Bai Francesca, Beringheli Tomaso, Vitaletti Virginia, Santoro Andrea, Molà Francesco, Copes Alessandro, Gemignani Nicole, Pettenuzzo Sofia, Castoldi Roberto, Varisco Benedetta, Nardo Riccardo, Lundgren Lorenzo Brando, Ligresti Riccardo, Sala Matteo, Albertini Lorenzo, Augello Matteo, Biasioli Lorenzo, Bono Valeria, Rovito Roberta, Bini Teresa, Passarella Sabrina, Orfeo Nicola Vincenzo, Monforte Antonella d'Arminio, Marchetti Giulia
Clinic of Infectious Diseases, Department of Health Sciences, San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Via A. Di Rudinì, 8, 20142, Milan, Italy.
Strategic Hospital Management, ASST Santi Paolo e Carlo, Milan, Italy.
Infect Dis Ther. 2024 Jul;13(7):1589-1605. doi: 10.1007/s40121-024-00994-3. Epub 2024 Jun 3.
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.
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.
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).
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.
我们比较了莫努匹拉韦、奈玛特韦/利托那韦和瑞德西韦在治疗后第7天（T7）对有临床进展高风险（HR）的新冠病毒感染患者的有效性和病毒清除情况（VC）。
我们进行了一项回顾性研究，纳入了2022年1月至10月接受奈玛特韦/利托那韦、莫努匹拉韦治疗或3天瑞德西韦治疗的轻至中度新冠患者。我们调查了T7时的临床恢复情况（症状缓解≥72小时或全因死亡）、T7时的病毒清除情况（PCR/抗原阴性鼻咽拭子）以及病毒清除的中位时间（从症状出现到首次拭子阴性的天数）。通过逻辑回归研究与病毒清除相关的因素。
在该研究中，92/376（43.8%）例患者接受了莫努匹拉韦治疗，150/376（24.7%）例接受了奈玛特韦/利托那韦治疗，134/376（31.5%）例接受了瑞德西韦治疗。49（13%）例患者未接种疫苗或未完全接种疫苗。接受奈玛特韦/利托那韦治疗的患者更年轻，免疫缺陷出现的频率更高；瑞德西韦在因其他疾病住院的患者中使用更为普遍。高比例患者实现了临床恢复，各治疗组之间无差异（莫努匹拉韦组为97.5%，奈玛特韦/利托那韦组为98.3%，瑞德西韦组为93.6%）；12（3.7%）例患者死亡。与莫努匹拉韦/瑞德西韦相比，奈玛特韦/利托那韦在T7时的病毒清除比例更高，且病毒清除时间更短，在调整年龄和免疫缺陷因素后也是如此（与莫努匹拉韦相比，瑞德西韦的调整后比值比[AOR]为0.445，95%置信区间[CI]为0.240 - 0.826，p = 0.010；与莫努匹拉韦相比，奈玛特韦/利托那韦的AOR为0.222，95% CI为0.105 - 0.472，p < 0.001）。
新冠病毒抗病毒治疗是HR患者的一种优秀治疗策略。奈玛特韦/利托那韦在治疗后7天就显示出更高的病毒清除比例，证实了其在间接比较中的可能优势。
