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Colaneri M, Matone M, Fassio F, Lai A, Bergna A, Ventura CD, Galli L, Scaglione G, Gori A, Schiavini M. Exploring early COVID-19 therapies, variants, and viral clearance dynamics: Insights from a high-risk outpatients study. Diagn Microbiol Infect Dis 2024; 110:116452. [PMID: 39032318 DOI: 10.1016/j.diagmicrobio.2024.116452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 07/01/2024] [Accepted: 07/16/2024] [Indexed: 07/23/2024]
Abstract
This retrospective observational study investigates the impact of early COVID-19 therapies, including antivirals and monoclonal antibodies (mAbs), on time to achieve negative swab results in high-risk outpatients infected with specific Omicron sublineages. The study enrolled 104 patients from Luigi Sacco Hospital in Milan between December 2021 and March 2023, categorizing them based on the Omicron sublineage they were infected with (BA.1, BA.2, BA.4/BA.5) and the early treatment they received (antivirals or mAbs). Key data collected included demographic and clinical characteristics, initial and follow-up cycle threshold (Ct) values from qPCR tests, and the interval between swabs. The median age of the participants was 63 years (Interquartile Range [IQR] 54.0-76.5), and 55.8% were male. Among the patients, 15 received mAbs (14.4%), and 99 received antiviral treatments (95.2%) - specifically, Paxlovid (51.9%), Molnupiravir (21.1%), and Remdesivir (12.5%). No patients required hospitalization or experienced mortality during the one-month follow-up period. Regarding Omicron sublineages, 23 patients (22.1%) were infected with BA.1, 53 (51%) with BA.2, and 28 (26.9%) with BA.4/BA.5. The median interval between the initial and follow-up swabs was 6 days (IQR 6.0-7.0). Initial Ct values had a median of 18.5 (IQR 16.5-22.1), which increased to a median of 30.5 (IQR 27.1-33.0) at follow-up, indicating a reduction in viral load. A non-significant trend suggested that patients infected with BA.2 and BA.4/BA.5 sublineages might experience a faster increase in Ct values-indicating quicker viral load reduction - compared to those infected with BA.1, regardless of treatment type. However, this trend did not achieve statistical significance (p=0.609), likely due to the limited sample size and the absence of a clear trend curve. In summary, the study did not find a significant association between specific early therapies and the time to achieve swab negativization. These findings underscore the complex dynamics of viral clearance and highlight the need for further research with larger patient cohorts to refine treatment protocols for high-risk COVID-19 patients.
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Affiliation(s)
- Marta Colaneri
- Department of Infectious Diseases, Unit II, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy; Centre for Multidisciplinary Research in Health Science (MACH), University of Milano, Milano, Italy
| | - Maddalena Matone
- Department of Infectious Diseases, Unit I, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy.
| | - Federico Fassio
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - Alessia Lai
- Department of Biomedical and Clinical Sciences, University of Milan, Milano, Italy
| | - Annalisa Bergna
- Department of Biomedical and Clinical Sciences, University of Milan, Milano, Italy
| | - Carla Della Ventura
- Department of Biomedical and Clinical Sciences, University of Milan, Milano, Italy
| | - Lucia Galli
- Department of Infectious Diseases, Unit II, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Giovanni Scaglione
- Department of Infectious Diseases, Unit II, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Andrea Gori
- Department of Infectious Diseases, Unit II, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milano, Italy; Centre for Multidisciplinary Research in Health Science (MACH), University of Milano, Milano, Italy
| | - Monica Schiavini
- Department of Infectious Diseases, Unit II, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
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Drysdale M, Berktas M, Gibbons DC, Rolland C, Lavoie L, Lloyd EJ. Real-world effectiveness of sotrovimab for the treatment of SARS-CoV-2 infection during Omicron BA.2 and BA.5 subvariant predominance: a systematic literature review. Infection 2024:10.1007/s15010-024-02245-6. [PMID: 38602623 DOI: 10.1007/s15010-024-02245-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/19/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE To evaluate clinical outcomes associated with sotrovimab use during Omicron BA.2 and BA.5 predominance. METHODS Electronic databases were searched for observational studies published in peer-reviewed journals, preprint articles and conference abstracts from January 1, 2022 to February 27, 2023. RESULTS The 14 studies identified were heterogeneous in terms of study design, population, endpoints and definitions. They included > 1.7 million high-risk patients with COVID-19, of whom approximately 41,000 received sotrovimab (range n = 20-5979 during BA.2 and n = 76-1383 during BA.5 predominance). Four studies compared the effectiveness of sotrovimab with untreated or no monoclonal antibody treatment controls, two compared sotrovimab with other treatments, and three single-arm studies compared outcomes during BA.2 and/or BA.5 versus BA.1. Five studies descriptively reported rates of clinical outcomes in patients treated with sotrovimab. Rates of COVID-19-related hospitalization or mortality (0.95-4.0% during BA.2; 0.5-2.0% during BA.5) and all-cause mortality (1.7-2.0% during BA.2; 3.4% during combined BA.2 and BA.5 periods) among sotrovimab-treated patients were consistently low. During BA.2, a lower risk of all-cause hospitalization or mortality was reported across studies with sotrovimab versus untreated cohorts. Compared with other treatments, sotrovimab was associated with a lower (molnupiravir) or similar (nirmatrelvir/ritonavir) risk of COVID-19-related hospitalization or mortality during BA.2 and BA.5. There was no significant difference in outcomes between the BA.1, BA.2 and BA.5 periods. CONCLUSIONS This systematic literature review suggests continued effectiveness of sotrovimab in preventing severe clinical outcomes during BA.2 and BA.5 predominance, both against active/untreated comparators and compared with BA.1 predominance.
