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Review
. 2023;12(2):23-35.
doi: 10.1007/s13665-023-00302-3. Epub 2023 Feb 16.

Current and Emerging Therapies for COVID-19 in Lung Transplantation

Daniel Z P Friedman  1 , Natasha N Pettit  2 , Erica MacKenzie  3 , Jennifer Pisano  1
Affiliations
Review

Current and Emerging Therapies for COVID-19 in Lung Transplantation

Daniel Z P Friedman et al. Curr Pulmonol Rep. 2023.

Abstract

Purpose of review: The landscape of the coronavirus disease 2019 (COVID-19) pandemic has rapidly changed over the past 3 years. Paralleling this evolution, the scientific and medical communities have reported many novel findings relating to the infection's epidemiology, transmission, diagnosis, and treatment. We review pertinent studies of COVID-19 therapeutics with an emphasis on their application to lung transplant recipients.

Recent findings: Agents that have been well-studied for treating COVID-19 include antivirals (remdesivir, nirmatrelvir/ritonavir, molnupiravir), monoclonal antibodies, and immunomodulators (for example, corticosteroids and tocilizumab).

Summary: Remdesivir remains an essential therapy for managing mild-moderate COVID-19. Though highly efficacious for mild-moderate COVID-19 for outpatient therapy, ritonavir-boosted nirmatrelvir has limited use in lung transplant recipients due to significant drug-drug interactions. Monoclonal antibodies, though useful, are the most affected by the emergence of new viral variants.

Keywords: COVID-19; Lung transplant; Molnupiravir; Monoclonal antibodies; Nirmatrelvir; Remdesivir.

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Conflict of interest statement

Conflict of InterestDZP Friedman declares that he has no conflicts of interest. N Pettit declares that she has no conflicts of interest. E Mackenzie declares that she has no conflicts of interest. J Pisano receives grant support from Pfizer, Moderna, and Gilead.

Figures

Fig. 1
Fig. 1
Proposed outpatient management strategy for lung transplant recipients with COVID-19. †Due to inferior efficacy, molnupiravir is not a preferred choice and should only be used if remdesivir or nirmatrelvir/ritonavir are not possible options (e.g., drug-drug interactions, toxicities, or unavailability)
Fig. 2
Fig. 2
Proposed inpatient management strategy for lung transplant recipients with COVID-19. Abbreviations: CRP, C-reactive protein; ECMO, extracorporeal membrane oxygenation; HFNC, high-flow nasal cannulae; LTR, lung transplant recipient; MV, mechanical ventilation; NIV, non-invasive ventilation. †Although specific CRP thresholds are not specified in the guidelines of the National Institute of Health [93], 75–100 mg/L were used in the REMAP-CAP and RECOVERY trials [63, 64]. ‡Baricitinib should be discontinued if the patient is discharged before 14 days. §If tocilizumab and baricitinib are not available, they may be substituted with either tofacitinib or sarilumab
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References

    1. World Health Organization. Weekly epidemiological update on COVID-19 - 15 June 2022. 2022. https://www.who.int/publications/m/item/weekly-epidemiological-update-on.... Accessed 15 Jun 2022.
    1. Pereira MR, Arcasoy S, Farr MA, Mohan S, Emond JC, Tsapepas DS, et al. Outcomes of COVID-19 in solid organ transplant recipients: a matched cohort study. Transpl Infect Dis. 2021;23:e13637. doi: 10.1111/tid.13637. - DOI - PMC - PubMed
    1. Rinaldi M, Bartoletti M, Bussini L, Pancaldi L, Pascale R, Comai G, et al. COVID-19 in solid organ transplant recipients: no difference in survival compared to general population. Transpl Infect Dis. 2021;23:e13421. doi: 10.1111/tid.13421. - DOI - PMC - PubMed
    1. An W, Wang Q, Kim T-E, Kang J-S. Clinical characteristics and outcome of coronavirus disease 2019 infection in patients with solid organ transplants: a systematic review and meta-analysis. J Infect Public Health. 2022;15:365–372. doi: 10.1016/j.jiph.2022.02.002. - DOI - PMC - PubMed
    1. Favà A, Donadeu L, Sabé N, Pernin V, González-Costello J, Lladó L, et al. SARS-CoV-2-specific serological and functional T cell immune responses during acute and early COVID-19 convalescence in solid organ transplant patients. Am J Transplant. 2021;21:2749–2761. doi: 10.1111/ajt.16570. - DOI - PMC - PubMed

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