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E. Haefeli W. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:761-762. [PMID: 36655292 PMCID: PMC9853239 DOI: 10.3238/arztebl.m2022.0261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Walter E. Haefeli
- *Abteilung Klinische Pharmakologie und Pharmakoepidemiologie Universitätsklinikum Heidelberg
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Hedvat J, Lange NW, Salerno DM, DeFilippis EM, Kovac D, Corbo H, Chen JK, Choe JY, Lee JH, Anamisis A, Jennings DL, Codispodo G, Shertel T, Brown RS, Pereira MR. COVID-19 therapeutics and outcomes among solid organ transplant recipients during the Omicron BA.1 era. Am J Transplant 2022; 22:2682-2688. [PMID: 35801839 PMCID: PMC9349644 DOI: 10.1111/ajt.17140] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 01/25/2023]
Abstract
Treatment outcomes associated with the use of novel COVID-19 therapeutics in solid organ transplant recipients (SOTR) are not well described in the literature. The objective of this analysis was to characterize 30-day hospitalization and other key secondary endpoints experienced by outpatient SOTR with mild-moderate COVID-19 treated with nirmatrelvir/ritonavir (NR), sotrovimab, or no SARS-CoV-2 specific treatment. This IRB-approved, retrospective study included 154 SOTR with a documented positive SARS-CoV-2 infection between December 16, 2021 and January 19, 2022 (a predominant Omicron BA.1 period in New York City). Patients who received NR (N = 28) or sotrovimab (N = 51) experienced a lower rate of 30-day hospitalization or death as compared to those who received no specific treatment (N = 75) (p = .009). A total of three deaths occurred, all among patients who initially received no specific treatment prior to hospitalization. These results suggest a role for SARS-CoV-2 specific agents in the treatment of SOTR with COVID-19, and that there does not appear to be any difference in effectiveness when comparing NR versus sotrovimab.
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Key Words
- aki, acute kidney injury
- arr, adjusted risk ratio
- bmi, body mass index
- ci, confidence interval
- eua, emergency use authorization
- fda, food and drug administration
- iqr, interquartile range
- mmf, mycophenolate mofetil
- nr, nirmatrelvir/ritonavir
- nyph, newyork-presbyterian hospital
- rrr, relative risk reduction
- scr, serum creatinine
- sotr, solid organ transplant recipient
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Affiliation(s)
- Jessica Hedvat
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA,Jessica Hedvat, Department of Pharmacy, NewYork-Presbyterian Hospital, New York City, NY, USA.
| | - Nicholas W. Lange
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - David M. Salerno
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Ersilia M. DeFilippis
- Division of Cardiology, Department of Medicine Columbia University Irving Medical Center New York City, New York USA
| | - Danielle Kovac
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Heather Corbo
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Justin K. Chen
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Jason Y. Choe
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Jennifer H. Lee
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Anastasia Anamisis
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Douglas L. Jennings
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Giovanna Codispodo
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Tara Shertel
- Department of Pharmacy NewYork-Presbyterian Hospital New York City, New York USA
| | - Robert S. Brown
- Department of Medicine Weill Cornell Medicine New York City, New York USA
| | - Marcus R. Pereira
- Department of Medicine Vagelos College of Physicians and Surgeons New York City, New York USA