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Affiliation(s)
- Myriam Drysdale
- Value Evidence and Outcomes, GSK, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK.
| | - Mehmet Berktas
- Value Evidence and Outcomes, GSK, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - Daniel C Gibbons
- Value Evidence and Outcomes, GSK, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - Catherine Rolland
- Evidence Synthesis, Modelling and Communications, PPD Evidera, London, UK
| | - Louis Lavoie
- Evidence Synthesis, Modelling and Communications, PPD Evidera, Montreal, Canada
| | - Emily J Lloyd
- Value Evidence and Outcomes, GSK, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
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Chen C, Li R, Xing S, Cao L, Qu Y, Lv Q, Li X, Chen Z. Nirmatrelvir and ritonavir combination against COVID-19 caused by omicron BA.2.2 in the elderly: A single-center large observational study. Immun Inflamm Dis 2024; 12:e1232. [PMID: 38578027 PMCID: PMC10996376 DOI: 10.1002/iid3.1232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/03/2024] [Accepted: 03/14/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Since coronavirus 2019 (COVID-19) swept the world, a variety of novel therapeutic and prevention strategies have been developed, among which nirmatrelvir-ritonavir is highly recommended. We intended to assess the effectiveness and safety of nirmatrelvir-ritonavir in the elderly mild-to-moderate COVID-19 population caused by the omicron BA.2.2 variant in real-world settings. METHODS An observational study was conducted retrospectively to review the outcomes of mild-to-moderate COVID-19 patients admitted between April 26 and June 30, 2022. Patients' baseline characteristics were collected and assessed. Participants in the intervention group were administered nirmatrelvir-ritonavir in addition to standard care, whereas those in the control group only received standard care. The primary outcome was the duration between the initial positive reverse-transcription polymerase chain reaction (RT-PCR) test and the subsequent conversion to a negative result. RESULTS The analysis included 324 patients who were administered nirmatrelvir-ritonavir and an equal number of control patients. The patient characteristics in both groups were evenly matched. The average duration from the initial positive RT-PCR to negative conversion was similar in both groups (16.2 ± 5.0 vs. 16.1 ± 6.3 days, p = .83). Control patients exhibited slower conversion in comparison to patients who received nirmatrelvir-ritonavir treatment within 10 days of symptom onset. CONCLUSIONS These findings suggest that administering nirmatrelvir-ritonavir within 10 days of symptom onset could potentially reduce the time it takes for SARS-CoV-2-infected patients to negative RT-PCR results, thereby expanding the current usage guidelines for nirmatrelvir-ritonavir.
