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SHR Neuro Krebs Kardio Lipid Stoffw Microb

Orth, HM; Flasshove, C; Berger, M; Hattenhauer, T; Biederbick, KD; Mispelbaum, R; Klein, U; Stemler, J; Fisahn, M; Doleschall, AD; Baermann, BN; Koenigshausen, E; Tselikmann, O; Killer, A; de, Angelis, C; Gliga, S; Stegbauer, J; Spuck, N; Silling, G; Rockstroh, JK; Strassburg, CP; Brossart, P; Panse, JP; Jensen, BO; Luedde, T; Boesecke, C; Heine, A; Cornely, OA; Monin, MB.
Early combination therapy of COVID-19 in high-risk patients.
Infection. 2024; 52(3): 877-889. Doi: 10.1007/s15010-023-02125-5 [OPEN ACCESS]
Web of Science PubMed PUBMED Central FullText FullText_MUG

 

Co-Autor*innen der Med Uni Graz
Heine Annkristin
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Abstract:
PURPOSE: 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 with certainty. Dual therapies may therefore have a synergistic effect. METHODS: This retrospective, multicentre study compared treatment strategies for corona virus disease-19 (COVID-19) with combinations of nirmatrelvir/ritonavir, remdesivir, molnupiravir, and/ or mABs during the Omicron surge. Co-primary endpoints were prolonged viral shedding (≥ 106 copies/ml at day 21 after treatment initiation) and days with SARS-CoV-2 viral load ≥ 106 copies/ml. Therapeutic strategies and risk groups were compared using odds ratios and Fisher's tests or Kaplan-Meier analysis and long-rank tests. Multivariable regression analysis was performed. RESULTS: 144 patients were included with a median duration of SARS-CoV-2 viral load ≥ 106 copies/ml of 8.0 days (IQR 6.0-15.3). Underlying haematological malignancies (HM) (p = 0.03) and treatment initiation later than five days after diagnosis (p < 0.01) were significantly associated with longer viral shedding. Prolonged viral shedding was observed in 14.6% (n = 21/144), particularly in patients with underlying HM (OR 3.5; 95% CI 1.2-9.9; p = 0.02). Clinical courses of COVID-19 were mild to moderate with only few adverse effects potentially related to combination treatment. CONCLUSION: Early combination treatment of COVID-19 effectively prevented prolonged viral shedding in 85.6% of cases. Considering the rapid viral clearance rates and low toxicity, individualized dual therapy approaches may be beneficial in high-risk patients.
Find related publications in this database (using NLM MeSH Indexing)
Humans - administration & dosage
Retrospective Studies - administration & dosage
Male - administration & dosage
Female - administration & dosage
Antiviral Agents - therapeutic use
COVID-19 Drug Treatment - administration & dosage
Middle Aged - administration & dosage
Drug Therapy, Combination - administration & dosage
SARS-CoV-2 - drug effects
Aged - administration & dosage
COVID-19 - virology
Virus Shedding - drug effects
Viral Load - drug effects
Ritonavir - therapeutic use
Adenosine Monophosphate - analogs & derivatives, therapeutic use
Antibodies, Monoclonal - therapeutic use
Alanine - analogs & derivatives, therapeutic use
Adult - administration & dosage
Cytidine - analogs & derivatives
Hydroxylamines - administration & dosage

Find related publications in this database (Keywords)
COVID-19
Immunocompromised host
Dual anti-SARS-CoV-2 therapies
Prolonged viral shedding
Individualized therapeutic approaches
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