Efficacy of Remdesivir and Neutralizing Monoclonal Antibodies in Monotherapy or Combination Therapy in Reducing the Risk of Disease Progression in Elderly or Immunocompromised Hosts Hospitalized for COVID-19: A Single Center Retrospective Study
Davide Fiore Bavaro, Lucia Diella, Alessandra Belati, Giuliana Metrangolo, Laura De Santis, Vito Spada, Michele Camporeale, Angelo Dargenio, Gaetano Brindicci, Flavia Balena, Deborah Fiordelisi, Fabio Signorile, Giacomo Loseto, Crescenza Pasciolla, Carla Minoia, Immacolata Attolico, Tommasina Perrone, Simona Simone, Maria Rendina, Nicoletta Giovine, Francesco Di Gennaro, Pellegrino Musto, Attilio Guarini, Alfredo Di Leo, Loreto Gesualdo, Maria Dell’aera, Annalisa Saracino
Viruses, doi:10.3390/v15051199
Introduction: Remdesivir (REM) and monoclonal antibodies (mAbs) could alleviate severe COVID-19 in at-risk outpatients. However, data on their use in hospitalized patients, particularly in elderly or immunocompromised hosts, are lacking. Methods: All consecutive patients hospitalized with COVID-19 at our unit from 1 July 2021 to 15 March 2022 were retrospectively enrolled. The primary outcome was the progression to severe COVID-19 (P/F < 200). Descriptive statistics, a Cox univariate-multivariate model, and an inverse probability treatment-weighted (IPTW) analysis were performed. Results: Overall, 331 subjects were included; their median (q1-q3) age was 71 (51-80) years, and they were males in 52% of the cases. Of them, 78 (23%) developed severe COVID-19. All-cause in-hospital mortality was 14%; it was higher in those with disease progression (36% vs. 7%, p < 0.001). REM and mAbs resulted in a 7% (95%CI = 3-11%) and 14% (95%CI = 3-25%) reduction in the risk of severe COVID-19, respectively, after adjusting the analysis with the IPTW. In addition, by evaluating only immunocompromised hosts, the combination of REM and mAbs was associated with a significantly lower incidence of severe COVID-19 (aHR = 0.06, 95%CI = 0.02-0.77) when compared with monotherapy. Conclusions: REM and mAbs may reduce the risk of COVID-19 progression in hospitalized patients. Importantly, in immunocompromised hosts, the combination of mAbs and REM may be beneficial.
Supplementary Materials: The following supporting information can be downloaded at: https: //www.mdpi.com/article/10.3390/v15051199/s1, Table S1 : Standardized differences of variables used to generate the IPTW model.
Institutional Review Board Statement: The study was conducted with the formal approval of the ethics committee of the University Hospital Policlinico (Bari, Italy) (Study Code: 6357). The study was
Conflicts of Interest: The authors declare no conflict of interest.
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'abstract': '<jats:p>Introduction: Remdesivir (REM) and monoclonal antibodies (mAbs) could alleviate '
'severe COVID-19 in at-risk outpatients. However, data on their use in hospitalized patients, '
'particularly in elderly or immunocompromised hosts, are lacking. Methods: All consecutive '
'patients hospitalized with COVID-19 at our unit from 1 July 2021 to 15 March 2022 were '
'retrospectively enrolled. The primary outcome was the progression to severe COVID-19 (P/F '
'< 200). Descriptive statistics, a Cox univariate–multivariate model, and an inverse '
'probability treatment-weighted (IPTW) analysis were performed. Results: Overall, 331 subjects '
'were included; their median (q1–q3) age was 71 (51–80) years, and they were males in 52% of '
'the cases. Of them, 78 (23%) developed severe COVID-19. All-cause in-hospital mortality was '
'14%; it was higher in those with disease progression (36% vs. 7%, p < 0.001). REM and mAbs '
'resulted in a 7% (95%CI = 3–11%) and 14% (95%CI = 3–25%) reduction in the risk of severe '
'COVID-19, respectively, after adjusting the analysis with the IPTW. In addition, by '
'evaluating only immunocompromised hosts, the combination of REM and mAbs was associated with '
'a significantly lower incidence of severe COVID-19 (aHR = 0.06, 95%CI = 0.02–0.77) when '
'compared with monotherapy. Conclusions: REM and mAbs may reduce the risk of COVID-19 '
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'combination of mAbs and REM may be beneficial.</jats:p>',
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