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Affiliation(s)
- Can Chen
- Department of Pharmacy, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Ranyi Li
- Department of Pharmacy, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Shuliang Xing
- Science and Education OfficeShanghai Geriatric Medical CenterShanghaiChina
| | - Lei Cao
- Medical Administration Office, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Yue Qu
- Department of Infectious DiseasesThe Alfred Hospital and Monash UniversityClaytonAustralia
| | - Qianzhou Lv
- Department of Pharmacy, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Xiaoyu Li
- Department of Pharmacy, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Zhangzhang Chen
- Department of Pharmacy, Zhongshan HospitalFudan UniversityShanghaiChina
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Colaneri M, Scaglione G, Fassio F, Galli L, Lai A, Bergna A, Gabrieli A, Tarkowski M, Ventura CD, Colombo V, Cordier L, Bernasconi D, Corbellino M, Dedivitiis G, Borghetti S, Visigalli D, Sollima S, Casalini G, Rizzardini G, Gori A, Antinori S, Riva A, Schiavini M. Early administration of nirmatrelvir/ritonavir leads to faster negative SARS-CoV-2 nasal swabs than monoclonal antibodies in COVID 19 patients at high-risk for severe disease. Virol J 2024; 21:68. [PMID: 38509536 PMCID: PMC10953281 DOI: 10.1186/s12985-024-02333-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/28/2024] [Indexed: 03/22/2024] Open
Abstract
PURPOSE Besides the well-established efficacy in preventing severe COVID-19, the impact of early treatments, namely antivirals and monoclonal antibodies (mAbs), on the time length to negativization of SARS-CoV-2 nasal swabs is still unclear. The aim of this study was to compare the efficacy of different early treatments in reducing the SARS-CoV-2 viral shedding, identifying a single drug that might potentially lead to a more rapid negativization of SARS-CoV-2 nasal swab. METHODS This was a single-centre, retrospective, observational study conducted at Ospedale Luigi Sacco in Milan. Data of high-risk COVID-19 patients who received early treatments between 23 December 2021 and March 2023 were extracted. The comparison across treatments was conducted using the Kruskall-Wallis test for continuous variables. Dunn's test with Bonferroni adjustment was performed for post-hoc comparisons of days to negativization. Secondly, a negative binomial regression adjusted for age, sex, number of comorbidities, immunosuppression, and SARS-CoV-2 vaccination status was implemented. RESULTS Data from 428 patients receiving early treatments were collected. The majority were treated with Nirmatrelvir/Ritonavir and were affected by SARS-CoV-2 Omicron infection with BA.2 sublineage. The median length time to SARS-CoV-2 nasal swab negativization was 9 days [IQR 7-13 days]. We found that Nirmatrelvir/Ritonavir determined a significant decrease of the length time to SARS-CoV-2 nasal swab negativization compared to mAbs (p = 0.003), but not compared to Remdesivir (p = 0.147) and Molnupiravir (p = 0.156). CONCLUSION Our findings highlight the importance of promptly treating high-risk COVID-19 patients with Nirmatrelvir/Ritonavir, as it also contributes to achieving a faster time to negative SARS-CoV-2 nasal swabs.
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Affiliation(s)
- Marta Colaneri
- Department of Infectious Diseases, Unit II, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
| | - Giovanni Scaglione
- Department of Infectious Diseases, Unit II, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Federico Fassio
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - Lucia Galli
- Department of Infectious Diseases, Unit II, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Alessia Lai
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Annalisa Bergna
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Arianna Gabrieli
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Maciej Tarkowski
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Carla Della Ventura
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Valeria Colombo
- Department of Infectious Diseases, Unit I, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Laura Cordier
- Department of Infectious Diseases, Unit II, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Davide Bernasconi
- Department of Infectious Diseases, Unit II, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Mario Corbellino
- Institute of Infectious Diseases & Tropical Medicine, III Division, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Gianfranco Dedivitiis
- Department of Infectious Diseases, Unit II, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Silvia Borghetti
- Pharmacy Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Debora Visigalli
- Pharmacy Unit, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Salvatore Sollima
- Institute of Infectious Diseases & Tropical Medicine, III Division, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Giacomo Casalini
- Institute of Infectious Diseases & Tropical Medicine, III Division, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Giuliano Rizzardini
- Department of Infectious Diseases, Unit I, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Andrea Gori
- Department of Infectious Diseases, Unit II, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- Institute of Infectious Diseases & Tropical Medicine, III Division, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Agostino Riva
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- Institute of Infectious Diseases & Tropical Medicine, III Division, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Monica Schiavini
- Department of Infectious Diseases, Unit II, L. Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy.
