Oral antivirals for COVID-19 among patients with cancer

DOI record: { "DOI": "10.21203/rs.3.rs-3876022/v1", "URL": "http://dx.doi.org/10.21203/rs.3.rs-3876022/v1", "abstract": "<jats:title>Abstract</jats:title>\n <jats:p>Purpose:\nImmunocompromised individuals, such as those diagnosed with cancer, are at a significantly higher risk for severe illness and mortality when infected with SARS-CoV-2 (COVID-19) than the general population. Two oral antiviral treatments are approved for COVID-19: Paxlovid® (nirmatrelvir/ritonavir) and Lagevrio® (molnupiravir). There is a paucity of data regarding the benefit from these antivirals among immunocompromised patients with cancer, and recent studies have questioned their efficacy among vaccinated patients, even those with risk factors for severe COVID-19.\nMethods:\nWe evaluated the efficacy and safety of nirmatrelvir/ritonavir and molnupiravir in preventing severe illness and death using our database of 457 patients with cancer and COVID-19 from Brown University-affiliated hospitals. 67 patients received nirmatrelvir/ritonavir or molnupiravir and were compared to 56 concurrent controls who received no antiviral treatment despite being eligible to receive it.\nResults:\nAdministration of nirmatrelvir/ritonavir or molnupiravir was associated with improved survival and lower 90-day all-cause and COVID-19-attributed mortality (p&lt;0.05) and with lower peak O2 requirements (ordinal odds ratio [OR] 1.52, 95% confidence interval [CI] 0.92-2.56).\nConclusion:\nAcknowledging the small size of our sample as a limitation, we concluded that early antiviral treatment might be beneficial to immunocompromised individuals, particularly those with cancer, when infected with SARS-CoV-2. Larger-scale, well-stratified studies are needed in this patient population.</jats:p>", "accepted": { "date-parts": [ [ 2024, 1, 18 ] ] }, "author": [ { "affiliation": [ { "name": "Brown University" } ], "family": "Guermazi", "given": "Dorra", "sequence": "first" }, { "affiliation": [ { "name": "The Warren Alpert Medical School of Brown University" } ], "family": "Arvanitis", "given": "Panos", "sequence": "additional" }, { "affiliation": [ { "name": "The Warren Alpert Medical School of Brown University" } ], "family": "Vieira", "given": "Kendra", "sequence": "additional" }, { "affiliation": [ { "name": "Rhode Island Hospital" } ], "family": "Warner", "given": "Jeremy L.", "sequence": "additional" }, { "affiliation": [ { "name": "The Warren Alpert Medical School of Brown University" } ], "family": "Farmakiotis", "given": "Dimitrios", "sequence": "additional" } ], "container-title": [], "content-domain": { "crossmark-restriction": false, "domain": [] }, "created": { "date-parts": [ [ 2024, 1, 24 ] ], "date-time": "2024-01-24T18:57:57Z", "timestamp": 1706122677000 }, "deposited": { "date-parts": [ [ 2024, 1, 24 ] ], "date-time": "2024-01-24T18:57:59Z", "timestamp": 1706122679000 }, "group-title": "In Review", "indexed": { "date-parts": [ [ 2024, 1, 25 ] ], "date-time": "2024-01-25T00:30:16Z", "timestamp": 1706142616549 }, "institution": [ { "name": "Research Square" } ], "is-referenced-by-count": 0, "issued": { "date-parts": [ [ 2024, 1, 24 ] ] }, "license": [ { "URL": "https://creativecommons.org/licenses/by/4.0/", "content-version": "unspecified", "delay-in-days": 0, "start": { "date-parts": [ [ 2024, 1, 24 ] ], "date-time": "2024-01-24T00:00:00Z", "timestamp": 1706054400000 } } ], "link": [ { "URL": "https://www.researchsquare.com/article/rs-3876022/v1", "content-type": "text/html", "content-version": "vor", "intended-application": "text-mining" }, { "URL": "https://www.researchsquare.com/article/rs-3876022/v1.html", "content-type": "unspecified", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "8761", "original-title": [], "posted": { "date-parts": [ [ 2024, 1, 24 ] ] }, "prefix": "10.21203", "published": { "date-parts": [ [ 2024, 1, 24 ] ] }, "publisher": "Research Square Platform LLC", "reference": [ { "DOI": "10.1007/s00432-022-04191-y", "article-title": "\"Effects of SARS-CoV-2 infections in patients with cancer on mortality, ICU admission and incidence: a systematic review with meta-analysis involving 709,908 participants and 31,732 cancer patients,\" (in eng)", "author": "Arayici ME", "doi-asserted-by": "publisher", "first-page": "1", "journal-title": "J Cancer Res Clin Oncol", "key": "ref1", "unstructured": "M. E. Arayici et al., \"Effects of SARS-CoV-2 infections in patients with cancer on mortality, ICU admission and incidence: a systematic review with meta-analysis involving 709,908 participants and 31,732 cancer patients,\" (in eng), J Cancer Res Clin Oncol, pp. 1–14, Jul 13 2022, doi: 10.1007/s00432-022-04191-y.", "year": "2022" }, { "DOI": "10.1016/j.xcrm.2022.100781", "article-title": "\"Functional immune responses against SARS-CoV-2 variants of concern after fourth COVID-19 vaccine dose or infection in patients with blood cancer,\" (in eng)", "author": "Fendler A", "doi-asserted-by": "publisher", "first-page": "100781", "issue": "10", "journal-title": "Cell Rep Med", "key": "ref2", "unstructured": "A. 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Elkrief et al., \"Learning through a Pandemic: The Current State of Knowledge on COVID-19 and Cancer,\" (in eng), Cancer Discov, vol. 12, no. 2, pp. 303–330, Feb 2022, doi: 10.1158/2159-8290.Cd-21-1368.", "volume": "12", "year": "2022" }, { "DOI": "10.1056/NEJMoa2118542", "article-title": "\"Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19,\"", "author": "Hammond J", "doi-asserted-by": "publisher", "first-page": "1397", "journal-title": "New England Journal of Medicine", "key": "ref4", "unstructured": "J. 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