Nirmatrelvir/ritonavir in COVID-19 patients with haematological malignancies: a report from the EPICOVIDEHA registry

Autoři	SALMANTON-GARCIA Jon MARCHESI Francesco GOMES da Silva Maria FARINA Francesca DAVILA-VALLS Julio BILGIN Yavuz M GLENTHOJ Andreas FALCES-ROMERO Iker JAAP Van Doesum LABRADOR Jorge BUQUICCHIO Caterina EL-ASHWAH Shaimaa PETZER Verena JENS Van Praet SCHOENLEIN Martin DARGENIO Michelina MENDEZ Gustavo-Adolfo MEERS Stef ITRI Federico GIORDANO Antonio PINCZES Laszlo Imre ESPIGADO Ildefonso STOJANOSKI Zlate LOPEZ-GARCIA Alberto PREZIOSO Lucia JAKSIC Ozren VENA Antonio FRACCHIOLLA Nicola S GONZALEZ-LOPEZ Tomas Jose COLOVIC Natasa DELIA Mario WEINBERGEROVÁ Barbora MARCHETTI Monia MARQUES de Almeida Joyce FINIZIO Olimpia BESSON Caroline BIERNAT Monika M VALKOVIC Toni LAHMER Tobias CUCCARO Annarosa ORMAZABAL-VELEZ Irati BATINIC Josip FERNANDEZ Noemi NICK De Jonge TASCINI Carlo ANASTASOPOULOU Amalia N DULERY Remy ILARIA Del Principe Maria PLANTEFEVE Gaetan PAPA Mario Virgilio NUCCI Marcio JIMENEZ Moraima AUJAYEB Avinash HERNANDEZ-RIVAS Jose-angel MERELLI Maria CATTANEO Chiara BLENNOW Ola NORDLANDER Anna CABIRTA Alba VARRICCHIO Gina SACCHI Maria Vittoria CORDOBA Raul ARELLANO Elena GRAFE Stefanie K WOLF Dominik EMARAH Ziad AMMATUNA Emanuele HERSBY Ditte Stampe MARTIN-PEREZ Sonia RODRIGUES Raquel Nunes RAHIMLI Laman PAGANO Livio CARTNEY Oliver A
Rok publikování	2023
Druh	Článek v odborném periodiku
Časopis / Zdroj	EClinicalMedicine
Fakulta / Pracoviště MU	Lékařská fakulta
Citace
www	https://www.sciencedirect.com/science/article/pii/S2589537023001165?via%3Dihub
Doi	http://dx.doi.org/10.1016/j.eclinm.2023.101939
Klíčová slova	Nirmatrelvir; SARS-CoV-2; Haematology; Malignancy; COVID-19
Popis	Background Nirmatrelvir/ritonavir treatment decreases the hospitalisation rate in immunocompetent patients with COVID-19, but data on efficacy in patients with haematological malignancy are scarce. Here, we describe the outcome of nirmatrelvir/ritonavir treatment in a large cohort of the latter patients. Methods This is a retrospective cohort study from the multicentre EPICOVIDEHA registry (NCT04733729) on pa-tients with haematological malignancy, who were diagnosed with COVID-19 between January and September 2022. Patients receiving nirmatrelvir/ritonavir were compared to those who did not. A logistic regression was run to determine factors associated with nirmatrelvir/ritonavir administration in our sample. Mortality between treatment groups was assessed with Kaplan-Meier survival plots after matching all the patients with a propensity score. Additionally, a Cox regression was modelled to detect factors associated with mortality in patients receiving nirmatrelvir/ritonavir. Findings A total of 1859 patients were analysed, 117 (6%) were treated with nirmatrelvir/ritonavir, 1742 (94%) were treated otherwise. Of 117 patients receiving nirmatrelvir/ritonavir, 80% had received >= 1 anti-SARS-CoV-2 vaccine dose before COVID-19 onset, 13% of which received a 2nd vaccine booster. 5% were admitted to ICU. Nirmatrelvir/ritonavir treatment was associated with the presence of extrapulmonary symptoms at COVID-19 onset, for example anosmia, fever, rhinitis, or sinusitis (aOR 2.509, 95%CI 1.448-4.347) and 2nd vaccine booster (aOR 3.624, 95%CI 1.619-8.109). Chronic pulmonary disease (aOR 0.261, 95%CI 0.093-0.732) and obesity (aOR 0.105, 95%CI 0.014-0.776) were not associated with nirmatrelvir/ritonavir use. After propensity score matching, day-30 mortality rate in patients treated with nirmatrelvir/ritonavir was 2%, significantly lower than in patients with SARS-CoV-2 directed treatment other than nirmatrelvir/ritonavir (11%, p = 0.036). No factor was observed explaining the mortality difference in patients after nirmatrelvir/ritonavir administration. Interpretation Haematological malignancy patients were more likely to receive nirmatrelvir/ritonavir when reporting extrapulmonary symptoms or 2nd vaccine booster at COVID-19 onset, as opposed to chronic pulmonary disease and obesity. The mortality rate in patients treated with nirmatrelvir/ritonavir was lower than in patients with targeted drugs other than nirmatrelvir/ritonavir. Funding EPICOVIDEHA has received funds from Optics COMMIT (COVID-19 Unmet Medical Needs and Asso-ciated Research Extension) COVID-19 RFP program by GILEAD Science, United States (Project 2020-8223). Copyright (c) 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).