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5
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Amani B, Amani B. Comparison of effectiveness and safety of nirmatrelvir/ritonavir versus sotrovimab for COVID-19: a systematic review and meta-analysis. Expert Rev Anti Infect Ther 2024:1-9. [PMID: 38457124 DOI: 10.1080/14787210.2024.2326561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/05/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND This study aims to compare the effectiveness and safety of nirmatrelvir/ritonavir (Paxlovid) and sotrovimab for coronavirus disease 2019 (COVID-19). METHODS A search was conducted on PubMed, Cochrane Library, and Web of Science to explore relevant studies from January 2021 to November 2023. The risk of bias in the included studies was assessed using the Cochrane Collaboration's tool. Data analysis was conducted using the Comprehensive Meta-Analysis software (version 3.0). RESULTS Fifteen retrospective studies involving 13, 306 patients were included. The meta-analysis revealed no significant difference between the nirmatrelvir/ritonavir and sotrovimab groups in terms of mortality rate (odds ratio [OR] = 0.62, 95% confidence interval [CI]: 0.28 to 1.38), hospitalization rate (OR = 0.76, 95% CI: 0.48 to 1.22), death or hospitalization rate (OR = 0.75, 95% CI: 0.51 to 1.10), and intensive unit care admission (OR = 1.97, 95% CI: 0.38 to 10.07). In terms of safety, nirmatrelvir/ritonavir was associated with a higher incidence of adverse events (OR = 3.44, 95% CI: 1.29 to 9.17). CONCLUSIONS The meta-analysis showed that nirmatrelvir/ritonavir and sotrovimab have similar effectiveness in treating COVID-19 patients. However, the certainty of evidence supporting these findings is low. High-quality research is needed to better compare these interventions in COVID-19.
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Affiliation(s)
- Behnam Amani
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahman Amani
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Wang P, Wu S, Tian M, Liu K, Cong J, Zhang W, Wei B. A conformal regressor for predicting negative conversion time of Omicron patients. Med Biol Eng Comput 2024:10.1007/s11517-024-03029-8. [PMID: 38363486 DOI: 10.1007/s11517-024-03029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 01/09/2024] [Indexed: 02/17/2024]
Abstract
In light of the situation and the characteristics of Omicron, the country has continuously optimized the rules for the prevention and control of COVID-19. The global epidemic is still spreading, and new cases of infection continue to emerge in China. To facilitate the infected person to estimate the course of virus infection, a prediction model for predicting negative conversion time is proposed in this article. The clinical features of Omicron-infected patients in Shandong Province in the first half of 2022 are retrospectively studied. These features are grouped by disease diagnosis result, clinical sign, traditional Chinese medicine symptoms, and drug use. These features are input to the eXtreme Gradient Boosting (XGBoost) model, and the output is the predicted number of negative conversion days. At the same time, XGBoost is used as the underlying algorithm of the conformal prediction (CP) framework, which can realize the probability interval estimation with a controllable error rate. The results show that the proposed model has a mean absolute error of 3.54 days and has the shortest interval prediction result. This shows that the method in this paper can carry more decision-making information and help people better understand the disease and self-estimate the course of the disease to a certain extent.
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Affiliation(s)
- Pingping Wang
- Qingdao Academy of Chinese Medical Sciences, Shandong University of Traditional Chinese Medicine, Qingdao, 266112, China
- Center for Medical Artificial Intelligence, Shandong University of Traditional Chinese Medicine, Qingdao, 266112, China
| | - Shenjing Wu
- Qingdao Academy of Chinese Medical Sciences, Shandong University of Traditional Chinese Medicine, Qingdao, 266112, China
- Center for Medical Artificial Intelligence, Shandong University of Traditional Chinese Medicine, Qingdao, 266112, China
| | - Mei Tian
- Affiliated Hospital of Shandong University of Chinese Medicine, Jinan, 250011, China
| | - Kunmeng Liu
- Qingdao Academy of Chinese Medical Sciences, Shandong University of Traditional Chinese Medicine, Qingdao, 266112, China
- Center for Medical Artificial Intelligence, Shandong University of Traditional Chinese Medicine, Qingdao, 266112, China
| | - Jinyu Cong
- Qingdao Academy of Chinese Medical Sciences, Shandong University of Traditional Chinese Medicine, Qingdao, 266112, China
- Center for Medical Artificial Intelligence, Shandong University of Traditional Chinese Medicine, Qingdao, 266112, China
| | - Wei Zhang
- Affiliated Hospital of Shandong University of Chinese Medicine, Jinan, 250011, China.
| | - Benzheng Wei
- Qingdao Academy of Chinese Medical Sciences, Shandong University of Traditional Chinese Medicine, Qingdao, 266112, China.
- Center for Medical Artificial Intelligence, Shandong University of Traditional Chinese Medicine, Qingdao, 266112, China.
