tetano
Editor, Senior Moderator
BMC Infect Dis
. 2022 Oct 20;22(1):793.
doi: 10.1186/s12879-022-07774-9.
Lessons learned and implications of early therapies for coronavirus disease in a territorial service centre in the Calabria region: a retrospective study
Vincenzo Scaglione[SUP] 1 [/SUP], Salvatore Rotundo[SUP] 1 [/SUP], Nadia Marascio[SUP] 2 [/SUP], Carmela De Marco[SUP] 3 [/SUP], Rosaria Lionello[SUP] 1 [/SUP], Claudia Veneziano[SUP] 3 [/SUP], Lavinia Berardelli[SUP] 1 [/SUP], Angela Quirino[SUP] 2 [/SUP], Vincenzo Olivadese[SUP] 1 [/SUP], Francesca Serapide[SUP] 1 [/SUP], Bruno Tassone[SUP] 1 [/SUP], Helen Linda Morrone[SUP] 1 [/SUP], Chiara Davoli[SUP] 1 [/SUP], Valentina La Gamba[SUP] 1 [/SUP], Andrea Bruni[SUP] 4 [/SUP], Bruno Mario Cesana[SUP] 5 [/SUP], Giovanni Matera[SUP] 2 [/SUP], Alessandro Russo[SUP] 1 [/SUP], Francesco Saverio Costanzo[SUP] 6 [/SUP], Giuseppe Viglietto[SUP] 3 [/SUP], Enrico Maria Trecarichi[SUP] 1 [/SUP], Carlo Torti[SUP] 7 [/SUP], IDTM U. M. G. COVID-19 Group
Collaborators, Affiliations
Abstract
Background: Monoclonal antibodies (mAbs) and antivirals have been approved for early therapy of coronavirus disease (COVID-19), however, in the real-life setting, there are difficulties to prescribe these therapies within few days from symptom onset as recommended, and effectiveness of combined use of these drugs have been hypothesised in most-at-risk patients (such as those immunocompromised) but data supporting this strategy are limited.
Methods: We describe the real-life experience of SARS-CoV-2 antivirals and/or monoclonal antibodies (mAbs) and focus on the hospitalisation rate due to the progression of COVID-19. Clinical results obtained through our risk-stratification algorithm and benefits achieved through a strategic proximity territorial centre are provided. We also report a case series with an in-depth evaluation of SARS-CoV-2 genome in relationship with treatment strategy and clinical evolution of patients.
Results: Two hundred eighty-eight patients were analysed; 94/288 (32.6%) patients were treated with mAb monotherapy, 171/288 (59.4%) patients were treated with antivirals, and 23/288 (8%) patients received both mAbs and one antiviral drug. Haematological malignancies were more frequent in patients treated with combination therapy than in the other groups (p = 0.0003). There was a substantial increase in the number of treated patients since the opening of the centre dedicated to early therapies for COVID-19. The provided disease-management and treatment appeared to be effective since 98.6% patients recovered without hospital admission. Moreover, combination therapy with mAbs and antivirals seemed successful because all patients admitted to the hospital for COVID-19 did not receive such therapies, while none of the most-at-risk patients treated with combination therapy were hospitalized or reported adverse events.
Conclusions: A low rate of COVID-19 progression requiring hospital admission was observed in patients included in this study. The dedicated COVID-19 proximity territorial service appeared to strengthen the regional sanitary system, avoiding the overwhelming of other services. Importantly, our results also support early combination therapy: it is possible that this strategy reduces the emergence of escape mutants of SARS-CoV-2, thereby increasing efficacy of early treatment, especially in immunocompromised individuals.
Keywords: Antivirals; COVID-19; Early therapies; Monoclonal antibodies; Territorial health services.
. 2022 Oct 20;22(1):793.
doi: 10.1186/s12879-022-07774-9.
Lessons learned and implications of early therapies for coronavirus disease in a territorial service centre in the Calabria region: a retrospective study
Vincenzo Scaglione[SUP] 1 [/SUP], Salvatore Rotundo[SUP] 1 [/SUP], Nadia Marascio[SUP] 2 [/SUP], Carmela De Marco[SUP] 3 [/SUP], Rosaria Lionello[SUP] 1 [/SUP], Claudia Veneziano[SUP] 3 [/SUP], Lavinia Berardelli[SUP] 1 [/SUP], Angela Quirino[SUP] 2 [/SUP], Vincenzo Olivadese[SUP] 1 [/SUP], Francesca Serapide[SUP] 1 [/SUP], Bruno Tassone[SUP] 1 [/SUP], Helen Linda Morrone[SUP] 1 [/SUP], Chiara Davoli[SUP] 1 [/SUP], Valentina La Gamba[SUP] 1 [/SUP], Andrea Bruni[SUP] 4 [/SUP], Bruno Mario Cesana[SUP] 5 [/SUP], Giovanni Matera[SUP] 2 [/SUP], Alessandro Russo[SUP] 1 [/SUP], Francesco Saverio Costanzo[SUP] 6 [/SUP], Giuseppe Viglietto[SUP] 3 [/SUP], Enrico Maria Trecarichi[SUP] 1 [/SUP], Carlo Torti[SUP] 7 [/SUP], IDTM U. M. G. COVID-19 Group
Collaborators, Affiliations
- PMID: 36266619
- DOI: 10.1186/s12879-022-07774-9
Abstract
Background: Monoclonal antibodies (mAbs) and antivirals have been approved for early therapy of coronavirus disease (COVID-19), however, in the real-life setting, there are difficulties to prescribe these therapies within few days from symptom onset as recommended, and effectiveness of combined use of these drugs have been hypothesised in most-at-risk patients (such as those immunocompromised) but data supporting this strategy are limited.
Methods: We describe the real-life experience of SARS-CoV-2 antivirals and/or monoclonal antibodies (mAbs) and focus on the hospitalisation rate due to the progression of COVID-19. Clinical results obtained through our risk-stratification algorithm and benefits achieved through a strategic proximity territorial centre are provided. We also report a case series with an in-depth evaluation of SARS-CoV-2 genome in relationship with treatment strategy and clinical evolution of patients.
Results: Two hundred eighty-eight patients were analysed; 94/288 (32.6%) patients were treated with mAb monotherapy, 171/288 (59.4%) patients were treated with antivirals, and 23/288 (8%) patients received both mAbs and one antiviral drug. Haematological malignancies were more frequent in patients treated with combination therapy than in the other groups (p = 0.0003). There was a substantial increase in the number of treated patients since the opening of the centre dedicated to early therapies for COVID-19. The provided disease-management and treatment appeared to be effective since 98.6% patients recovered without hospital admission. Moreover, combination therapy with mAbs and antivirals seemed successful because all patients admitted to the hospital for COVID-19 did not receive such therapies, while none of the most-at-risk patients treated with combination therapy were hospitalized or reported adverse events.
Conclusions: A low rate of COVID-19 progression requiring hospital admission was observed in patients included in this study. The dedicated COVID-19 proximity territorial service appeared to strengthen the regional sanitary system, avoiding the overwhelming of other services. Importantly, our results also support early combination therapy: it is possible that this strategy reduces the emergence of escape mutants of SARS-CoV-2, thereby increasing efficacy of early treatment, especially in immunocompromised individuals.
Keywords: Antivirals; COVID-19; Early therapies; Monoclonal antibodies; Territorial health services.