Clinical Characteristics of 22 Patients Treated With Late or Retreatment Coronavirus Disease 2019 Antiviral Therapy for Persistently Polymerase Chain Reaction Positive Infection
| Characteristic . | Patients, No. (%)a . |
|---|---|
| Age, median (IQR), y | 64 (54–74) |
| Male sex | 15 (68.2) |
| Immunosuppression | |
| Hematological conditionb,c | 16 (72.7) |
| Renal SOT | 2 (9.1) |
| Anti–CD-20 therapy (nonmalignant condition) | 4 (18.2) |
| COVID-19 infection details at diagnosis | |
| Results available within 48 h after COVID-19 diagnosis | 18 (81.8) |
| Blood cell count, median (IQR), ×109/L | |
| WBCs | 4.5 (2.9–8.4) |
| Lymphocytes | 0.65 (0.38–1.62) |
| Neutrophils | 2.9 (1.6–4.5) |
| CRP, median (IQR), mg/L | 19 (4–48) |
| Prior COVID-19 vaccine doses, median (IQR), no. | 3 (3–3) |
| Prior tixagevimab-cilgavimab therapy | 7 (31.8) |
| Hospital admission | 15 (68.2) |
| ICU admission | 6 (27.3) |
| COVID-19 therapy at diagnosis | |
| MPV | 3 (13.6) |
| NIR/r | 7 (31.8) |
| RDV | 8 (36.4) |
| MPV + RDV | 1 (4.5) |
| Nil AV therapy | 3 (13.6) |
| Steroid | 8 (36.4) |
| Baracitinib | 1 (4.5) |
| Tixagevimab-cilgavimab | 1 (4.5) |
| COVID-19 infection details at late/retreatment AV use | |
| Time from initial COVID-19 diagnosis, median (IQR), d | 35 (29–42) |
| PCR Ct on d 1 of AV use, median (IQR) | 22 (20–25) |
| Hospital admission | 19 (8.64) |
| ICU admission | 7 (31.8) |
| Change or delay to other immunosuppressive therapy due to COVID-19 status | 10 (45.5) |
| COVID-19 severity at time of late/retreatment AV used | |
| Asymptomatic | 4 (18.2) |
| Mild/moderate | 11 (50) |
| Severe/critical | 7 (32.8) |
| Late/retreatment COVID-19 therapy | |
| Single agent | 3 (13.6) |
| MPV | 1 (4.5) |
| NIR/r | 0 (0) |
| RDV | 2 (9.1) |
| Sequential single agents | 2 (9.1) |
| Dual agents at any time | 17 (77.3) |
| MPV + NIR/r | 10 (45.5) |
| MPV + RDV | 4 (18.2) |
| NIR/r + RDV | 3 (13.6) |
| Steroid therapy | 14 (63.6) |
| Baracitinib | 6 (27.3) |
| Tocilizumab | 0 (0) |
| Tixagevimab-cilgavimab | 3 (13.6) |
| Negative PCR result or sequential Ct >30 | |
| At d 14 after late/retreatment AVs | 9 (40.9) |
| Dual agents (n = 17) | 8 (47.0) |
| Single or sequential agents (n = 5) | 1 (20.0) |
| Short-total-duration therapy (n = 14) | 7 (50.0) |
| Longer-total-duration therapy (n = 8) | 2 (25.0) |
| At d 30 after late/retreatment AVs | 15 (68.2) |
| Characteristic . | Patients, No. (%)a . |
|---|---|
| Age, median (IQR), y | 64 (54–74) |
| Male sex | 15 (68.2) |
| Immunosuppression | |
| Hematological conditionb,c | 16 (72.7) |
| Renal SOT | 2 (9.1) |
| Anti–CD-20 therapy (nonmalignant condition) | 4 (18.2) |
| COVID-19 infection details at diagnosis | |
| Results available within 48 h after COVID-19 diagnosis | 18 (81.8) |
| Blood cell count, median (IQR), ×109/L | |
| WBCs | 4.5 (2.9–8.4) |
| Lymphocytes | 0.65 (0.38–1.62) |
| Neutrophils | 2.9 (1.6–4.5) |