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7
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Russo A, Grimaldi P, Pisaturo M, Onorato L, Coppola N. Efficacy of sotrovimab on omicron BA.2, BA.4 and BA.5 subvariants of sars-cov-2 vs. other early therapies: a systematic review and meta-analysis of literature data. Front Immunol 2024; 15:1295029. [PMID: 38352882 PMCID: PMC10861778 DOI: 10.3389/fimmu.2024.1295029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
Background The aim of this meta-analysis was to ascertain whether sotrovimab was effective in reducing COVID-19 related hospitalization and mortality also in Omicron BA.2, BA.4 and BA.5 subvariants compared to other antivirals effective in index period. Methods A systematic review and meta-analysis of Randomized Controlled Trials (RCTs) and observational studies comparing the efficacy of early treatment with sotrovimab compared to other early treatment effective in index period, antivirals or monoclonal antibodies (mAbs), in patients with COVID-19 during BA.2, BA.4, BA.5 waves, conducted in accordance with PRISMA guidelines. We searched MEDLINE, Google Scholar and the Cochrane Library. Mortality and hospitalization were defined as outcomes. Results Four studies were included, allowing a meta-analysis of 8,041 patients. Meta-analysis showed no statistical difference between groups in hospitalization and mortality. Precisely, the RR of mortality showed no difference in the sotrovimab group compared to treatment with other drugs (OR 0.38, 95% CI 0.10-1.49, p<0.166). As regards the rate of hospitalization, no significant difference resulted between the patients treated with sotrovimab and those with other drugs (OR 1.66, 95% CI 0.41-6.66, p=0.477). Interpretation In conclusion, this meta-analysis showed no significant difference between sotrovimab or other antivirals in reducing COVID-19 evolution in patients with a high risk of progression, considering both hospitalization and mortality.
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Affiliation(s)
| | | | | | | | - Nicola Coppola
- Department of Mental Health and Public Medicine - Infectious Disease Unit, University of Campania Luigi Vanvitelli, Naples, Italy
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8
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Lo CKL, Lo CKF, Komorowski AS, Leung V, Matic N, McKenna S, Perez-Patrigeon S, Sheth PM, Lowe CF, Chagla Z, Bai AD. Evaluating in vivo effectiveness of sotrovimab for the treatment of Omicron subvariant BA.2 versus BA.1: a multicentre, retrospective cohort study. BMC Res Notes 2024; 17:37. [PMID: 38267971 PMCID: PMC10809552 DOI: 10.1186/s13104-024-06695-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND In vitro data suggested reduced neutralizing capacity of sotrovimab, a monoclonal antibody, against Omicron BA.2 subvariant. However, limited in vivo data exist regarding clinical effectiveness of sotrovimab for coronavirus disease 2019 (COVID-19) due to Omicron BA.2. METHODS A multicentre, retrospective cohort study was conducted at three Canadian academic tertiary centres. Electronic medical records were reviewed for patients ≥ 18 years with mild COVID-19 (sequencing-confirmed Omicron BA.1 or BA.2) treated with sotrovimab between February 1 to April 1, 2022. Thirty-day co-primary outcomes included hospitalization due to moderate or severe COVID-19; all-cause intensive care unit (ICU) admission, and all-cause mortality. Risk differences (BA.2 minus BA.1 group) for co-primary outcomes were adjusted with propensity score matching (e.g., age, sex, vaccination, immunocompromised status). RESULTS Eighty-five patients were included (15 BA.2, 70 BA.1) with similar baseline characteristics between groups. Adjusted risk differences were non-statistically significant between groups for 30-day hospitalization (- 14.3%; 95% confidence interval (CI): - 32.6 to 4.0%), ICU admission (- 7.1%; 95%CI: - 20.6 to 6.3%), and mortality (- 7.1%; 95%CI: - 20.6 to 6.3%). CONCLUSIONS No differences were demonstrated in hospitalization, ICU admission, or mortality rates within 30 days between sotrovimab-treated patients with BA.1 versus BA.2 infection. More real-world data may be helpful to properly assess sotrovimab's effectiveness against infections due to specific emerging COVID-19 variants.
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Affiliation(s)
- Carson K L Lo
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, ON, Canada.
