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Kinsella PM, Moso MA, Morrissey CO, Dendle C, Guy S, Bond K, Sasadeusz J, Slavin MA. Antiviral therapies for the management of persistent coronavirus disease 2019 in immunocompromised hosts: A narrative review. Transpl Infect Dis 2024; 26:e14301. [PMID: 38809102 DOI: 10.1111/tid.14301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 04/11/2024] [Accepted: 05/08/2024] [Indexed: 05/30/2024]
Abstract
Antiviral agents with activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have played a critical role in disease management; however, little is known regarding the efficacy of these medications in the treatment of SARS-CoV-2 infection in immunocompromised patients, particularly in the management of persistent SARS-CoV-2 positivity. This narrative review discusses the management of persistent coronavirus disease 2019 in immunocompromised hosts, with a focus on antiviral therapies. We identified 84 cases from the literature describing a variety of approaches, including prolonged antiviral therapy (n = 11), combination antivirals (n = 13), and mixed therapy with antiviral and antibody treatments (n = 60). A high proportion had an underlying haematologic malignancy (n = 67, 80%), and were in receipt of anti-CD20 agents (n = 51, 60%). Success was reported in 70 cases (83%) which varied according to the therapy type. Combination therapies with antivirals may be an effective approach for individuals with persistent SARS-CoV-2 positivity, particularly those that incorporate treatments aimed at increasing neutralizing antibody levels. Any novel approaches taken to this difficult management dilemma should be mindful of the emergence of antiviral resistance.
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Affiliation(s)
- Paul M Kinsella
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Infectious Diseases, University of Melbourne at the Doherty Institute of Infection and Immunity, Melbourne, Australia
| | - Michael A Moso
- Department of Infectious Diseases, University of Melbourne at the Doherty Institute of Infection and Immunity, Melbourne, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Doherty Institute of Infection and Immunity, Melbourne, Australia
| | | | - Claire Dendle
- Monash Infectious Diseases, Monash Health, Melbourne, Australia
- School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Stephen Guy
- Department of Infectious Diseases, Eastern Health, Melbourne, Australia
- Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Katherine Bond
- Department of Microbiology, Royal Melbourne Hospital, Melbourne, Australia
- Victorian Infectious Diseases Reference Laboratory (VIDRL) at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Department of Microbiology and Immunology, University of Melbourne at the Doherty Institute of Infection and Immunity, Melbourne, Australia
| | - Joseph Sasadeusz
- Department of Infectious Diseases, University of Melbourne at the Doherty Institute of Infection and Immunity, Melbourne, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Doherty Institute of Infection and Immunity, Melbourne, Australia
| | - Monica A Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Doherty Institute of Infection and Immunity, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Libra A, Ciancio N, Sambataro G, Sciacca E, Muscato G, Marino A, Vancheri C, Spicuzza L. Use of Remdesivir in Patients Hospitalized for COVID-19 Pneumonia: Effect on the Hypoxic and Inflammatory State. Viruses 2023; 15:2101. [PMID: 37896877 PMCID: PMC10612076 DOI: 10.3390/v15102101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
Remdesivir is one of the most attractive options for patients with hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19). The aim of our study was to evaluate the effect of remdesivir on the hypoxic and inflammatory state in patients with moderate to severe COVID-19. We retrospectively enrolled 112 patients admitted for COVID-19 pneumonia, requiring low-flow oxygen, 57 treated with remdesivir plus standard of care (SoC) and 55 treated only with SoC that were similar for demographic and clinical data. We evaluated changes in hypoxemia and inflammatory markers at admission (Day 0) and after 5 days of treatment (Day 5) and the clinical course of the disease. From Day 0 to Day 5, the ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F) increased from 222 ± 62 to 274 ± 97 (p < 0.0001) in the remdesivir group and decreased from 223 ± 62 to 183 ± 76 (p < 0.05) in the SoC group. Interleukine-6 levels decreased in the remdesivir (45.9 to 17.5 pg/mL, p < 0.05) but not in the SoC group. Remdesivir reduced the need for ventilatory support and the length of hospitalization. In conclusion, compared to standard care, remdesivir rapidly improves hypoxia and inflammation, causing a better course of the disease in moderate to severe COVID-19.
