학술논문
Nirmatrelvir/ritonavir in COVID-19 patients with haematological malignancies: a report from the EPICOVIDEHA registryResearch in context
Document Type
article
Author
Jon Salmanton-García; Francesco Marchesi; Maria Gomes da Silva; Francesca Farina; Julio Dávila-Valls; Yavuz M. Bilgin; Andreas Glenthøj; Iker Falces-Romero; Jaap Van Doesum; Jorge Labrador; Caterina Buquicchio; Shaimaa El-Ashwah; Verena Petzer; Jens Van Praet; Martin Schönlein; Michelina Dargenio; Gustavo-Adolfo Méndez; Stef Meers; Federico Itri; Antonio Giordano; László Imre Pinczés; Ildefonso Espigado; Zlate Stojanoski; Alberto López-García; Lucia Prezioso; Ozren Jaksic; Antonio Vena; Nicola S. Fracchiolla; Tomás José González-López; Natasa Colović; Mario Delia; Barbora Weinbergerová; Monia Marchetti; Joyce Marques de Almeida; Olimpia Finizio; Caroline Besson; Monika M. Biernat; Toni Valković; Tobias Lahmer; Annarosa Cuccaro; Irati Ormazabal-Vélez; Josip Batinić; Noemí Fernández; Nick De Jonge; Carlo Tascini; Amalia N. Anastasopoulou; Rémy Duléry; Maria Ilaria Del Principe; Gaëtan Plantefeve; Mario Virgilio Papa; Marcio Nucci; Moraima Jiménez; Avinash Aujayeb; José-Ángel Hernández-Rivas; Maria Merelli; Chiara Cattaneo; Ola Blennow; Anna Nordlander; Alba Cabirta; Gina Varricchio; Maria Vittoria Sacchi; Raul Cordoba; Elena Arellano; Stefanie K. Gräfe; Dominik Wolf; Ziad Emarah; Emanuele Ammatuna; Ditte Stampe Hersby; Sonia Martín-Pérez; Raquel Nunes Rodrigues; Laman Rahimli; Livio Pagano; Oliver A. Cornely; Klára Piukovics; Cristina De Ramón; François Danion; Ayel Yahya; Anna Guidetti; Carolina Garcia-Vidal; Uluhan Sili; Joseph Meletiadis; Elizabeth De Kort; Luisa Verga; Laura Serrano; Nurettin Erben; Roberta Di Blasi; Athanasios Tragiannidis; José-María Ribera-Santa Susana; Hans-Beier Ommen; Alessandro Busca; Nicola Coppola; Rui Bergantim; Giulia Dragonetti; Marianna Criscuolo; Luana Fianchi; Matteo Bonanni; Andrés Soto-Silva; Malgorzata Mikulska; Marina Machado; Chi Shan Kho; Nazia Hassan; Eleni Gavriilaki; Gregorio Cordini; Louis Yi Ann Chi; Matthias Eggerer; Martin Hoenigl; Juergen Prattes; María-Josefa Jiménez-Lorenzo; Sofia Zompi; Giovanni Paolo Maria Zambrotta; Gökçe Melis Çolak; Nicole García-Poutón; Tommaso Francesco Aiello; Romane Prin; Maria Stamouli; Michail Samarkos
Source
EClinicalMedicine, Vol 58, Iss , Pp 101939- (2023)
Subject
Language
English
ISSN
2589-5370
Abstract
Summary: Background: Nirmatrelvir/ritonavir treatment decreases the hospitalisation rate in immunocompetent patients with COVID-19, but data on efficacy in patients with haematological malignancy are scarce. Here, we describe the outcome of nirmatrelvir/ritonavir treatment in a large cohort of the latter patients. Methods: This is a retrospective cohort study from the multicentre EPICOVIDEHA registry (NCT04733729) on patients with haematological malignancy, who were diagnosed with COVID-19 between January and September 2022. Patients receiving nirmatrelvir/ritonavir were compared to those who did not. A logistic regression was run to determine factors associated with nirmatrelvir/ritonavir administration in our sample. Mortality between treatment groups was assessed with Kaplan–Meier survival plots after matching all the patients with a propensity score. Additionally, a Cox regression was modelled to detect factors associated with mortality in patients receiving nirmatrelvir/ritonavir. Findings: A total of 1859 patients were analysed, 117 (6%) were treated with nirmatrelvir/ritonavir, 1742 (94%) were treated otherwise. Of 117 patients receiving nirmatrelvir/ritonavir, 80% had received ≥1 anti-SARS-CoV-2 vaccine dose before COVID-19 onset, 13% of which received a 2nd vaccine booster. 5% were admitted to ICU. Nirmatrelvir/ritonavir treatment was associated with the presence of extrapulmonary symptoms at COVID-19 onset, for example anosmia, fever, rhinitis, or sinusitis (aOR 2.509, 95%CI 1.448–4.347) and 2nd vaccine booster (aOR 3.624, 95%CI 1.619–8.109). Chronic pulmonary disease (aOR 0.261, 95%CI 0.093–0.732) and obesity (aOR 0.105, 95%CI 0.014–0.776) were not associated with nirmatrelvir/ritonavir use. After propensity score matching, day-30 mortality rate in patients treated with nirmatrelvir/ritonavir was 2%, significantly lower than in patients with SARS-CoV-2 directed treatment other than nirmatrelvir/ritonavir (11%, p = 0.036). No factor was observed explaining the mortality difference in patients after nirmatrelvir/ritonavir administration. Interpretation: Haematological malignancy patients were more likely to receive nirmatrelvir/ritonavir when reporting extrapulmonary symptoms or 2nd vaccine booster at COVID-19 onset, as opposed to chronic pulmonary disease and obesity. The mortality rate in patients treated with nirmatrelvir/ritonavir was lower than in patients with targeted drugs other than nirmatrelvir/ritonavir. Funding: EPICOVIDEHA has received funds from Optics COMMIT (COVID-19 Unmet Medical Needs and Associated Research Extension) COVID-19 RFP program by GILEAD Science, United States (Project 2020-8223).