- Transplant Infectious Diseases and Ajmera Transplant Centre, University Health Network, 585 University Avenue, MaRS Building, 9th Floor, Toronto, ON, M5G 2N2, Canada.
| | - Calvin K F Lo
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Adam S Komorowski
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Medical Microbiology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Victor Leung
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Medical Microbiology and Virology, St. Paul's Hospital, Providence Health Care, Vancouver, BC, Canada
| | - Nancy Matic
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Medical Microbiology and Virology, St. Paul's Hospital, Providence Health Care, Vancouver, BC, Canada
| | - Susan McKenna
- Department of Pharmacy Services, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Santiago Perez-Patrigeon
- Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Prameet M Sheth
- Division of Microbiology, Kingston Health Sciences Centre, Kingston, ON, Canada
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
- Department of Biomedical & Molecular Sciences, Queen's University, Kingston, ON, Canada
- Gastrointestinal Disease Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Christopher F Lowe
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Medical Microbiology and Virology, St. Paul's Hospital, Providence Health Care, Vancouver, BC, Canada
| | - Zain Chagla
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Anthony D Bai
- Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, ON, Canada
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De Vito A, Moi G, Saderi L, Puci MV, Colpani A, Firino L, Puggioni A, Uzzau S, Babudieri S, Sotgiu G, Madeddu G. Vaccination and Antiviral Treatment Reduce the Time to Negative SARS-CoV-2 Swab: A Real-Life Study. Viruses 2023; 15:2180. [PMID: 38005858 PMCID: PMC10675806 DOI: 10.3390/v15112180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
Clinical trials demonstrated the role of vaccines and antiviral treatments against SARS-CoV-2 in reducing the likelihood of disease progression and death. However, there are limited data available regarding the time to negativity of people who received these treatments. Further, several comorbidities and risk factors might affect the impact of vaccines and antiviral treatments. To this end, we aimed to evaluate and disentangle the impact of anti-SARS-CoV-2 treatments and that of underlying clinical factors associated with a shortened length of SARS-CoV-2 infection. Hence, we recorded the timeframe of positive nasopharyngeal swab in people infected while being hospitalized for reasons other than SARS-CoV-2 infection. All patients who died or were discharged with a positive swab were excluded from the study. A total of 175 patients were included in this study. Clinical conditions encompass malignancies, immunological disorders, cardiovascular, metabolic, neurodegenerative, and chronic kidney disease. Most of the participants (91.4%) were vaccinated before admission to the hospital, and 65.1% received antiviral treatment within three days after the symptom's onset. Unvaccinated patients had a longer median time to negativity than people who received at least two doses of vaccine (18 vs. 10 days). Concerning the clinical conditions of all patients, multivariate analysis highlighted a lower probability of 14-day conversion of antigenic test positivity in patients with hematological malignancy, including those vaccinated and those exposed to antiviral therapies. In conclusion, our data showed that prompt administration of antiviral treatments accelerates the clearance of SARS-CoV-2. Further, in the elderly patients under study, previous vaccination and antiviral treatment synergize to reduce time to negativity. This translates into a shorter hospitalization time and a lower risk of transmission through patients and connected healthcare workers in a hospital ward setting, with considerable improvement in cost-effective care management.
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Affiliation(s)
- Andrea De Vito
- Unit of Infectious Disease, Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy; (G.M.); (A.C.); (S.B.); (G.M.)
| | - Giulia Moi
- Unit of Infectious Disease, Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy; (G.M.); (A.C.); (S.B.); (G.M.)
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (L.S.); (M.V.P.); (G.S.)
| | - Mariangela V. Puci
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (L.S.); (M.V.P.); (G.S.)
| | - Agnese Colpani
- Unit of Infectious Disease, Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy; (G.M.); (A.C.); (S.B.); (G.M.)
| | - Laura Firino
- Division of Microbiology and Virology, Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (L.F.); (A.P.); (S.U.)
| | - Anna Puggioni
- Division of Microbiology and Virology, Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (L.F.); (A.P.); (S.U.)
| | - Sergio Uzzau
- Division of Microbiology and Virology, Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (L.F.); (A.P.); (S.U.)
| | - Sergio Babudieri
- Unit of Infectious Disease, Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy; (G.M.); (A.C.); (S.B.); (G.M.)
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (L.S.); (M.V.P.); (G.S.)
| | - Giordano Madeddu
- Unit of Infectious Disease, Department of Medicine, Surgery, and Pharmacy, University of Sassari, 07100 Sassari, Italy; (G.M.); (A.C.); (S.B.); (G.M.)
