Real-Life Comparison of Antivirals for SARS-CoV-2 Omicron Infection in Patients With Hematologic Malignancies

Abstract

Background: We aimed to describe a cohort of hematologic patients with COVID-19 treated with antivirals early.

Methods: Non-interventional chart review study. Comparison of baseline characteristics and outcomes in high-risk hematologic patients treated with remdesivir between December 2021 and April 2022 versus those treated with nirmatrelvir/ritonavir between May and August 2022.

Results: Eighty-three patients were analyzed. Forty-two received remdesivir, and 41 nirmatrelvir/ritonavir. Patients with remdesivir were younger, vaccinated with lower number of doses, and received prior corticosteroids less frequently and sotrovimab, hyperimmune plasma and corticosteroids more often. Viral shedding median (IQR) duration was 18 (13-23) and 11 (8-21) days in the remdesivir and nirmatrelvir/ritonavir groups, respectively (p = 0.004). Median (IQR) Ct values before treatment were similar in both groups. Within 5 days of treatment, median (IQR) Ct values were 26 (23-29) and 33 (30-37) in the remdesivir and nirmatrelvir/ritonavir groups, respectively (p < 0.0001). All patients were hospitalized for remdesivir administration and only four (9.8%) in the nirmatrelvir/ritonavir group. The overall outcomes in this cohort of COVID-19 patients with Omicron variant was good, as no patient needed oxygen or ICU admission. One patient in remdesivir group died from septic shock. No severe adverse event was recorded in both treatment groups.

Conclusions: Patients with hematologic malignancies and non-severe COVID-19 who received nirmatrelvir/ritonavir experienced faster decrease in viral load and shorter viral shedding. Furthermore, besides the advantage of oral administration, nirmatrelvir/ritonavir administration reduced the need of hospital admission.

Keywords: COVID-19; Omicron; nirmatrelvir/ritonavir; outcome; phenotypes.

FIGURE 1

SARS‐CoV‐2 rRT‐PCR Ct shift after 5 days of treatment per antiviral regimen. White boxes refer to rRT‐PCR Ct of patients treated with remdesivir. Gray boxes refer to rRT‐PCR Ct of patients treated with nirmatrelvir/ritonavir. Box plots show the interquartile range (IQR). The black horizontal line inside de box indicates the median rRT‐PCR Ct. Whereas median (IQR) Ct values before antiviral treatment were similar (19 [17–23] in the remdesivir group and 21 [17–24] in the nirmatrelvir/ritonavir group), 5‐day median Ct values were 26 (23‐29) and 33 (30–37) in the in the remdesivir and nirmatrelvir/ritonavir groups, respectively (p < 0.0001). Black dots indicate low and high outliers.

FIGURE 2

Median (IQ) duration in days of SARS‐CoV‐2 positive test per antiviral regimen. White box refers to duration in days of SARS‐CoV‐2 positive test of patients treated with remdesivir. Gray box refers to patients treated with nirmatrelvir/ritonavir. Box plots show the interquartile range (IQR). The black horizontal line inside de box indicates de median duration in days of SARS‐CoV‐2 positive test. White dots indicate low and high outliers.