免疫功能低下患者 COVID-19 的抗病毒联合治疗：迈向明确其治疗地位

In this retrospective single-center study (October 2022-March 2024), patients receiving antiviral combinations were stratified according to treatment indication: prolonged/relapsed infection (group 1), severe COVID-19 (group 2), or early treatment of non-severe COVID-19 (group 3). Outcomes included virological clearance at day 14, and success rate at days 30 and 100.

Seventy-one patients were included (group 1: 43; group 2 and 3: 14 each); 52% had non-Hodgkin lymphoma, 39.4% prior anti-CD20 therapy, 32% transplant/CAR-T. Most (92.6%) were vaccinated (median three doses). Treatment consisted of two antivirals in 59 patients (82%), mainly 10 days of both remdesivir and nirmatrelvir/ritonavir (n = 52, 73%), two antivirals plus single-dose tixagevimab/cilgavimab in 11 (15%), and three antivirals in 1. Virological clearance by day 14 was achieved in 79% (52/66 evaluable patients): 85% (34/40) in group 1, 58% (7/12) in group 2, 78.6% (11/14) in group 3. In group 1, predictors of day 14 clearance were prior vaccination and combination treatment with 10 days of oral antiviral. Success rates at days 30 and 100 were 80% (57/71) and 79% (56/71), respectively, with no significant differences between groups. Five patients required further treatment courses. COVID-19-related mortality was 12.5% (9/71). Three grade 2 adverse events occurred.

Antiviral combination therapy was effective in prolonged/relapsed and severe COVID-19 while its role in early mild infections warrants further study. Stratifying patients by treatment indication facilitates outcome interpretation and comparisons.