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Observational Study
. 2023 Oct 8;15(10):2066.
doi: 10.3390/v15102066.

Remdesivir or Nirmatrelvir/Ritonavir Therapy for Omicron SARS-CoV-2 Infection in Hematological Patients and Cell Therapy Recipients

José Luis Piñana  1   2 , Inmaculada Heras  3 , Tommaso Francesco Aiello  4 , Irene García-Cadenas  5 , Lourdes Vazquez  6 , Javier Lopez-Jimenez  7 , Pedro Chorão  8 , Cristina Aroca  3 , Carolina García-Vidal  4 , Ignacio Arroyo  1   2 , Eva Soler-Espejo  3 , Lucia López-Corral  6 , Alejandro Avendaño-Pita  6 , Anna Arrufat  5 , Valentín Garcia-Gutierrez  7 , Elena Arellano  9 , Lorena Hernández-Medina  6 , Clara González-Santillana  10 , Julia Morell  1   2 , José Ángel Hernández-Rivas  11 , Paula Rodriguez-Galvez  1   2 , Mireia Mico-Cerdá  1   2 , Manuel Guerreiro  8 , Diana Campos  1   2   12 , David Navarro  13   14 , Ángel Cedillo  15 , Rodrigo Martino  5 , Carlos Solano  1   2   14 ; Infectious Complications Subcommittee of the Spanish Hematopoietic Stem Cell Transplantation and Cell Therapy Group (GETH-TC)
Affiliations
Observational Study

Remdesivir or Nirmatrelvir/Ritonavir Therapy for Omicron SARS-CoV-2 Infection in Hematological Patients and Cell Therapy Recipients

José Luis Piñana et al. Viruses. .

Abstract

Background: Scarce data exist that analyze the outcomes of hematological patients with SARS-CoV-2 infection during the Omicron variant period who received treatment with remdesivir or nirmatrelvir/ritonavir.

Methods: This study aims to address this issue by using a retrospective observational registry, created by the Spanish Hematopoietic Stem Cell Transplantation and Cell Therapy Group, spanning from 27 December 2021 to 30 April 2023.

Results: This study included 466 patients, 243 (52%) who were treated with remdesivir and 223 (48%) with nirmatrelvir/ritonavir. Nirmatrelvir/ritonavir was primarily used for mild cases, resulting in a lower COVID-19-related mortality rate (1.3%), while remdesivir was preferred for moderate to severe cases (40%), exhibiting a higher mortality rate (9%). A multivariate analysis in the remdesivir cohort showed that male gender (odds ratio (OR) 0.35, p = 0.042) correlated with a lower mortality risk, while corticosteroid use (OR 9.4, p < 0.001) and co-infection (OR 2.8, p = 0.047) were linked to a higher mortality risk. Prolonged virus shedding was common, with 52% of patients shedding the virus for more than 25 days. In patients treated with remdesivir, factors associated with prolonged shedding included B-cell malignancy as well as underlying disease, severe disease, a later onset of and shorter duration of remdesivir treatment and a higher baseline viral load. Nirmatrelvir/ritonavir demonstrated a comparable safety profile to remdesivir, despite a higher risk of drug interactions.

Conclusions: Nirmatrelvir/ritonavir proved to be a safe and effective option for treating mild cases in the outpatient setting, while remdesivir was preferred for severe cases, where corticosteroids and co-infection significantly predicted worse outcomes. Despite antiviral therapy, prolonged shedding remains a matter of concern.

Keywords: COVID-19; Omicron; allogeneic stem cell transplantation; autologous stem cell transplantation; hematological malignancies; immunocompromised patients; mRNA vaccine; molnupiravir SARS-CoV-2 vaccines; nirmatrelvir/ritonavir; remdesivir; respiratory virus.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Distribution of antiviral use over the study period.
Figure 2
Figure 2
Cycle threshold (Ct) kinetics before and two weeks after antiviral treatment, according to the antiviral drug in 66 patients with mild COVID-19 (32 treated with remdesivir and 34 with nirmatrelvir/ritonavir).
See this image and copyright information in PMC

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Supplementary concepts