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Gelibter S, Pirro F, Saraceno L, Susani E, Moioli MC, Puoti M, Agostoni EC, Protti A. Tixagevimab and cilgavimab use in Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder during anti-CD20 treatment: A single-center experience. J Neuroimmunol 2023; 383:578199. [PMID: 37717427 DOI: 10.1016/j.jneuroim.2023.578199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND B-cell-depleting treatments, such as ocrelizumab and rituximab (anti-CD20), reduce humoral response to SARS-CoV-2 in people with Multiple Sclerosis (pwMS) and Neuromyelitis Optica Spectrum Disorder (NMOSD) and are associated with an increased risk of a more severe course of COVID-19 disease. The combination of tixagevimab and cilgavimab was authorized for COVID-19 prevention in immunocompromised subjects at high risk of severe COVID-19 disease, including patients treated with anti-CD20. Few real-world studies are available regarding the use of tixagevimab/cilgavimab in pwMS/NMOSD. In the present study, we describe the use of tixagevimab/cilgavimab for SARS-CoV-2 pre-exposure prophylaxis in a cohort of pwMS and NMOSD, treated with ocrelizumab and rituximab respectively. METHODS 26 subjects were treated with tixagevimab/cilgavimab, while we used 18 patients as the control group. We collected clinical data at baseline in all patients and during scheduled follow up evaluations. SARS-CoV-2 serological status pre- and post-tixagevimab/cilgavimab treatment was available for 10 patients. RESULTS We observed no adverse events following tixagevimab/cilgavimab treatment. Post-tixagevimab/cilgavimab anti-Spike-1-RBD IgG were significantly higher when compared to baseline values. No difference was found when comparing the percentage of COVID-19 infections between groups. All patients infected with SARS-CoV-2 had mild disease which did not require hospitalization. In patients treated with tixagevimab/cilgavimab, the rate of infection among patients exposed to SARS-CoV-2 was lower, without reaching statistical significance. We observed a significantly longer negativization time in the treated group. CONCLUSIONS Our results are not consistent with what was observed in the registration trial and some more recent studies. We did not observe a difference in COVID-19 incidence nor in disease severity in MS and NMOSD between treated and untreated patients. Our different results may be partially explained by the change in SARS-CoV-2 variants epidemiology (i.e. reduced efficacy of tixagevimab and cilgavimab against the currently dominant variants) as well as different patient selection included in the trial and different dose of tixagevimab/cilgavimab used in other studies. The present report provides a real-life experience with tixagevimab/cilgavimab in pwMS and NMOSD treated with anti-CD20, with findings that are in line with the current SARS-CoV-2 epidemiology and the recent evidence regarding SARS-CoV-2 variants. Our results warrant further research to best treat patients in the present and future pandemic scenario.
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Affiliation(s)
- Stefano Gelibter
- Department of Neurosciences, Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Fiammetta Pirro
- Department of Neurosciences, Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lorenzo Saraceno
- Department of Neurosciences, Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Emanuela Susani
- Department of Neurosciences, Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Maria Cristina Moioli
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Massimo Puoti
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Elio Clemente Agostoni
- Department of Neurosciences, Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandra Protti
- Department of Neurosciences, Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Nakamura K, Sugiyama M, Ishizuka H, Sasajima T, Minakawa Y, Sato H, Miyazawa M, Kitakawa K, Fujita S, Saito N, Kashiwabara N, Kohata H, Hara Y, Kanari Y, Shinka T, Kanemitsu K. Prolonged infective SARS-CoV-2 omicron variant shedding in a patient with diffuse large B cell lymphoma successfully cleared after three courses of remdesivir. J Infect Chemother 2023:S1341-321X(23)00113-7. [PMID: 37182841 PMCID: PMC10176961 DOI: 10.1016/j.jiac.2023.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/14/2023] [Accepted: 05/01/2023] [Indexed: 05/16/2023]
Abstract
We report a case of prolonged shedding of the infective SARS-CoV-2 omicron variant BA.1.1.2 in a 79-year-old male patient with diffuse large B-cell lymphoma, after receiving chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). The patient was admitted to our hospital in late March 2022 for the sixth course of R-CHOP chemotherapy. Initially, the patient tested negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using an in-hospital loop-mediated amplification assay with a nasopharyngeal swab, both on the day of admission and three days later. However, the patient developed fever and was diagnosed with coronavirus disease (COVID-19) six days after admission and was suspected to have contracted the infection in the ward. Viral shedding continued for more than three months, with confirmed viral infectivity. As compared to the original Wuhan-Hu-1/2019 strain, amino acid substitutions including S36N in non-structural protein (NSP)2, S148P and SL1265I in NSP3, G105D in NSP4, G496S, A831V, or V987F in spike protein, and I45T in open-reading frame (ORF)9b were randomly detected in isolated viruses. Although the patient had received two doses of the BNT162b2 vaccine approximately six months earlier and the third dose on day 127 after the infection, both serum anti-spike and anti-nuclear protein IgG and IgM tests were negative at day 92, 114, and 149 after the infection. The patient finally cleared the virus after the third course of remdesivir and did not have further recurrence.