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Affiliation(s)
- Alessandro Libra
- Regional Referral Centre for Rare Lung Disease, University Hospital “Policlinico-San Marco”, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (N.C.); (G.S.); (E.S.); (G.M.); (C.V.); (L.S.)
| | - Nicola Ciancio
- Regional Referral Centre for Rare Lung Disease, University Hospital “Policlinico-San Marco”, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (N.C.); (G.S.); (E.S.); (G.M.); (C.V.); (L.S.)
| | - Gianluca Sambataro
- Regional Referral Centre for Rare Lung Disease, University Hospital “Policlinico-San Marco”, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (N.C.); (G.S.); (E.S.); (G.M.); (C.V.); (L.S.)
| | - Enrico Sciacca
- Regional Referral Centre for Rare Lung Disease, University Hospital “Policlinico-San Marco”, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (N.C.); (G.S.); (E.S.); (G.M.); (C.V.); (L.S.)
| | - Giuseppe Muscato
- Regional Referral Centre for Rare Lung Disease, University Hospital “Policlinico-San Marco”, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (N.C.); (G.S.); (E.S.); (G.M.); (C.V.); (L.S.)
| | - Andrea Marino
- Department of Biomedical and Biotechnological Sciences, Unit of Infectious Diseases, University of Catania, 95123 Catania, Italy;
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Disease, University Hospital “Policlinico-San Marco”, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (N.C.); (G.S.); (E.S.); (G.M.); (C.V.); (L.S.)
| | - Lucia Spicuzza
- Regional Referral Centre for Rare Lung Disease, University Hospital “Policlinico-San Marco”, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (N.C.); (G.S.); (E.S.); (G.M.); (C.V.); (L.S.)
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Wayham NP, Niedecken AR, Simons JF, Chiang YY, Medina-Cucurella AV, Mizrahi RA, Wagner EK, Gras A, Segal I, Witte P, Enstrom A, Bountouvas A, Nelson SM, Weinberger T, Tan D, Asensio MA, Subramanian A, Lim YW, Adler AS, Keating SM. A Potent Recombinant Polyclonal Antibody Therapeutic for Protection Against New Severe Acute Respiratory Syndrome Coronavirus 2 Variants of Concern. J Infect Dis 2023; 228:555-563. [PMID: 37062677 PMCID: PMC10469345 DOI: 10.1093/infdis/jiad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/30/2023] [Accepted: 04/13/2023] [Indexed: 04/18/2023] Open
Abstract
Emerging variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) possess mutations that prevent antibody therapeutics from maintaining antiviral binding and neutralizing efficacy. Monoclonal antibodies (mAbs) shown to neutralize Wuhan-Hu-1 SARS-CoV-2 (ancestral) strain have reduced potency against newer variants. Plasma-derived polyclonal hyperimmune drugs have improved neutralization breadth compared with mAbs, but lower titers against SARS-CoV-2 require higher dosages for treatment. We previously developed a highly diverse, recombinant polyclonal antibody therapeutic anti-SARS-CoV-2 immunoglobulin hyperimmune (rCIG). rCIG was compared with plasma-derived or mAb standards and showed improved neutralization of SARS-CoV-2 across World Health Organization variants; however, its potency was reduced against some variants relative to ancestral, particularly omicron. Omicron-specific antibody sequences were enriched from yeast expressing rCIG-scFv and exhibited increased binding and neutralization to omicron BA.2 while maintaining ancestral strain binding and neutralization. Polyclonal antibody libraries such as rCIG can be utilized to develop antibody therapeutics against present and future SARS-CoV-2 threats.
