Yetmar Zachary A, Thao Viengneesee, Helfinstine David A, Pennington Kelly M, Razonable Raymund R
Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio, USA.
Transpl Infect Dis. 2025 Mar-Apr;27(2):e14436. doi: 10.1111/tid.14436. Epub 2025 Jan 10.
Multiple outpatient therapies have been developed for COVID-19 in high-risk individuals, but solid organ transplant (SOT) recipients were not well represented in controlled clinical trials. To date, few comparative studies have evaluated outcomes between outpatient therapies in this population.
We performed a retrospective cohort study using de-identified administrative claims data from OptumLabs Data Warehouse. Patients were included if they were age ≥ 18 years, diagnosed with COVID-19 between January 2022 and December 2023, and underwent SOT prior to COVID-19. The primary outcome was 30-day hospitalization. Stabilized inverse probability of treatment weighting was used to account for potential confounding variables.
4192 SOT recipients with COVID-19 were identified. 1403 received an outpatient COVID-19 therapy, including anti-spike monoclonal antibodies (N = 748, 53.3%), molnupiravir (N = 327, 23.3%), ritonavir-boosted nirmatrelvir (N = 217, 15.5%), or remdesivir (N = 141, 10.0%). In weighted analysis compared to no treatment, anti-spike monoclonal antibodies (hazard ratio [HR] 0.39, 95% confidence interval [CI] 0.28-0.55; p < 0.001), molnupiravir (HR 0.56, 95% CI 0.36-0.89; p = 0.013), and nirmatrelvir (HR 0.47, 95% CI 0.25-0.89; p = 0.020) were associated with reduced hospitalization risk, while remdesivir (HR 1.00, 95% CI 0.50-1.98; p = 0.992) was not. Hospitalization rates were similar between the treatment agents, apart from remdesivir showing a higher risk compared to anti-spike monoclonal antibodies.
Outpatient COVID-19 therapies were largely associated with improved outcomes among SOT recipients. These treatment agents showed similar rates of 30-day hospitalization, except for remdesivir. The choice of outpatient COVID-19 therapy in SOT recipients should primarily account for patients' individual circumstances and drug-drug interactions rather than differential therapeutic efficacy.
针对高危个体的新冠病毒病（COVID-19）已开发出多种门诊治疗方法，但实体器官移植（SOT）受者在对照临床试验中的代表性不足。迄今为止，很少有比较研究评估该人群门诊治疗方法之间的疗效。
我们使用OptumLabs数据仓库中去识别化的行政索赔数据进行了一项回顾性队列研究。纳入年龄≥18岁、在2022年1月至2023年12月期间被诊断为COVID-19且在感染COVID-19之前接受过SOT的患者。主要结局是30天内住院情况。使用稳定的逆概率治疗加权法来处理潜在的混杂变量。
共识别出4192例感染COVID-19的SOT受者。1403例接受了门诊COVID-19治疗，包括抗刺突单克隆抗体（N = 748，53.3%）、莫努匹拉韦（N = 327，23.3%）、利托那韦增强的奈玛特韦（N = 217，15.5%）或瑞德西韦（N = 141，10.0%）。在加权分析中，与未治疗相比，抗刺突单克隆抗体（风险比[HR] 0.39，95%置信区间[CI] 0.28 - 0.55；p < 0.001）、莫努匹拉韦（HR 0.56，95% CI 0.36 - 0.89；p = 0.013）和奈玛特韦（HR 0.47，95% CI 0.25 - 0.89；p = 0.020）与住院风险降低相关，而瑞德西韦（HR 1.00，95% CI 0.50 - 1.98；p = 0.992）则不然。除瑞德西韦与抗刺突单克隆抗体相比显示出更高风险外，各治疗药物的住院率相似。
门诊COVID-19治疗在很大程度上与SOT受者的预后改善相关。这些治疗药物的30天住院率相似，但瑞德西韦除外。SOT受者门诊COVID-19治疗的选择应主要考虑患者的个体情况和药物相互作用，而非不同的治疗效果。
