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Volume 12
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Article

Sequential or Combination Treatments as Rescue Therapies in Immunocompromised Patients with Persistent SARS-CoV-2 Infection in the Omicron Era: A Case Series

by
Bianca Maria Longo
1,
Francesco Venuti
1,
Alberto Gaviraghi
1,
Tommaso Lupia
2,*,
Fabio Antonino Ranzani
1,
Andrea Pepe
1,
Laura Ponzetta
1,
Davide Vita
1,
Tiziano Allice
3,
Vanesa Gregorc
4,
Pio Manlio Mirko Frascione
4,
Francesco Giuseppe De Rosa
1,5,
Andrea Calcagno
1 and
Stefano Bonora
1
1
Unit of Infectious Diseases, Department of Medical Sciences, University of Turin, “Amedeo di Savoia” Hospital, ASL “Città di Torino”, 10060 Turin, Italy
2
Unit of Infectious Diseases, Cardinal Massaia Hospital, 14100 Asti, Italy
3
Microbiology and Molecular Biology Laboratory, “Amedeo di Savoia” Hospital, ASL “Città di Torino”, 10060 Turin, Italy
4
Unit of Oncology and Haematology, Candiolo Cancer Institute, FPO-IRCCS, 10060 Candiolo, Italy
5
Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
*
Author to whom correspondence should be addressed.
Antibiotics 2023, 12(9), 1460; https://doi.org/10.3390/antibiotics12091460
Submission received: 18 July 2023 / Revised: 11 September 2023 / Accepted: 12 September 2023 / Published: 19 September 2023
(This article belongs to the Special Issue Healthcare-Associated Infections (HAIs): Prevention, Control and Surveillance)
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Abstract

Prolonged SARS-CoV-2 infections are widely described in immunosuppressed patients, but safe and effective treatment strategies are lacking. We aimed to outline our approach to treating persistent COVID-19 in patients with immunosuppression from different causes. In this case series, we retrospectively enrolled all immunosuppressed patients with persistent SARS-CoV-2 infections treated at our centers between March 2022 and February 2023. Patients received different sequential or combination regimens, including antivirals (remdesivir, nirmatrelvir/ritonavir, or molnupiravir) and/or monoclonal antibodies (mAbs) (tixagevimab/cilgavimab or sotrovimab). The main outcome was a complete virological response (negative SARS-CoV-2 RT-PCR on nasopharyngeal swabs) at the end of treatment. Fifteen patients were included as follows: eleven (11/15; 73%) with hematological disease and four (4/15; 27%) with recently diagnosed HIV/AIDS infection. Six patients (6/15; 40%) received a single antiviral course, four patients (4/15; 27%) received an antiviral and mAbs sequentially, and two patients (13%) received three lines of treatment (a sequence of three antivirals or two antivirals and mAbs). A combination of two antivirals or one antiviral plus mAbs was administered in three cases (3/15, 20%). One patient died while still positive for SARS-CoV-2, while fourteen (14/15; 93%) tested negative within 16 days after the end of treatment. The median time to negativization since the last treatment was 2.5 days. Both sequential and combination regimens used in this study demonstrated high efficacy and safety in the high-risk group of immunosuppressed patients.
Keywords: SARS-CoV-2; persistent infection; antiviral therapy; monoclonal antibodies; HIV/AIDS; immunosuppressive therapy; hematological malignancies SARS-CoV-2; persistent infection; antiviral therapy; monoclonal antibodies; HIV/AIDS; immunosuppressive therapy; hematological malignancies

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MDPI and ACS Style

Longo, B.M.; Venuti, F.; Gaviraghi, A.; Lupia, T.; Ranzani, F.A.; Pepe, A.; Ponzetta, L.; Vita, D.; Allice, T.; Gregorc, V.; et al. Sequential or Combination Treatments as Rescue Therapies in Immunocompromised Patients with Persistent SARS-CoV-2 Infection in the Omicron Era: A Case Series. Antibiotics 2023, 12, 1460. https://doi.org/10.3390/antibiotics12091460

AMA Style

Longo BM, Venuti F, Gaviraghi A, Lupia T, Ranzani FA, Pepe A, Ponzetta L, Vita D, Allice T, Gregorc V, et al. Sequential or Combination Treatments as Rescue Therapies in Immunocompromised Patients with Persistent SARS-CoV-2 Infection in the Omicron Era: A Case Series. Antibiotics. 2023; 12(9):1460. https://doi.org/10.3390/antibiotics12091460

Chicago/Turabian Style

Longo, Bianca Maria, Francesco Venuti, Alberto Gaviraghi, Tommaso Lupia, Fabio Antonino Ranzani, Andrea Pepe, Laura Ponzetta, Davide Vita, Tiziano Allice, Vanesa Gregorc, and et al. 2023. "Sequential or Combination Treatments as Rescue Therapies in Immunocompromised Patients with Persistent SARS-CoV-2 Infection in the Omicron Era: A Case Series" Antibiotics 12, no. 9: 1460. https://doi.org/10.3390/antibiotics12091460

APA Style

Longo, B. M., Venuti, F., Gaviraghi, A., Lupia, T., Ranzani, F. A., Pepe, A., Ponzetta, L., Vita, D., Allice, T., Gregorc, V., Frascione, P. M. M., De Rosa, F. G., Calcagno, A., & Bonora, S. (2023). Sequential or Combination Treatments as Rescue Therapies in Immunocompromised Patients with Persistent SARS-CoV-2 Infection in the Omicron Era: A Case Series. Antibiotics, 12(9), 1460. https://doi.org/10.3390/antibiotics12091460

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