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Amani B, Amani B. Efficacy and safety of sotrovimab in patients with COVID-19: A rapid review and meta-analysis. Rev Med Virol 2022; 32:e2402. [PMID: 36226323 PMCID: PMC9874927 DOI: 10.1002/rmv.2402] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/01/2022] [Accepted: 10/03/2022] [Indexed: 01/27/2023]
Abstract
The therapeutic potential of sotrovimab in the treatment of coronavirus disease 2019 (COVID-19) is a controversial issue. The aim of this study was to evaluate the efficacy and safety of sotrovimab in COVID-19 patients. To this end, PubMed, Cochrane Library, Embase, Web of Science, medRxiv, and Google Scholar were searched up to 15 August 2022. The reference lists of key studies were also scanned to find additional records. Meta-analysis was performed using Comprehensive Meta-Analysis. Seventeen studies involving 27,429 patients were included. A significant difference was observed in mortality rate (odds ratio [OR] = 0.40; 95% CI: 0.25-0.63, p = 0.00), hospitalisation rate (OR = 0.53; 95% CI: 0.43-0.65. p = 0.00), hospital or death rate (OR = 0.43; 95% CI: 0.25-0.73, p = 0.00), the need for mechanical ventilation (OR = 0.57; 95% CI: 0.33-0.96, p = 0.03), and ICU admission (OR = 0.33; 95% CI: 0.17-0.67, p = 0.00) of the sotrovimab-receiving group compared to those having no sotrovimab. However, no significant difference was observed between the two groups in terms of disease progression (OR = 0.45; 95% CI: 0.16-1.24, p = 0.12) and emergency department visit (OR = 1.01; 95% CI: 0.83-1.24, p = 0.87). The two groups had no significant difference in terms of incidence of adverse events (OR = 0.98; 95% CI: 0.78-1.23, p = 0.88). The findings of the present meta-analysis support that sotrovimab could be an effective and safe treatment option to reduce mortality and hospitalisation rate in both Delta and Omicron Variants of COVID-19.
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Affiliation(s)
- Bahman Amani
- Department of EpidemiologySchool of HealthIlam University of Medical SciencesIlamIran
| | - Behnam Amani
- Department of EpidemiologySchool of HealthIlam University of Medical SciencesIlamIran
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Czarnecka K, Czarnecka P, Tronina O, Durlik M. Molnupiravir Outpatient Treatment for Adults with COVID-19 in a Real-World Setting-A Single Center Experience. J Clin Med 2022; 11:6464. [PMID: 36362691 PMCID: PMC9656557 DOI: 10.3390/jcm11216464] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/15/2022] [Accepted: 10/28/2022] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Molnupiravir is approved for the treatment of adult patients with mild to moderate COVID-19. The main goal of the treatment is to reduce hospitalization and mortality rate. This study aimed at the all-cause hospitalization and all-cause death assessment in patients at high risk of severe COVID-19 treated with molnupiravir. METHODS This was a prospective, observational single center study. Non-hospitalized patients with SARS-CoV-2 infection, COVID-19 symptoms with the onset of up to 5 days, and at high risk of severe COVID-19 illness received molnupiravir based on attending physician decisions. RESULTS In total, 107 patients were enrolled. Adverse events were reported in 28.0% of patients, with nausea and abdominal pain being the most commonly observed. No treatment-emergent AEs resulted in therapy discontinuation. Overall, 15 patients required hospitalization. During the observation, 2.8% (n = 3) of patients subsequently died. All deaths were considered to be related to COVID-19 complications. Age over 65 years, heart failure, and ischemic heart disease showed a significant correlation with the severe course of COVID-19. CONCLUSION Molnupiravir may be perceived as an alternative treatment for patients with immunosuppression and advanced chronic kidney disease. Nevertheless, further studies are required to conclusively establish a role for molnupiravir in future COVID-19 treatment recommendations.