| CRP, median (IQR), mg/L | 19 (4–48) |
| Prior COVID-19 vaccine doses, median (IQR), no. | 3 (3–3) |
| Prior tixagevimab-cilgavimab therapy | 7 (31.8) |
| Hospital admission | 15 (68.2) |
| ICU admission | 6 (27.3) |
| COVID-19 therapy at diagnosis | |
| MPV | 3 (13.6) |
| NIR/r | 7 (31.8) |
| RDV | 8 (36.4) |
| MPV + RDV | 1 (4.5) |
| Nil AV therapy | 3 (13.6) |
| Steroid | 8 (36.4) |
| Baracitinib | 1 (4.5) |
| Tixagevimab-cilgavimab | 1 (4.5) |
| COVID-19 infection details at late/retreatment AV use | |
| Time from initial COVID-19 diagnosis, median (IQR), d | 35 (29–42) |
| PCR Ct on d 1 of AV use, median (IQR) | 22 (20–25) |
| Hospital admission | 19 (8.64) |
| ICU admission | 7 (31.8) |
| Change or delay to other immunosuppressive therapy due to COVID-19 status | 10 (45.5) |
| COVID-19 severity at time of late/retreatment AV used | |
| Asymptomatic | 4 (18.2) |
| Mild/moderate | 11 (50) |
| Severe/critical | 7 (32.8) |
| Late/retreatment COVID-19 therapy | |
| Single agent | 3 (13.6) |
| MPV | 1 (4.5) |
| NIR/r | 0 (0) |
| RDV | 2 (9.1) |
| Sequential single agents | 2 (9.1) |
| Dual agents at any time | 17 (77.3) |
| MPV + NIR/r | 10 (45.5) |
| MPV + RDV | 4 (18.2) |
| NIR/r + RDV | 3 (13.6) |
| Steroid therapy | 14 (63.6) |
| Baracitinib | 6 (27.3) |
| Tocilizumab | 0 (0) |
| Tixagevimab-cilgavimab | 3 (13.6) |
| Negative PCR result or sequential Ct >30 | |
| At d 14 after late/retreatment AVs | 9 (40.9) |
| Dual agents (n = 17) | 8 (47.0) |
| Single or sequential agents (n = 5) | 1 (20.0) |
| Short-total-duration therapy (n = 14) | 7 (50.0) |
| Longer-total-duration therapy (n = 8) | 2 (25.0) |
| At d 30 after late/retreatment AVs | 15 (68.2) |
Abbreviations: AV, antiviral; COVID-19, coronavirus disease 2019; CRP, C-reactive protein; Ct, cycle threshold; ICU, intensive care unit; IQR, interquartile range; MPV, molnupirivair; NIR/r, nirmatrelvir/ritonavir; PCR, polymerase chain reaction; RDV, remdesevir; SOT, solid organ transplant; WBCs, white blood cells.
aData represent no. (%) of patients unless otherwise specified.
bHematological conditions include lymphoma (n = 7), leukemia (n = 5), hematopoietic stem cell transplant (n = 3), and multiple myeloma (n = 1).
cFive of 18 were also on anti–CD-20 therapy.
dCOVID-19 severity was defined according to World Health Organization criteria (https://iris.who.int/bitstream/handle/10665/332196/WHO-2019-nCoV-clinical-2020.5-eng.pdf). Mild was defined as symptomatic without clinical signs of pneumonia; moderate, as oxygen saturation (Spo2) ≥90% at rest on room air with clinical signs of pneumonia (eg, fever, cough, or dyspnea); severe, as Spo2 <90% at rest on room air, respiratory rate >30 breaths/min, or severe respiratory distress; and critical, as (1) respiratory failure or adult respiratory distress syndrome requiring high-flow nasal oxygen or noninvasive ventilation/intubation or (2) sepsis/septic shock.
