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Molnupiravir compared to nirmatrelvir/ritonavir for COVID-19 in high-risk patients with haematological malignancy in Europe. A matched-paired analysis from the EPICOVIDEHA registry
J. Salmanton-García, F. Marchesi, P. Koehler, B. Weinbergerová, N. Čolović, I. Falces-Romero, C. Buquicchio, F. Farina, J. van Praet, MM. Biernat, F. Itri, L. Prezioso, C. Tascini, A. Vena, A. Romano, M. Delia, J. Dávila-Valls, S. Martín-Pérez,...
Jazyk angličtina Země Nizozemsko
Typ dokumentu časopisecké články
- MeSH
- antivirové látky terapeutické užití MeSH
- COVID-19 * MeSH
- farmakoterapie COVID-19 MeSH
- hematologické nádory * komplikace farmakoterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- ritonavir terapeutické užití MeSH
- SARS-CoV-2 MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
INTRODUCTION: Molnupiravir and nirmatrelvir/ritonavir are antivirals used to prevent progression to severe SARS-CoV-2 infections and decrease hospitalisation and mortality rates. Nirmatrelvir/ritonavir was authorised in Europe in December 2021, whereas molnupiravir is not yet licensed in Europe as of February 2022. Molnupiravir may be an alternative to nirmatrelvir/ritonavir because it is associated with fewer drug-drug interactions and contraindications. A caveat for molnupiravir is the mode of action induces viral mutations. Mortality rate reduction with molnupiravir was less pronounced than that with nirmatrelvir/ritonavir in patients without haematological malignancy. Little is known about the comparative efficacy of the two drugs in patients with haematological malignancy at high-risk of severe COVID-19. Thus, molnupiravir and nirmatrelvir/ritonavir were compared in a cohort of patients with haematological malignancies. METHODS: Clinical data from patients treated with molnupiravir or nirmatrelvir/ritonavir monotherapy for COVID-19 were retrieved from the EPICOVIDEHA registry. Patients treated with molnupiravir were matched by sex, age (±10 years), and severity of baseline haematological malignancy to controls treated with nirmatrelvir/ritonavir. RESULTS: A total of 116 patients receiving molnupiravir for the clinical management of COVID-19 were matched to an equal number of controls receiving nirmatrelvir/ritonavir. In each of the groups, 68 (59%) patients were male; with a median age of 64 years (interquartile range [IQR] 53-74) for molnupiravir recipients and 64 years (IQR 54-73) for nirmatrelvir/ritonavir recipients; 56.9% (n=66) of the patients had controlled baseline haematological malignancy, 12.9% (n=15) had stable disease, and 30.2% (n=35) had active disease at COVID-19 onset in each group. During COVID-19 infection, one third of patients from each group were admitted to hospital. Although a similar proportion of patients in the two groups were vaccinated (molnupiravir n=77, 66% vs. nirmatrelvir/ritonavir n=87, 75%), more of those treated with nirmatrelvir/ritonavir had received four vaccine doses (n=27, 23%) compared with those treated with molnupiravir (n=5, 4%) (P<0.001). No differences were detected in COVID-19 severity (P=0.39) or hospitalisation (P=1.0). No statistically significant differences were identified in overall mortality rate (P=0.78) or survival probability (d30 P=0.19, d60 P=0.67, d90 P=0.68, last day of follow up P=0.68). Deaths were either attributed to COVID-19, or the infection was judged by the treating physician to have contributed to death. CONCLUSIONS: Hospitalisation and mortality rates with molnupiravir were comparable to those with nirmatrelvir/ritonavir in high-risk patients with haematological malignancies and COVID-19. Molnupiravir is a plausible alternative to nirmatrelvir/ritonavir for COVID-19 treatment in patients with haematological malignancy.
1 Department of Medicine University Medical Center Hamburg Eppendorf Hamburg Germany
3 Department of Medicine University Medical Center Hamburg Eppendorf Hamburg Germany
AOU Policlinico Rodolico San Marco Catania Italy
Aristotle University of Thessaloniki Thessaloniki Greece
Azienda Ospedaliera Nazionale SS Antonio e Biagio e Cesare Arrigo Alessandria Italy
Azienda Sanitaria Universitaria del Friuli Centrale Udine Italy
Center of Radiology University Clinical Center of Serbia Belgrade Serbia
Centre Hospitalier de Versailles Le Chesnay France
CIBERINFEC Instituto de Salud Carlos 3 Madrid Spain
Clinic of Hematology University Clinical Center of Serbia Belgrade Serbia
COVID hospital ''Batajnica'' Belgrade Serbia
Department of Hematology and Oncology Comprehensive Cancer Center Innsbruck Innsbruck Austria
Department of Hematology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
Department of Hematology Research Unit Hospital Universitario de Burgos Burgos Spain
Department of Infectious Diseases Karolinska University Hospital Stockholm Sweden
Department of Nephrology and Infectious diseases AZ Sint Jan Brugge Oostende AV Brugge Belgium
Departmento de Medicina Universidad Complutense de Madrid Madrid Spain
Ematologia con Trapianto Ospedale Dimiccoli Barletta Barletta Italy
Facultad de Ciencias de la Salud Universidad Isabel 1 Burgos Spain
Faculty of Medicine University of Belgrade Belgrade Serbia
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
Fundacion Jimenez Diaz University Hospital Health Research Institute IIS FJD Madrid Spain
German Centre for Infection Research Partner Site Bonn Cologne Cologne Germany
Hematology and Stem Cell transplan Unit Vito Fazzi Lecce
Hematology and Stem Cell Transplant Unit IRCCS Regina Elena National Cancer Institute Rome Italy
Hematology and Stem Cell Transplantation Unit AOUC Policlinico Bari Italy
Hematology Centre Hospitalier Sud Francilien Corbeil Essonnes France
