Department of Infectious Diseases, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Carrer de Villarroel 170, 08036 Barcelona, Spain.
Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, F75012 Paris, France.
J Antimicrob Chemother. 2024 Sep 3;79(9):2364-2368. doi: 10.1093/jac/dkae237.
To describe the management of haematological patients experiencing prolonged SARS-CoV-2 viral shedding, as the optimal management strategy for this condition remains undetermined.
We conducted a retrospective evaluation of our prospectively followed cohort of haematological patients treated with remdesivir for more than 10 days. Starting January 2023, upon COVID-19 diagnosis, the treatment strategy was based on symptoms and PCR cycle threshold (Ct) as follows: (i) when Ct was 25 or less or if the patient had symptoms, a course of remdesivir for at least 10 days, nirmatrelvir/ritonavir for 5 days (whenever possible) and convalescent plasma was administered; and (ii) when the patient was asymptomatic and had a PCR Ct of more than 25, when possible, a course of 5 days of nirmatrelvir/ritonavir was administered. The patient was considered to have achieved viral clearance and, thus, remdesivir was stopped, in either of these cases: (i) PCR negativity, or (ii) subgenomic RNA negativity.
From January to November 2023, 18 patients benefited from a safe extended remdesivir administration, resulting in detection of SARS-CoV-2 viral clearance in a median time of 3.5 weeks (IQR 2.6-3.9) (min-max 1.6-8.0). No clinical or biological side effects were detected. No patient died or needed further treatment for their COVID-19 episode.
The extended course of remdesivir, combined with other active therapies for COVID-19 infection, was well tolerated. Cure and virus negativity were obtained in all these high-risk patients.
描述在 SARS-CoV-2 病毒持续排出期间接受治疗的血液系统疾病患者的管理，因为这种情况下的最佳管理策略尚未确定。
我们对接受瑞德西韦治疗超过 10 天的前瞻性随访血液系统疾病患者进行了回顾性评估。自 2023 年 1 月起，在 COVID-19 诊断后，治疗策略基于症状和 PCR 循环阈值（Ct）如下：（i）当 Ct 值为 25 或更低，或患者有症状时，给予至少 10 天的瑞德西韦治疗，给予奈玛特韦/利托那韦 5 天（只要可能），并给予恢复期血浆；（ii）当患者无症状且 PCR Ct 值大于 25 时，只要可能，给予奈玛特韦/利托那韦 5 天疗程。在以下任何一种情况下，患者被认为实现了病毒清除，从而停止使用瑞德西韦：（i）PCR 阴性，或（ii）亚基因组 RNA 阴性。
从 2023 年 1 月至 11 月，18 名患者受益于安全的瑞德西韦延长治疗，中位时间 3.5 周（IQR 2.6-3.9）（最小值-最大值 1.6-8.0）实现 SARS-CoV-2 病毒清除。未检测到临床或生物学副作用。没有患者因 COVID-19 发作而死亡或需要进一步治疗。
延长的瑞德西韦疗程，结合 COVID-19 感染的其他活性治疗，耐受性良好。所有这些高危患者均获得治愈和病毒阴性。
