SARS-CoV-2奥密克戎变异株时代早期抗SARS治疗对严重免疫功能低下的COVID-19门诊患者的真实世界疗效：一项倾向评分调整的回顾性队列研究

Real-world effectiveness of early anti-SARS therapy in severely immunocompromised COVID-19 outpatients during the SARS-CoV-2 omicron variant era: a propensity score-adjusted retrospective cohort study.

作者信息

Pinargote-Celorio Héctor, Moreno-Pérez Óscar, González-De-La-Aleja Pilar, Llenas-García Jara, Martínez Pérez-Crespo Pedro María, Rodríguez-Díaz Juan-Carlos, Martínez-López Belén, Merchante Gutiérrez Nicolás, Ramos-Rincón José-Manuel, Merino Esperanza

机构信息

Unit of Infectious Diseases, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.

Endocrinology Department Dr. Balmis General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain.

出版信息

J Antimicrob Chemother. 2024 Dec 2;79(12):3248-3253. doi: 10.1093/jac/dkae351.

DOI:10.1093/jac/dkae351

PMID:39374379

Abstract

BACKGROUND

The effectiveness of the early treatment for antiviral agents in SARS-CoV-2 infection is closely related to patient comorbidities. Data on effectiveness in immunocompromised patients are limited, with reports involving highly heterogeneous and not well-defined populations. We aimed to assess the effectiveness of treatment in reducing hospitalizations in a real-world cohort of severely immunocompromised COVID-19 outpatients.

PATIENTS AND METHODS

We conducted a multicentre, retrospective, observational cohort study of immunocompromised outpatients attended in infectious diseases departments from 1 January to 31 December 2022. Propensity score matching (PSM) multivariable logistic regression models were used to estimate the adjusted odds ratio [(aOR, 95% confidence interval (CI)] for the association between antiviral prescription and outcome (COVID-19-related hospitalization up to Day 90).

RESULTS

We identified 746 immunocompromised outpatients with confirmed SARS-CoV-2 infection. After eligibility criteria and PSM, a total of 410 patients were analysed: 205 receiving treatment (remdesivir, sotrovimab or nirmatrelvir/ritonavir) and 205 matched controls. Fifty-two patients required at least one COVID-19-related hospitalization 8 (3.9%) versus 44 (21.5%) in the antiviral and matched control cohorts, respectively. There were 13 deaths at 90 days, of which only 4 were COVID-19-related and none in the antiviral treatment group. After adjustment for residual confounders, the use of early therapy was associated with a protective effect on the risk of hospitalization [aOR 0.13 (0.05-0.29)], as was the use of biological immunomodulators [aOR 0.27 (0.10-0.74)], whereas chronic obstructive pulmonary disease [aOR 4.65 (1.09-19.69)] and anti-CD20 use [aOR 2.76 (1.31-5.81)] increased the odds.

CONCLUSIONS

Early antiviral treatment was associated with a reduced risk of COVID-19-related hospitalization in ambulatory severely immunocompromised COVID-19 patients.

摘要

背景

抗新冠病毒药物早期治疗的有效性与患者的合并症密切相关。免疫功能低下患者的治疗有效性数据有限，相关报告涉及的人群高度异质且定义不明确。我们旨在评估在一个真实世界队列中，针对严重免疫功能低下的新冠门诊患者，治疗在减少住院方面的有效性。

患者和方法

我们对2022年1月1日至12月31日在传染病科就诊的免疫功能低下门诊患者进行了一项多中心、回顾性、观察性队列研究。采用倾向评分匹配（PSM）多变量逻辑回归模型来估计抗病毒药物处方与结局（至第90天与新冠相关的住院）之间关联的调整比值比（[aOR，95%置信区间（CI）]）。

结果

我们确定了746例确诊感染新冠病毒的免疫功能低下门诊患者。经过纳入标准筛选和PSM后，共分析了410例患者：205例接受治疗（瑞德西韦、索托维单抗或奈玛特韦/利托那韦），205例为匹配对照。52例患者需要至少一次与新冠相关的住院治疗，抗病毒治疗组和匹配对照组分别有8例（3.9%）和44例（21.5%）。90天时共有13例死亡，其中只有4例与新冠相关且抗病毒治疗组无死亡病例。在对残余混杂因素进行调整后，早期治疗的使用与住院风险的保护作用相关[aOR 0.13（0.05 - 0.29）]，生物免疫调节剂的使用也是如此[aOR 0.27（0.10 - 0.74）]，而慢性阻塞性肺疾病[aOR 4.65（1.09 - 19.69）]和抗CD20药物的使用[aOR 2.76（1.31 - 5.81）]会增加比值。