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Salmanton-García, J; Marchesi, F; Gomes, da, Silva, M; Farina, F; Dávila-Valls, J; Bilgin, YM; Glenthøj, A; Falces-Romero, I; Van, Doesum, J; Labrador, J; Buquicchio, C; El-Ashwah, S; Petzer, V; Van, Praet, J; Schönlein, M; Dargenio, M; Méndez, GA; Meers, S; Itri, F; Giordano, A; Pinczés, LI; Espigado, I; Stojanoski, Z; López-García, A; Prezioso, L; Jaksic, O; Vena, A; Fracchiolla, NS; González-López, TJ; Colović, N; Delia, M; Weinbergerová, B; Marchetti, M; Marques, de, Almeida, J; Finizio, O; Besson, C; Biernat, MM; Valković, T; Lahmer, T; Cuccaro, A; Ormazabal-Vélez, I; Batinić, J; Fernández, N; De, Jonge, N; Tascini, C; Anastasopoulou, AN; Duléry, R; Del, Principe, MI; Plantefeve, G; Papa, MV; Nucci, M; Jiménez, M; Aujayeb, A; Hernández-Rivas, JÁ; Merelli, M; Cattaneo, C; Blennow, O; Nordlander, A; Cabirta, A; Varricchio, G; Sacchi, MV; Cordoba, R; Arellano, E; Gräfe, SK; Wolf, D; Emarah, Z; Ammatuna, E; Hersby, DS; Martín-Pérez, S; Nunes, Rodrigues, R; Rahimli, L; Pagano, L; Cornely, OA, , EPICOVIDEHA, registry.
Nirmatrelvir/ritonavir in COVID-19 patients with haematological malignancies: a report from the EPICOVIDEHA registry.
EClinicalMedicine. 2023; 58: 101939 Doi: 10.1016/j.eclinm.2023.101939 [OPEN ACCESS]
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Abstract:
BACKGROUND: Nirmatrelvir/ritonavir treatment decreases the hospitalisation rate in immunocompetent patients with COVID-19, but data on efficacy in patients with haematological malignancy are scarce. Here, we describe the outcome of nirmatrelvir/ritonavir treatment in a large cohort of the latter patients. METHODS: This is a retrospective cohort study from the multicentre EPICOVIDEHA registry (NCT04733729) on patients with haematological malignancy, who were diagnosed with COVID-19 between January and September 2022. Patients receiving nirmatrelvir/ritonavir were compared to those who did not. A logistic regression was run to determine factors associated with nirmatrelvir/ritonavir administration in our sample. Mortality between treatment groups was assessed with Kaplan-Meier survival plots after matching all the patients with a propensity score. Additionally, a Cox regression was modelled to detect factors associated with mortality in patients receiving nirmatrelvir/ritonavir. FINDINGS: A total of 1859 patients were analysed, 117 (6%) were treated with nirmatrelvir/ritonavir, 1742 (94%) were treated otherwise. Of 117 patients receiving nirmatrelvir/ritonavir, 80% had received ≥1 anti-SARS-CoV-2 vaccine dose before COVID-19 onset, 13% of which received a 2nd vaccine booster. 5% were admitted to ICU. Nirmatrelvir/ritonavir treatment was associated with the presence of extrapulmonary symptoms at COVID-19 onset, for example anosmia, fever, rhinitis, or sinusitis (aOR 2.509, 95%CI 1.448-4.347) and 2nd vaccine booster (aOR 3.624, 95%CI 1.619-8.109). Chronic pulmonary disease (aOR 0.261, 95%CI 0.093-0.732) and obesity (aOR 0.105, 95%CI 0.014-0.776) were not associated with nirmatrelvir/ritonavir use. After propensity score matching, day-30 mortality rate in patients treated with nirmatrelvir/ritonavir was 2%, significantly lower than in patients with SARS-CoV-2 directed treatment other than nirmatrelvir/ritonavir (11%, p = 0.036). No factor was observed explaining the mortality difference in patients after nirmatrelvir/ritonavir administration. INTERPRETATION: Haematological malignancy patients were more likely to receive nirmatrelvir/ritonavir when reporting extrapulmonary symptoms or 2nd vaccine booster at COVID-19 onset, as opposed to chronic pulmonary disease and obesity. The mortality rate in patients treated with nirmatrelvir/ritonavir was lower than in patients with targeted drugs other than nirmatrelvir/ritonavir. FUNDING: EPICOVIDEHA has received funds from Optics COMMIT (COVID-19 Unmet Medical Needs and Associated Research Extension) COVID-19 RFP program by GILEAD Science, United States (Project 2020-8223).

Find related publications in this database (Keywords)
Nirmatrelvir
SARS-CoV-2
Haematology
Malignancy
COVID-19
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