Clinical Outcome and 7-Day Virological Clearance in High-Risk Patients with Mild-Moderate COVID-19 Treated with Molnupiravir, Nirmatrelvir/Ritonavir, or Remdesivir.

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES Infectious Diseases and Therapy Pub Date : 2024-07-01 Epub Date: 2024-06-03 DOI:10.1007/s40121-024-00994-3

Francesca Bai, Tomaso Beringheli, Virginia Vitaletti, Andrea Santoro, Francesco Molà, Alessandro Copes, Nicole Gemignani, Sofia Pettenuzzo, Roberto Castoldi, Benedetta Varisco, Riccardo Nardo, Lorenzo Brando Lundgren, Riccardo Ligresti, Matteo Sala, Lorenzo Albertini, Matteo Augello, Lorenzo Biasioli, Valeria Bono, Roberta Rovito, Teresa Bini, Sabrina Passarella, Nicola Vincenzo Orfeo, Antonella d'Arminio Monforte, Giulia Marchetti

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Abstract

Introduction: We compared the effectiveness and virological clearance (VC) at day 7 (T7) post-treatment with molnupiravir, nirmatrelvir/ritonavir, and remdesivir in SARS-CoV-2-infected patients at high risk (HR) for clinical progression.

Methods: We conducted a retrospective study enrolling HR patients with mild-to-moderate COVID-19 (Jan-Oct 2022) treated with nirmatrelvir/ritonavir or molnupiravir or 3 days of remdesivir. We investigated clinical recovery at T7 (resolution of symptoms for ≥ 72 h or all-cause death), VC at T7 (PCR/antigenic negative nasopharyngeal swab), and median time to VC (days from symptom onset to the first negative swab). Factors associated with VC were investigated by logistic regression.

Results: In the study, 92/376 (43.8%) patients received molnupiravir, 150/376 (24.7%) nirmatrelvir/ritonavir, and 134/376 (31.5%) remdesivir. Forty-nine (13%) patients were unvaccinated or incompletely vaccinated. Patients treated with nirmatrelvir/ritonavir were younger and presented immunodeficiencies more frequently; remdesivir was used more commonly in patients hospitalized for other diseases. A high proportion of patients obtained clinical recovery without differences among the therapies (97.5% for molnupiravir, 98.3% for nirmatrelvir/ritonavir, and 93.6% for remdesivir); 12 (3.7%) patients died. Nirmatrelvir/ritonavir was associated with a higher proportion of T7 VC and a shorter time to VC compared to molnupiravir/remdesivir, also after adjustment for age and immunodeficiency (AOR 0.445 RDV vs. NMV-r, 95% CI 0.240-0.826, p = 0.010; AOR 0.222 MNP vs. NMV-r, 95% CI 0.105-0.472, p < 0.001).

Conclusions: SARS-COV-2 antiviral treatments are an excellent therapeutic strategy in HR patients. Nirmatrelvir/ritonavir showed a higher proportion of VC as early as 7 days after treatment, confirming its likely superiority in indirect comparisons.

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轻度-中度 COVID-19 高危患者接受莫能吡韦、奈伐韦/利托那韦或雷米替韦治疗后的临床疗效和 7 天病毒清除率

简介我们比较了在临床进展高风险（HR）的SARS-CoV-2感染者中使用莫仑吡韦、尼尔马特韦/利托那韦和雷米替韦治疗后第7天（T7）的有效性和病毒学清除率（VC）：我们开展了一项回顾性研究，对轻度至中度 COVID-19 的高危患者（2022 年 1 月至 10 月）进行了 nirmatrelvir/ritonavir 或 molnupiravir 或 3 天 remdesivir 治疗。我们调查了T7时的临床恢复（症状缓解≥72小时或全因死亡）、T7时的VC（PCR/抗原阴性鼻咽拭子）和VC的中位时间（从症状发作到第一个阴性拭子的天数）。通过逻辑回归研究了与VC相关的因素：研究中，92/376（43.8%）名患者接受了莫仑吡韦治疗，150/376（24.7%）名患者接受了尼马瑞韦/利托那韦治疗，134/376（31.5%）名患者接受了雷米替韦治疗。49名（13%）患者未接种或未完全接种疫苗。接受尼马瑞韦/利托那韦治疗的患者更年轻，更常出现免疫缺陷；雷米地韦更常用于因其他疾病住院的患者。很高比例的患者获得了临床康复，不同疗法之间没有差异（莫鲁吡拉韦为 97.5%，尼马瑞韦/利托那韦为 98.3%，雷米替韦为 93.6%）；12 例（3.7%）患者死亡。与molnupiravir/remdesivir相比，Nirmatrelvir/ritonavir与较高的T7 VC比例和较短的VC时间相关，同样在调整年龄和免疫缺陷后也是如此（AOR 0.445 RDV vs. NMV-r，95% CI 0.240-0.826，p = 0.010；AOR 0.222 MNP vs. NMV-r，95% CI 0.105-0.472，p 结论：与molnupiravir/remdesivir相比，Nirmatrelvir/ritonavir与较高的T7 VC比例和较短的VC时间相关，同样在调整年龄和免疫缺陷后也是如此：SARS-COV-2抗病毒治疗对HR患者是一种很好的治疗策略。尼马瑞韦/利托那韦在治疗后 7 天就显示出较高的 VC 比例，这证实了其在间接比较中可能具有的优越性。

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来源期刊

Infectious Diseases and Therapy Medicine-Microbiology (medical)

CiteScore

8.60

自引率

1.90%

发文量

136

审稿时长

6 weeks

期刊介绍： Infectious Diseases and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of infectious disease therapies and interventions, including vaccines and devices. Studies relating to diagnostic products and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to, bacterial and fungal infections, viral infections (including HIV/AIDS and hepatitis), parasitological diseases, tuberculosis and other mycobacterial diseases, vaccinations and other interventions, and drug-resistance, chronic infections, epidemiology and tropical, emergent, pediatric, dermal and sexually-transmitted diseases.