follow-up 13.4% (n. 11) included opportunistic infections cardiovascular events. In conclusion, this approach reduced incidence specific compared previous cohorts, but remain high risk further complications.

Язык: Английский

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Early 3‑day course of remdesivir for the prevention of the progression to severe COVID‑19 in the elderly: A single‑centre, real‑life cohort study

Experimental and Therapeutic Medicine, Год журнала: 2023, Номер 26(4)

Опубликована: Авг. 9, 2023

Remdesivir, a viral RNA polymerase inhibitor, has constituted key component of therapeutic regimens against the pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Originally approved for administration in hospitalized patients, remdesivir leads to improved outcomes patients with moderate coronavirus disease 2019 (COVID-19). After proving be effective its use gained approval early-stage symptomatic outpatients who are at high risk progression disease. The present study is real-life prospective cohort involving 143 elderly non-hospitalized SARS-CoV-2 (≥65 years age) attended emergency department authors' hospital seeking care COVID-19 symptoms appearing within prior 7 days. Eligible received intravenous dose 200 mg on first day and 100 days 2 3. efficacy endpoints were set as need COVID-19-related hospitalization all-cause mortality following 28 A total participated study. Of these 118 (82.5%) vaccinated least two doses. All enrolled completed 3-day course, 6 out (4.2%) having 28, 5 (3.5%) succumbing period. In univariate Cox regression analysis, neutrophil-to-lymphocyte ratio haematological malignancy identified predictors disease, albumin levels, C-reactive protein-to-albumin (CAR) 28-day mortality. On whole, findings demonstrated that among outpatients, course was associated favourable outcomes.

Язык: Английский

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Omicron related COVID-19 prevention and treatment measures for patients with hematological malignancy and strategies for modifying hematologic treatment regimes

Frontiers in Cellular and Infection Microbiology, Год журнала: 2023, Номер 13

Опубликована: Окт. 19, 2023

The Omicron variant of SARS-CoV-2 has rapidly become the dominant strain worldwide due to its high transmissibility, although it appears be less pathogenic than previous strains. However, individuals with hematological malignancy (HM) and COVID-19 remain susceptible severe infection mortality, especially those chronic lymphocytic leukemia (CLL) undergoing chimeric antigen receptor T-cell (CAR-T) treatment. Hematologists should thoroughly assess severity patient’s disease potential risk before initiating chemotherapy or immunosuppressive Vaccination booster doses are strongly recommended patients a poor vaccine response may benefit from long-acting neutralizing monoclonal antibodies (such as Evusheld). Early use small molecule antiviral drugs is for managing mild in HM immunodeficiency antibody therapy high-titer convalescent plasma (CCP). For moderate cases, low-dose glucocorticoids combination early treatment can administered, cytokine antagonists JAK inhibitors added if condition persists worsens. In malignancies, delaying preferable CLL, acute (AL), low-risk myelodysplastic syndrome (MDS), but progresses, appropriate adjustments dosage frequency required, avoidance anti-CD20 antibody, CAR-T hematopoietic stem cell transplantation (HSCT). Patients myelocytic (CML) myeloproliferative neoplasms (MPNs) continue current What’s more, non-drug protective measures, development new vaccines drugs, monitoring mutations immunocompromised populations particularly important.

Язык: Английский

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Omicron SARS-CoV-2 infection management and outcomes in patients with hematologic disease and recipients of cell therapy

Frontiers in Oncology, Год журнала: 2024, Номер 14

Опубликована: Июнь 19, 2024

Scarce real-life data exists for COVID-19 management in hematologic disease (HD) patients the Omicron era.

Язык: Английский

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