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

• Published in: Journal of antimicrobial chemotherapy 2024-12, Vol.79 (12), p.3248-3253
• Main Authors: 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
• Format: Article
• Language: English
• Subjects: Adenosine Monophosphate - analogs & derivatives; Adult; Aged; Alanine - analogs & derivatives; Alanine - therapeutic use; Antiviral Agents - therapeutic use; COVID-19 - epidemiology; COVID-19 - immunology; COVID-19 - mortality; COVID-19 - virology; COVID-19 Drug Treatment; Drug Combinations; Female; Hospitalization - statistics & numerical data; Humans; Immunocompromised Host; Lopinavir - therapeutic use; Male; Middle Aged; Outpatients; Propensity Score; Retrospective Studies; Ritonavir - therapeutic use; SARS-CoV-2 - immunology; Treatment Outcome
• ISSN: 0305-7453; 1460-2091; 1460-2091
• DOI: 10.1093/jac/dkae351

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