免疫功能低下患者早期新冠病毒病治疗的安全性及结果：一项单中心队列研究
Safety Profile and Outcomes of Early COVID-19 Treatments in Immunocompromised Patients: A Single-Centre Cohort Study.
作者信息
Biscarini Simona, Villa Simone, Genovese Camilla, Tomasello Mara, Tonizzo Anna, Fava Marco, Iannotti Nathalie, Bolis Matteo, Mariani Bianca, Valzano Antonia Grazia, Morlacchi Letizia Corinna, Donato Francesca, Castellano Giuseppe, Cassin Ramona, Carrabba Maria, Muscatello Antonio, Gori Andrea, Bandera Alessandra, Lombardi Andrea
机构信息
Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
Centre for Multidisciplinary Research in Health Science (MACH), University of Milano, 20122 Milano, Italy.
出版信息
Biomedicines. 2022 Aug 18;10(8):2002. doi: 10.3390/biomedicines10082002.
BACKGROUND
Early treatment with remdesivir (RMD) or monoclonal antibodies (mAbs) could be a valuable tool in patients at risk of severe COVID-19 with unsatisfactory responses to vaccination. We aim to assess the safety and clinical outcomes of these treatments among immunocompromised subjects.
METHODS
We retrospectively reviewed all nonhospitalized patients who received an early treatment with RMD or mAbs for COVID-19, from 25 November 2021 to 25 January 2022, in a large tertiary hospital. Outcomes included frequency of adverse drug reaction (ADR), duration of symptoms and molecular swab positivity, emergency department access, hospital or intensive care unit admission, and mortality in the 14 days following treatment administration.
RESULTS
Early treatments were administered to 143 patients, 106/143 (74.1%) immunocompromised, including 41 solid organ and 6 hematopoietic stem cell transplant recipients. Overall, 23/143 (16.1%) subjects reported ADRs. Median time from treatment start to SARS-CoV-2 nasopharyngeal swab negativity and symptom resolution was 10 (IQR 6-16) and 2.5 days (IQR 1.0-6.0), respectively, without differences between immunocompromised and nonimmunocompromised patients. In the 14 days after treatment administration, 5/143 patients (3.5%) were hospitalized and one died as a result of causes related to COVID-19, all of them were immunocompromised.
CONCLUSIONS
RMD and mAbs have minimal ADRs and favourable outcomes in immunocompromised patients.
背景
对于接种疫苗反应不佳且有发生重症 COVID-19 风险的患者，早期使用瑞德西韦（RMD）或单克隆抗体（mAbs）可能是一种有价值的治疗手段。我们旨在评估这些治疗方法在免疫功能低下患者中的安全性和临床结局。
方法
我们回顾性分析了 2021 年 11 月 25 日至 2022 年 1 月 25 日期间在一家大型三级医院接受 RMD 或 mAbs 早期治疗的所有非住院 COVID-19 患者。结局指标包括药物不良反应（ADR）的发生率、症状持续时间和分子拭子阳性率、急诊就诊情况、住院或重症监护病房收治情况以及治疗给药后 14 天内的死亡率。
结果
共对 143 例患者进行了早期治疗，其中 106/143（74.1%）为免疫功能低下患者，包括 41 例实体器官移植受者和 6 例造血干细胞移植受者。总体而言，23/143（16.1%）的患者报告了 ADR。从治疗开始到 SARS-CoV-2 鼻咽拭子转阴和症状缓解的中位时间分别为 10 天（四分位间距 6 - 16）和 2.5 天（四分位间距 1.0 - 6.0），免疫功能低下患者和非免疫功能低下患者之间无差异。在治疗给药后的 14 天内，5/143 例患者（3.5%）住院，1 例因与 COVID-19 相关的原因死亡，所有死亡患者均为免疫功能低下患者。
结论
RMD 和 mAbs 在免疫功能低下患者中的不良反应最小且结局良好。
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