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Affiliation(s)
- Kiwamu Nakamura
- Department of Infection Control, Fukushima Medical University, Fukushima, Japan.
| | | | - Hikari Ishizuka
- Department of Oncology, Fukushima Rosai Hospital, Iwaki, Japan.
| | - Tomomi Sasajima
- Infection Control Unit, Fukushima Rosai Hospital, Iwaki, Japan.
| | - Yoko Minakawa
- Infection Control Unit, Fukushima Rosai Hospital, Iwaki, Japan.
| | - Hiroko Sato
- Infection Control Unit, Fukushima Rosai Hospital, Iwaki, Japan.
| | | | - Kazuhiro Kitakawa
- Department of Microbiology, Fukushima Prefectural Institute of Public Health, Fukushima, Japan.
| | - Shohei Fujita
- Department of Microbiology, Fukushima Prefectural Institute of Public Health, Fukushima, Japan.
| | - Nozomi Saito
- Department of Microbiology, Fukushima Prefectural Institute of Public Health, Fukushima, Japan.
| | - Naoko Kashiwabara
- Department of Microbiology, Fukushima Prefectural Institute of Public Health, Fukushima, Japan.
| | - Hironobu Kohata
- Department of Microbiology, Fukushima Prefectural Institute of Public Health, Fukushima, Japan.
| | - Yasuka Hara
- Department of Infection Control, Fukushima Medical University, Fukushima, Japan.
| | - Yumiko Kanari
- Social Health and Welfare Department, Fukushima Prefectural Government, Fukushima, Japan.
| | | | - Keiji Kanemitsu
- Department of Infection Control, Fukushima Medical University, Fukushima, Japan.
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12
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Tian F, Chen Z, Feng Q. Nirmatrelvir-ritonavir compared with other antiviral drugs for the treatment of COVID-19 patients: A systematic review and meta-analysis. J Med Virol 2023; 95:e28732. [PMID: 37183808 DOI: 10.1002/jmv.28732] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 05/16/2023]
Abstract
At present, there are some differences in the research results of nirmatrelvir-ritonavir compared with other antiviral drugs for the treatment of COVID-19 patients. We aimed to evaluate the efficacy and safety of nirmatrelvir-ritonavir compared with other antiviral drugs and the impact of different antiviral drugs on the short- and long-term effects of COVID-19. PubMed, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), Web of Science, Google Scholar, and MedRxiv were searched to identify relevant studies from inception to March 30, 2023. We conducted a meta-analysis to estimate the effects of nirmatrelvir-ritonavir compared with other antiviral drugs for the treatment of COVID-19 patients and safety outcomes. The RoB1 and ROBINS-I were used to assess the bias risk of the included studies. Revman 5.4 software was used for meta-analysis (PROSPERO Code No: CRD42023397816). Twelve studies were included, including 30 588 COVID-19 patients, of whom 13 402 received nirmatrelvir-ritonavir. The meta-analysis results showed that the nirmatrelvir-ritonavir group had a lower proportion of patients than the control group in terms of long-term mortality (odds ratio [OR] = 0.29, 95% confidence interval [CI]: 0.13-0.66), hospitalization (OR = 0.44, 95% CI: 0.37-0.53, short term; OR = 0.52, 95% CI: 0.36-0.77, long term), and disease progression (OR = 0.56, 95% CI: 0.38-0.83, short term; OR = 0.60, 95% CI: 0.48-0.74, long term), and nirmatrelvir ritonavir showed little difference in safety compared to the control group. Nirmatrelvir-ritonavir can reduce the mortality and hospitalization of COVID-19 patients compared with other antiviral drugs. Further large-scale studies remain to validate these findings.
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Affiliation(s)
- Fangyuan Tian
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Zhaoyan Chen
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Qiyi Feng
- Sichuan Provincial Key Laboratory of Precision Medicine, West China Hospital, Precision Medicine Research Center, Sichuan University, Chengdu, China
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