Clinical Characteristics of 22 Patients Treated With Late or Retreatment Coronavirus Disease 2019 Antiviral Therapy for Persistently Polymerase Chain Reaction Positive Infection
| Characteristic . | Patients, No. (%)a . |
|---|---|
| Age, median (IQR), y | 64 (54–74) |
| Male sex | 15 (68.2) |
| Immunosuppression | |
| Hematological conditionb,c | 16 (72.7) |
| Renal SOT | 2 (9.1) |
| Anti–CD-20 therapy (nonmalignant condition) | 4 (18.2) |
| COVID-19 infection details at diagnosis | |
| Results available within 48 h after COVID-19 diagnosis | 18 (81.8) |
| Blood cell count, median (IQR), ×109/L | |
| WBCs | 4.5 (2.9–8.4) |
| Lymphocytes | 0.65 (0.38–1.62) |
| Neutrophils | 2.9 (1.6–4.5) |
| CRP, median (IQR), mg/L | 19 (4–48) |
| Prior COVID-19 vaccine doses, median (IQR), no. | 3 (3–3) |
| Prior tixagevimab-cilgavimab therapy | 7 (31.8) |
| Hospital admission | 15 (68.2) |
| ICU admission | 6 (27.3) |
| COVID-19 therapy at diagnosis | |
| MPV | 3 (13.6) |
| NIR/r | 7 (31.8) |
| RDV | 8 (36.4) |
| MPV + RDV | 1 (4.5) |
| Nil AV therapy | 3 (13.6) |
| Steroid | 8 (36.4) |
| Baracitinib | 1 (4.5) |
| Tixagevimab-cilgavimab | 1 (4.5) |
| COVID-19 infection details at late/retreatment AV use | |
| Time from initial COVID-19 diagnosis, median (IQR), d | 35 (29–42) |
| PCR Ct on d 1 of AV use, median (IQR) | 22 (20–25) |
| Hospital admission | 19 (8.64) |
| ICU admission | 7 (31.8) |
| Change or delay to other immunosuppressive therapy due to COVID-19 status | 10 (45.5) |
| COVID-19 severity at time of late/retreatment AV used | |
| Asymptomatic | 4 (18.2) |
| Mild/moderate | 11 (50) |
| Severe/critical | 7 (32.8) |
| Late/retreatment COVID-19 therapy | |
| Single agent | 3 (13.6) |
| MPV | 1 (4.5) |
| NIR/r | 0 (0) |
| RDV | 2 (9.1) |
| Sequential single agents | 2 (9.1) |
| Dual agents at any time | 17 (77.3) |
| MPV + NIR/r | 10 (45.5) |
| MPV + RDV | 4 (18.2) |
| NIR/r + RDV | 3 (13.6) |
| Steroid therapy | 14 (63.6) |
| Baracitinib | 6 (27.3) |
| Tocilizumab | 0 (0) |
| Tixagevimab-cilgavimab | 3 (13.6) |
| Negative PCR result or sequential Ct >30 | |
| At d 14 after late/retreatment AVs | 9 (40.9) |
| Dual agents (n = 17) | 8 (47.0) |
| Single or sequential agents (n = 5) | 1 (20.0) |
| Short-total-duration therapy (n = 14) | 7 (50.0) |
| Longer-total-duration therapy (n = 8) | 2 (25.0) |
| At d 30 after late/retreatment AVs | 15 (68.2) |
| Characteristic . | Patients, No. (%)a . |
|---|---|
| Age, median (IQR), y | 64 (54–74) |
| Male sex | 15 (68.2) |
| Immunosuppression | |
| Hematological conditionb,c | 16 (72.7) |
| Renal SOT | 2 (9.1) |
| Anti–CD-20 therapy (nonmalignant condition) | 4 (18.2) |
| COVID-19 infection details at diagnosis | |
| Results available within 48 h after COVID-19 diagnosis | 18 (81.8) |
| Blood cell count, median (IQR), ×109/L | |
| WBCs | 4.5 (2.9–8.4) |
| Lymphocytes | 0.65 (0.38–1.62) |
| Neutrophils | 2.9 (1.6–4.5) |
| CRP, median (IQR), mg/L | 19 (4–48) |
