tetano
Editor, Senior Moderator
Ann Med
. 2025 Dec;57(1):2439541.
doi: 10.1080/07853890.2024.2439541. Epub 2024 Dec 11. Early combination of sotrovimab with nirmatrelvir/ritonavir or remdesivir is associated with low rate of persisting SARS CoV-2 infection in immunocompromised outpatients with mild-to-moderate COVID-19: a prospective single-centre study
I Gentile[SUP] 1 [/SUP], G Viceconte[SUP] 1 [/SUP], F Cuccurullo[SUP] 1 [/SUP], D Pietroluongo[SUP] 1 [/SUP], A D'Agostino[SUP] 1 [/SUP], M Silvitelli[SUP] 1 [/SUP], S Mercinelli[SUP] 1 [/SUP], R Scotto[SUP] 1 [/SUP], F Grimaldi[SUP] 2 [/SUP], S Palmieri[SUP] 3 [/SUP], A Gravetti[SUP] 3 [/SUP], F Trastulli[SUP] 3 [/SUP], M Moccia[SUP] 4 [/SUP], A R Buonomo[SUP] 1 [/SUP]
Affiliations
Background: Immunocompromised patients are at high risk of developing persisting/prolonged COVID-19. Data on the early combined use of antivirals and monoclonal antibodies in this population are scarce.
Research design and methods: We performed an observational, prospective study, enrolling immunocompromised outpatients with mild-to-moderate COVID-19, treated with a combination of sotrovimab plus one antiviral (remdesivir or nirmatrelvir/ritonavir) within 7 days from symptom onset. Primary outcome was hospitalization within 30 days. Secondary outcomes were: needing for oxygen therapy; development of persistent infection; death within 60 days and reinfection or relapse within 90 days.
Results: We enrolled 52 patients. No patient was hospitalized within 30 days of disease onset, required oxygen administration, died within 60 days, or experienced a reinfection or clinical relapse within 90 days.The clearance rates were 67% and 97% on the 14th day after the end of therapy and at the end of the follow-up period, respectively.Factors associated with longer infection were initiation of therapy 3 days after symptom onset and enrollment for more than 180 days from the beginning of the study. However, only the latter factor was independently associated with a longer SARS-CoV-2 infection, suggesting a loss of efficacy of this strategy with the evolution of SARS-CoV-2 variants.
Conclusions: Early administration of combination therapy with a direct antiviral and sotrovimab seems to be effective in preventing hospitalization, progression to severe COVID-19, and development of prolonged/persisting SARS-CoV-2 infection in immunocompromised patients.
Keywords: COVID-19; combination; immunocompromised; nirmatrelvir; remdesivir; sotrovimab.
. 2025 Dec;57(1):2439541.
doi: 10.1080/07853890.2024.2439541. Epub 2024 Dec 11. Early combination of sotrovimab with nirmatrelvir/ritonavir or remdesivir is associated with low rate of persisting SARS CoV-2 infection in immunocompromised outpatients with mild-to-moderate COVID-19: a prospective single-centre study
I Gentile[SUP] 1 [/SUP], G Viceconte[SUP] 1 [/SUP], F Cuccurullo[SUP] 1 [/SUP], D Pietroluongo[SUP] 1 [/SUP], A D'Agostino[SUP] 1 [/SUP], M Silvitelli[SUP] 1 [/SUP], S Mercinelli[SUP] 1 [/SUP], R Scotto[SUP] 1 [/SUP], F Grimaldi[SUP] 2 [/SUP], S Palmieri[SUP] 3 [/SUP], A Gravetti[SUP] 3 [/SUP], F Trastulli[SUP] 3 [/SUP], M Moccia[SUP] 4 [/SUP], A R Buonomo[SUP] 1 [/SUP]
Affiliations
- PMID: 39661366
- DOI: 10.1080/07853890.2024.2439541
Background: Immunocompromised patients are at high risk of developing persisting/prolonged COVID-19. Data on the early combined use of antivirals and monoclonal antibodies in this population are scarce.
Research design and methods: We performed an observational, prospective study, enrolling immunocompromised outpatients with mild-to-moderate COVID-19, treated with a combination of sotrovimab plus one antiviral (remdesivir or nirmatrelvir/ritonavir) within 7 days from symptom onset. Primary outcome was hospitalization within 30 days. Secondary outcomes were: needing for oxygen therapy; development of persistent infection; death within 60 days and reinfection or relapse within 90 days.
Results: We enrolled 52 patients. No patient was hospitalized within 30 days of disease onset, required oxygen administration, died within 60 days, or experienced a reinfection or clinical relapse within 90 days.The clearance rates were 67% and 97% on the 14th day after the end of therapy and at the end of the follow-up period, respectively.Factors associated with longer infection were initiation of therapy 3 days after symptom onset and enrollment for more than 180 days from the beginning of the study. However, only the latter factor was independently associated with a longer SARS-CoV-2 infection, suggesting a loss of efficacy of this strategy with the evolution of SARS-CoV-2 variants.
Conclusions: Early administration of combination therapy with a direct antiviral and sotrovimab seems to be effective in preventing hospitalization, progression to severe COVID-19, and development of prolonged/persisting SARS-CoV-2 infection in immunocompromised patients.
Keywords: COVID-19; combination; immunocompromised; nirmatrelvir; remdesivir; sotrovimab.