Hematology Department of Biomedicine and Prevention University of Rome Tor Vergata Rome Italy
Hematology Unit ASST Spedali Civili Brescia Italy
Hematology Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
Hematology Unit Università Cattolica del Sacro Cuore Rome Italy
Hospital 12 de Octubre Madrid Spain
Hospital Nuestra Señora de Sonsoles Ávila Spain
Hospital Universitario Infanta Leonor Madrid Spain
Hospital Universitario Lucus Augusti Lugo Spain
Hospital University of Parma Hematology and Bone Marrow Unit Parma Italy
IRCCS Ospedale San Raffaele Milan Italy
La Paz University Hospital Madrid Spain
Ospedale Policlinico San Martino Genoa Italy
San Luigi Gonzaga Hospital Orbassano Orbassano Italy
Université Paris Saclay UVSQ Inserm Équipe Exposome et Hérédité CESP Villejuif France
University Clinical Center Serbia Medical Faculty University Belgrade Belgrade Serbia
Citace poskytuje Crossref.org
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- $a Salmanton-García, Jon $u University of Cologne, Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany. Electronic address: jon.salmanton-garcia@uk-koeln.de
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- $a Molnupiravir compared to nirmatrelvir/ritonavir for COVID-19 in high-risk patients with haematological malignancy in Europe. A matched-paired analysis from the EPICOVIDEHA registry / $c J. Salmanton-García, F. Marchesi, P. Koehler, B. Weinbergerová, N. Čolović, I. Falces-Romero, C. Buquicchio, F. Farina, J. van Praet, MM. Biernat, F. Itri, L. Prezioso, C. Tascini, A. Vena, A. Romano, M. Delia, J. Dávila-Valls, S. Martín-Pérez, E. Lavilla-Rubira, T. Adžić-Vukičević, D. García-Bordallo, A. López-García, M. Criscuolo, V. Petzer, NS. Fracchiolla, I. Espigado, U. Sili, S. Meers, N. Erben, C. Cattaneo, A. Tragiannidis, E. Gavriilaki, M. Schönlein, M. Mitrovic, N. Pantic, M. Merelli, J. Labrador, JÁ. Hernández-Rivas, A. Glenthøj, G. Fouquet, MI. Del Principe, M. Dargenio, M. Calbacho, C. Besson, M. Kohn, S. Gräfe, DS. Hersby, E. Arellano, GM. Çolak, D. Wolf, M. Marchetti, A. Nordlander, O. Blennow, R. Cordoba, B. Mišković, M. Mladenović, M. Bavastro, A. Limongelli, L. Rahimli, L. Pagano, OA. Cornely
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- $a INTRODUCTION: Molnupiravir and nirmatrelvir/ritonavir are antivirals used to prevent progression to severe SARS-CoV-2 infections and decrease hospitalisation and mortality rates. Nirmatrelvir/ritonavir was authorised in Europe in December 2021, whereas molnupiravir is not yet licensed in Europe as of February 2022. Molnupiravir may be an alternative to nirmatrelvir/ritonavir because it is associated with fewer drug-drug interactions and contraindications. A caveat for molnupiravir is the mode of action induces viral mutations. Mortality rate reduction with molnupiravir was less pronounced than that with nirmatrelvir/ritonavir in patients without haematological malignancy. Little is known about the comparative efficacy of the two drugs in patients with haematological malignancy at high-risk of severe COVID-19. Thus, molnupiravir and nirmatrelvir/ritonavir were compared in a cohort of patients with haematological malignancies. METHODS: Clinical data from patients treated with molnupiravir or nirmatrelvir/ritonavir monotherapy for COVID-19 were retrieved from the EPICOVIDEHA registry. Patients treated with molnupiravir were matched by sex, age (±10 years), and severity of baseline haematological malignancy to controls treated with nirmatrelvir/ritonavir. RESULTS: A total of 116 patients receiving molnupiravir for the clinical management of COVID-19 were matched to an equal number of controls receiving nirmatrelvir/ritonavir. In each of the groups, 68 (59%) patients were male; with a median age of 64 years (interquartile range [IQR] 53-74) for molnupiravir recipients and 64 years (IQR 54-73) for nirmatrelvir/ritonavir recipients; 56.9% (n=66) of the patients had controlled baseline haematological malignancy, 12.9% (n=15) had stable disease, and 30.2% (n=35) had active disease at COVID-19 onset in each group. During COVID-19 infection, one third of patients from each group were admitted to hospital. Although a similar proportion of patients in the two groups were vaccinated (molnupiravir n=77, 66% vs. nirmatrelvir/ritonavir n=87, 75%), more of those treated with nirmatrelvir/ritonavir had received four vaccine doses (n=27, 23%) compared with those treated with molnupiravir (n=5, 4%) (P<0.001). No differences were detected in COVID-19 severity (P=0.39) or hospitalisation (P=1.0). No statistically significant differences were identified in overall mortality rate (P=0.78) or survival probability (d30 P=0.19, d60 P=0.67, d90 P=0.68, last day of follow up P=0.68). Deaths were either attributed to COVID-19, or the infection was judged by the treating physician to have contributed to death. CONCLUSIONS: Hospitalisation and mortality rates with molnupiravir were comparable to those with nirmatrelvir/ritonavir in high-risk patients with haematological malignancies and COVID-19. Molnupiravir is a plausible alternative to nirmatrelvir/ritonavir for COVID-19 treatment in patients with haematological malignancy.
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- $a Marchesi, Francesco $u Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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- $a Koehler, Philipp $u University of Cologne, Faculty of Medicine, and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine, University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany
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- 700 1_
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- 700 1_
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- 700 1_
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