| Prior COVID-19 vaccine doses, median (IQR), no. | 3 (3–3) |
| Prior tixagevimab-cilgavimab therapy | 7 (31.8) |
| Hospital admission | 15 (68.2) |
| ICU admission | 6 (27.3) |
| COVID-19 therapy at diagnosis | |
| MPV | 3 (13.6) |
| NIR/r | 7 (31.8) |
| RDV | 8 (36.4) |
| MPV + RDV | 1 (4.5) |
| Nil AV therapy | 3 (13.6) |
| Steroid | 8 (36.4) |
| Baracitinib | 1 (4.5) |
| Tixagevimab-cilgavimab | 1 (4.5) |
| COVID-19 infection details at late/retreatment AV use | |
| Time from initial COVID-19 diagnosis, median (IQR), d | 35 (29–42) |
| PCR Ct on d 1 of AV use, median (IQR) | 22 (20–25) |
| Hospital admission | 19 (8.64) |
| ICU admission | 7 (31.8) |
| Change or delay to other immunosuppressive therapy due to COVID-19 status | 10 (45.5) |
| COVID-19 severity at time of late/retreatment AV used | |
| Asymptomatic | 4 (18.2) |
| Mild/moderate | 11 (50) |
| Severe/critical | 7 (32.8) |
| Late/retreatment COVID-19 therapy | |
| Single agent | 3 (13.6) |
| MPV | 1 (4.5) |
| NIR/r | 0 (0) |
| RDV | 2 (9.1) |
| Sequential single agents | 2 (9.1) |
| Dual agents at any time | 17 (77.3) |
| MPV + NIR/r | 10 (45.5) |
| MPV + RDV | 4 (18.2) |
| NIR/r + RDV | 3 (13.6) |
| Steroid therapy | 14 (63.6) |
| Baracitinib | 6 (27.3) |
| Tocilizumab | 0 (0) |
| Tixagevimab-cilgavimab | 3 (13.6) |
| Negative PCR result or sequential Ct >30 | |
| At d 14 after late/retreatment AVs | 9 (40.9) |
| Dual agents (n = 17) | 8 (47.0) |
| Single or sequential agents (n = 5) | 1 (20.0) |
| Short-total-duration therapy (n = 14) | 7 (50.0) |
| Longer-total-duration therapy (n = 8) | 2 (25.0) |
| At d 30 after late/retreatment AVs | 15 (68.2) |
Abbreviations: AV, antiviral; COVID-19, coronavirus disease 2019; CRP, C-reactive protein; Ct, cycle threshold; ICU, intensive care unit; IQR, interquartile range; MPV, molnupirivair; NIR/r, nirmatrelvir/ritonavir; PCR, polymerase chain reaction; RDV, remdesevir; SOT, solid organ transplant; WBCs, white blood cells.
aData represent no. (%) of patients unless otherwise specified.
bHematological conditions include lymphoma (n = 7), leukemia (n = 5), hematopoietic stem cell transplant (n = 3), and multiple myeloma (n = 1).
cFive of 18 were also on anti–CD-20 therapy.
dCOVID-19 severity was defined according to World Health Organization criteria (https://iris.who.int/bitstream/handle/10665/332196/WHO-2019-nCoV-clinical-2020.5-eng.pdf). Mild was defined as symptomatic without clinical signs of pneumonia; moderate, as oxygen saturation (Spo2) ≥90% at rest on room air with clinical signs of pneumonia (eg, fever, cough, or dyspnea); severe, as Spo2 <90% at rest on room air, respiratory rate >30 breaths/min, or severe respiratory distress; and critical, as (1) respiratory failure or adult respiratory distress syndrome requiring high-flow nasal oxygen or noninvasive ventilation/intubation or (2) sepsis/septic shock.
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