Early administration of nirmatrelvir/ritonavir leads to faster negative SARS-CoV-2 nasal swabs than monoclonal antibodies in COVID 19 patients at high-risk for severe disease

Besides the well-established efficacy in preventing severe COVID-19, the impact of early treatments, namely antivirals and monoclonal antibodies (mAbs), on the time length to negativization of SARS-CoV-2 nasal swabs is still unclear. The aim of this study was to compare the efficacy of different ear...

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Published in:	Virology journal Vol. 21; no. 1; p. 68
Main Authors:	Colaneri, Marta, Scaglione, Giovanni, Fassio, Federico, Galli, Lucia, Lai, Alessia, Bergna, Annalisa, Gabrieli, Arianna, Tarkowski, Maciej, Ventura, Carla Della, Colombo, Valeria, Cordier, Laura, Bernasconi, Davide, Corbellino, Mario, Dedivitiis, Gianfranco, Borghetti, Silvia, Visigalli, Debora, Sollima, Salvatore, Casalini, Giacomo, Rizzardini, Giuliano, Gori, Andrea, Antinori, Spinello, Riva, Agostino, Schiavini, Monica
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 20-03-2024 BioMed Central BMC
Subjects:	Antibodies, Monoclonal - therapeutic use Antiviral agents Antiviral Agents - therapeutic use Antiviral drugs Brief Report Cerebrovascular disease Comorbidity Comparative analysis COVID-19 COVID-19 Drug Treatment COVID-19 Vaccines Disease transmission Dosage and administration Health aspects Hospitalization Humans Immunization Immunosuppression Lactams Leucine Monoclonal antibodies Nirmatrelvir/Ritonavir Nitriles Patient outcomes Patients Proline Retrospective Studies Risk factors Ritonavir Ritonavir - therapeutic use SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 Time to negativization Vaccination Italy COVID-19 Monoclonal antibodies Nirmatrelvir/Ritonavir Immunosuppression Time to negativization
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Summary:	Besides the well-established efficacy in preventing severe COVID-19, the impact of early treatments, namely antivirals and monoclonal antibodies (mAbs), on the time length to negativization of SARS-CoV-2 nasal swabs is still unclear. The aim of this study was to compare the efficacy of different early treatments in reducing the SARS-CoV-2 viral shedding, identifying a single drug that might potentially lead to a more rapid negativization of SARS-CoV-2 nasal swab. This was a single-centre, retrospective, observational study conducted at Ospedale Luigi Sacco in Milan. Data of high-risk COVID-19 patients who received early treatments between 23 December 2021 and March 2023 were extracted. The comparison across treatments was conducted using the Kruskall-Wallis test for continuous variables. Dunn's test with Bonferroni adjustment was performed for post-hoc comparisons of days to negativization. Secondly, a negative binomial regression adjusted for age, sex, number of comorbidities, immunosuppression, and SARS-CoV-2 vaccination status was implemented. Data from 428 patients receiving early treatments were collected. The majority were treated with Nirmatrelvir/Ritonavir and were affected by SARS-CoV-2 Omicron infection with BA.2 sublineage. The median length time to SARS-CoV-2 nasal swab negativization was 9 days [IQR 7-13 days]. We found that Nirmatrelvir/Ritonavir determined a significant decrease of the length time to SARS-CoV-2 nasal swab negativization compared to mAbs (p = 0.003), but not compared to Remdesivir (p = 0.147) and Molnupiravir (p = 0.156). Our findings highlight the importance of promptly treating high-risk COVID-19 patients with Nirmatrelvir/Ritonavir, as it also contributes to achieving a faster time to negative SARS-CoV-2 nasal swabs.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	1743-422X 1743-422X
DOI:	10.1186/s12985-024-02333-x