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. 2025 Feb 26;17(2):17.
doi: 10.3390/idr17020017.

Effectiveness and Tolerability of Dual Antiviral Therapy in Immunosuppressed Patients with Protracted SARS-CoV-2 Infection

Giovanna Travi  1 , Francesco Peracchi  1   2 , Marco Merli  1 , Emanuele Ravano  3 , Anna Frustaci  3 , Marina Deodato  3 , Diana Fanti  4 , Alice Nava  4 , Valeriana Colombo  5 , Nicholas Brian Bana  1   2 , Carlotta Rogati  1 , Alessandro Raimondi  1 , Cristina Moioli  1 , Anna Maria Pazzi  1 , Marta Vecchi  1 , Davide Motta  1 , Roberto Rossotti  1 , Chiara Oltolini  1 , Fulvio Crippa  1 , Enrico Minetti  5 , Chiara Vismara  4 , Roberto Cairoli  3 , Massimo Puoti  1   2
Affiliations

Effectiveness and Tolerability of Dual Antiviral Therapy in Immunosuppressed Patients with Protracted SARS-CoV-2 Infection

Giovanna Travi et al. Infect Dis Rep. .

Abstract

Background: Immunosuppressed patients still exhibit a high mortality rate due to SARS-CoV-2 infection, up to 21%. Persistent viral load replication and protracted viral symptoms result in a high risk of developing pneumonia, a potential risk of antiviral resistance, and a subsequent delay of onco-hematological treatments.

Methods: Hematological patients and kidney transplant patients with SARS-CoV-2 infection, treated at GOM Niguarda Hospital (Milan) with combined antiviral therapy (remdesivir plus nirmatrelvir/ritonavir at standard doses) between November 2022 and March 2024, were retrospectively reviewed.

Results: Thirty-four patients were analyzed. Twenty-four (71%) patients had pneumonia. The median duration of SARS-CoV-2 positivity before antiviral treatment was 40 (10-34) days. The median treatment duration was 11 (10-10) days. All patients went through clinical resolution. Thirteen patients were exposed to a new immune-chemotherapy cycle early after antiviral treatment (median 13, IQR 6-12 days), while five resumed a standard immunosuppressive regimen immediately after viral clearance. No relapse or recurrence of symptoms was reported for up to 226 (106-318) days of follow-up. Antiviral therapy was well tolerated, and no adverse events were observed. The 30-day overall survival was 94%, while the 90-day survival was 88%. No patient died of SARS-CoV-2 infection.

Conclusions: The administration of nirmatrelvir/ritonavir and remdesivir lead to the complete resolution of SARS-CoV-2 pneumonia with no side effects in this cohort. The combination of these two antivirals may be a safe option in immunosuppressed population at risk of severe complications and prolonged SARS-CoV-2 infection in order to treat severe clinical presentation and to avoid viral recurrence after chemotherapy.

Keywords: SARS-CoV-2; SOT; dual antiviral therapy; hematological; immunodepression.

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Conflict of interest statement

The authors declare that they have no competing interests for this work.

Figures

Figure 1
Figure 1
Kaplan–Mayer for overall survival.
Figure 2
Figure 2
Kaplan–Mayer for hematological group survival (Log-rank test p = 0.4497).
See this image and copyright information in PMC

References

    1. Dioverti V., Salto-Alejandre S., Haidar G. Immunocompromised Patients with Protracted COVID-19: A Review of “Long Persisters”. Curr. Transplant. Rep. 2022;9:209–218. - PMC - PubMed
    1. Carlin A.F., Clark A.E., Chaillon A., Garretson A.F., Bray W., Porrachia M., Santos A.T., Rana T.M., Smith D.M. Virologic and Immunologic Characterization of Coronavirus Disease 2019 Recrudescence After Nirmatrelvir/Ritonavir Treatment. Clin. Infect. Dis. 2022;76:e530–e532. - PMC - PubMed
    1. Martinez M.A., Chen T.Y., Choi H., Hwang M., Navarathna D., Hao L., Gale M., Camus G., Ramirez H.E., Jinadatha C. Extended Remdesivir Infusion for Persistent Coronavirus Disease 2019 Infection. Open Forum Infect. Dis. 2022;9:ofac382. - PMC - PubMed
    1. Helleberg M., Niemann C.U., Moestrup K.S., Kirk O., Lebech A.M., Lane C., Lundgren J. Persistent COVID-19 in an immunocompromised patient temporarily responsive to two courses of remdesivir therapy. J. Infect. Dis. 2020;222:1103–1107. - PMC - PubMed
    1. Lee C.Y., Shah M.K., Hoyos D., Solovyov A., Douglas M., Taur Y., Maslak P., Babady N.E., Greenbaum B., Kamboj M., et al. Prolonged SARS-CoV-2 Infection in Patients with Lymphoid Malignancies. Cancer Discov. 2022;12:62–73. - PMC - PubMed

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