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Affiliation(s)
| | | | | | - Yao Y Chiang
- GigaGen, Inc. (A Grifols Company), San Carlos, California, USA
| | | | - Rena A Mizrahi
- GigaGen, Inc. (A Grifols Company), San Carlos, California, USA
| | - Ellen K Wagner
- GigaGen, Inc. (A Grifols Company), San Carlos, California, USA
| | - Ashley Gras
- GigaGen, Inc. (A Grifols Company), San Carlos, California, USA
| | - Ilana Segal
- GigaGen, Inc. (A Grifols Company), San Carlos, California, USA
| | - Peyton Witte
- GigaGen, Inc. (A Grifols Company), San Carlos, California, USA
| | - Alexis Enstrom
- GigaGen, Inc. (A Grifols Company), San Carlos, California, USA
| | | | | | - Tess Weinberger
- GigaGen, Inc. (A Grifols Company), San Carlos, California, USA
| | - David Tan
- GigaGen, Inc. (A Grifols Company), San Carlos, California, USA
| | | | | | - Yoong Wearn Lim
- GigaGen, Inc. (A Grifols Company), San Carlos, California, USA
| | - Adam S Adler
- GigaGen, Inc. (A Grifols Company), San Carlos, California, USA
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Ong RYL, Seah VXF, Chong CY, Thoon KC, Tan NWH, Li J, Nadua KD, Soh SY, Seng MSF, Pham TNA, Yung CF, Kam KQ. A cohort study of COVID-19 infection in pediatric oncology patients plus the utility and safety of remdesivir treatment. Acta Oncol 2023; 62:53-57. [PMID: 36661030 DOI: 10.1080/0284186x.2023.2169079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Rina Yue Ling Ong
- Department of Pharmacy, KK Women's and Children's Hospital, Singapore, Singapore
| | - Valerie Xue Fen Seah
- Department of Pharmacy, KK Women's and Children's Hospital, Singapore, Singapore
| | - Chia Yin Chong
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Koh Cheng Thoon
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Natalie Woon Hui Tan
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Jiahui Li
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Karen Donceras Nadua
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Shui Yen Soh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Haematology/Oncology Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Michaela Su-Fern Seng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Haematology/Oncology Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Thi Ngoc Anh Pham
- Nursing Clinical Services, Division of Nursing, KK Women's and Children's Hospital, Singapore, Singapore
| | - Chee Fu Yung
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Kai-Qian Kam
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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5
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Lasagna A, Cassaniti I, Lilleri D, Quaccini M, Ferrari A, Sacchi P, Bruno R, Baldanti F, Pedrazzoli P. Effectiveness of the available early therapies in reducing severe COVID-19 in non-hospitalized patients with solid tumors on active treatment. Front Med (Lausanne) 2022; 9:1036473. [PMID: 36388947 PMCID: PMC9643502 DOI: 10.3389/fmed.2022.1036473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/03/2022] [Indexed: 12/02/2022] Open
Abstract
Emergency use authorization of drugs against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by regulatory authorities has provided new options to treat high-risk outpatients with mild-to-moderate Coronavirus disease 2019 (COVID-19). We conducted an ambispective cohort study of patients with solid tumors on active treatment to examine the effectiveness of these drugs in preventing the progression to severe COVID-19. Sixty-nine patients with solid tumors (43 women, 26 men; median age 61, range 26–80) reported a laboratory-confirmed diagnosis of SARS-CoV-2 infection. Forty-nine patients received early therapy. Only one patient (14.5%) required hospitalization for COVID-19. As for safety, two patients (5.9%) reported nausea during nirmatrelvir/ritonavir. The majority of treated patients showed a reduced time to negative sample (73 vs. 18%, p = 0.0011) and shorter symptoms’ duration (94 vs. 27%; p < 0.0001) compared to the patients not treated with the early COVID-19 therapies. Our data suggest that early therapies may reduce the morbidity of COVID-19 in patients with solid tumors.
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Affiliation(s)
- Angioletta Lasagna
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- *Correspondence: Angioletta Lasagna,
| | - Irene Cassaniti
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniele Lilleri
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mattia Quaccini
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Ferrari
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Sacchi
- Division of Infectious Diseases I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Raffaele Bruno
- Division of Infectious Diseases I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Fausto Baldanti
- Molecular Virology Unit, Department of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
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