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Affiliation(s)
- Kinga Czarnecka
- Department of Transplant Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, 59 Nowogrodzka Street, 02-006 Warsaw, Poland
| | - Paulina Czarnecka
- Department of Transplant Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, 59 Nowogrodzka Street, 02-006 Warsaw, Poland
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Poznański P, Augustyniak-Bartosik H, Magiera-Żak A, Skalec K, Jakuszko K, Mazanowska O, Janczak D, Krajewska M, Kamińska D. Molnupiravir When Used Alone Seems to Be Safe and Effective as Outpatient COVID-19 Therapy for Hemodialyzed Patients and Kidney Transplant Recipients. Viruses 2022; 14:v14102224. [PMID: 36298779 PMCID: PMC9610487 DOI: 10.3390/v14102224] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Molnupiravir demonstrated an in vitro antiviral activity against positive-sense RNA viruses, including SARS-CoV-2. The study aimed to present the results of outpatient molnupiravir use in kidney transplant recipients and hemodialysis patients during the first months of 2022 in Poland. Methods: The retrospective observational cohort study at one kidney transplant center included 36 patients diagnosed with COVID-19 with an automated nucleic acid amplification test on nasopharyngeal swab specimens. All patients received molnupiravir for home-based therapy at a dose of 800 mg every 12 h orally for 5 days. Both kidney transplant recipients (n = 16) and hemodialysis patients (n = 20) presented a lot of comorbidities with a Charlson comorbidity index of 4.1 and 5.1, respectively. Results: Patients presented with fever, cough, and weakness followed by muscle and joint pain. Five kidney transplant recipients experienced acute kidney injury with a rise in serum creatinine level from 0.4 to 1.9 mg/dL. No serious side effects of molnupiravir therapy or interactions with immunosuppressive medications were observed. Symptoms of COVID-19 improved rapidly or resolved within 24–48 h of starting treatment. Conclusion: The study suggests the safety and efficacy of molnupiravir therapy alone early after the onset of SARS-CoV-2 infection, but further investigations should be performed to confirm our preliminary results. To the best of the authors’ knowledge, it is the first published report on molnupiravir use in end-stage kidney disease (ESKD) patients on hemodialysis and the third concerning kidney transplant recipients.
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Affiliation(s)
- Paweł Poznański
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
- Correspondence: ; Tel.: +48-717332500
| | - Hanna Augustyniak-Bartosik
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Anna Magiera-Żak
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Karolina Skalec
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Katarzyna Jakuszko
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Oktawia Mazanowska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Dariusz Janczak
- Department of Vascular, General and Transplant Surgery, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Dorota Kamińska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
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Devresse A, Briol S, De Greef J, Lemaitre F, Boland L, Haufroid V, Scohy A, Kabamba B, Yombi JC, Belkhir L, Darius T, Buemi A, De Potter K, Mantegazza R, Bearzatto B, Goffin E, Kanaan N. Safety, Efficacy and Relapse of Nirmatrelvir-Ritonavir in Kidney Transplant Recipients Infected with SARS-CoV-2. Kidney Int Rep 2022; 7:2356-2363. [PMID: 36060621 PMCID: PMC9420244 DOI: 10.1016/j.ekir.2022.08.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/09/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction The efficacy of nirmatrelvir-ritonavir (NR; Paxlovid, Pfizer, New York, NY) to decrease the risk of progression to severe COVID-19 in high-risk patients has been demonstrated. However, evidence in infected kidney transplant recipients (KTRs) is lacking. Moreover, NR has significant and potentially harmful interactions with calcineurin inhibitors (CNIs). Methods In this single-center retrospective study, we included all KTRs treated with NR from April 28 to June 3, 2022. A standard management strategy of CNI dose adaptation (discontinuation of tacrolimus 12 hours before the start of NR and administration of 20% of the cyclosporine dose) and laboratory follow-up was applied. Results A total of 14 patients were included. Compared with day-0 (day before NR initiation), day-7 plasma creatinine concentrations and SARS-CoV-2 viral loads were similar (P = 0.866) and decreased (P = 0.002), respectively. CNI trough concentrations at the end of the treatment were satisfactory, nonetheless, with high individual variability. After a median follow-up time of 34 days, no death or viral pneumonia were observed. Nevertheless, 2 patients experienced early SARS-CoV-2 infection relapses (at day-10 and day-21) associated with an increase in SARS-CoV-2 viral loads. Conclusion NR can be used in KTRs but requires a strict protocol of drug adaptation. We observed 2 cases of early relapse after NR treatment that need further investigations.
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