Clinical efficacy analysis of paxlovid in children with hematological diseases infected with the omicron SARS-CoV-2 new variant
Yixian Li, Yong Liu, Luping Wen, Hui Chen, Wenqing Wang, Mengyao Tian, Yucai Cheng, Hongman Xue, Chun Chen
Frontiers in Pediatrics, doi:10.3389/fped.2023.1160929
Objective: To summarize the clinical characteristics of children with hematological malignancies co-infected with novel coronavirus and explore the safety and effectiveness of Paxlovid treatment. Methods: From December 10, 2022, to January 20, 2023, the clinical data of children with hematological diseases diagnosed with novel coronavirus infection in the outpatient and emergency department of the Seventh Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. Results: According to whether to give paxlovid or not, it is divided into group A (paxlovid group) and group B (non-paxlovid group). The length of fever was 1-6 days in group A and 0-3 days in group B. The viral clearance time was shorter in group A than in group B. The inflammatory indexes CRP and PCT were significantly higher in group A than in group B (P < 0.05). Twenty patients were followed up for 1 month after leaving the hospital, and there were 5 cases of reappearance of fever, 1 case of increased sleep, 1 case of physical fatigue and 1 case of loss of appetite within 2 weeks. Conclusions: Paxlovid has no apparent adverse reactions in children 12 years old and younger with underlying hematological diseases infected with the new coronavirus. Focusing on the interaction between paxlovid and other drugs is necessary during the treatment.
Ethics statement The studies involving human participants were reviewed and approved by Ethics Committee of the Seventh Affiliated Hospital of Sun Yat-sen University. Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin. Written informed consent was obtained from the individual(s), and minor(s)' legal guardian/next of kin, for the publication of any potentially identifiable images or data included in this article.
Author contributions CC, HX and YC designed research; YL and YL analyzed data, and wrote the manuscript; LW, HC and WW acquired data, collected clinical data. MT reviewed the data. CC interpreted the data and reviewed the manuscript. All authors contributed to the article and approved the submitted version.
Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
Badri, Dutta, Coakley, Cohen, Ding et al., Pharmacokinetics and dose recommendations for cyclosporine and tacrolimus when coadministered with ABT-450, ombitasvir, and dasabuvir, Am J Transplant,
doi:10.1111/ajt.13111Cazalilla, COVID-19 in pediatric hematopoietic stem cell transplantation: the experience of spanish group of transplant (GETMON/GETH), Pediatr Blood Cancer,
doi:10.1002/pbc.28514Cesaro, Ljungman, Mikulska, Hirsch, Lilienfeld-Toal et al., Recommendations for the management of COVID-19 in patients with haematological malignancies or haematopoietic cell transplantation,
doi:10.1038/s41375-022-01578-1Creech, Anderson, Berthaud, Yildirim, Atz et al., Evaluation of mRNA-1273 COVID-19 vaccine in children 6 to 11 years of age, N Engl J Med,
doi:10.1056/NEJMoa2203315Diesch-Furlanetto, Gabriel, Zajac-Spychala, Cattoni, Hoeben et al., Late effects after haematopoietic stem cell transplantation in ALL, longterm follow-up and transition: a step into adult life, Front Pediatr,
doi:10.3389/fped.2021.773895Elens, Langman, Hesselink, Bergan, Moes et al., Pharmacologic treatment of transplant recipients infected with SARS-CoV-2: considerations regarding therapeutic drug monitoring and drug-drug interactions, Ther Drug Monit,
doi:10.1097/FTD.0000000000000761Fernandes, Inchakalody, Merhi, Mestiri, Taib et al., Emerging COVID-19 variants and their impact on SARS-CoV-2 diagnosis, therapeutics and vaccines, Ann Med,
doi:10.1080/07853890.2022.2031274Groll, Townsend, Desai, Azie, Jones et al., Drugdrug interactions between triazole antifungal agents used to treat invasive aspergillosis and immunosuppressants metabolized by cytochrome P450 3A4, Transpl Infect Dis,
doi:10.1111/tid.12751Haeusler, Ammann, Carlesse, Groll, Averbuch et al., SARS-CoV-2 in children with cancer or after haematopoietic stem cell transplant: an analysis of 131 patients, Eur J Cancer,
doi:10.1016/j.ejca.2021.09.027Hammond, Leister-Tebbe, Gardner, Abreu, Wisemandle, Oral nirmatrelvir for high-risk, nonhospitalized adults with COVID-19, N Engl J Med,
doi:10.1056/NEJMoa2118542Huang, Yin, Qin, Yu, Jiang et al., Case report: application of nirmatrelvir/ritonavir to treat COVID-19 in a severe aplastic anemia child after allogeneic hematopoietic stem cell transplantation, Front Pediatr,
doi:10.3389/fped.2022.935118Jayaweera, Perera, Gunawardana, Manatunge, Transmission of COVID-19 virus by droplets and aerosols: a critical review on the unresolved dichotomy, Environ Res,
doi:10.1016/j.envres.2020.109819Koinuma, Nunomiya, Wada, Koyama, Suzuki, Concurrent treatment with a tumor necrosis factor-alpha inhibitor and veno-venous extracorporeal membrane oxygenation in a post-hematopoietic stem cell transplant patient with idiopathic pneumonia syndrome: a case report, J Intensive Care,
doi:10.1186/s40560-014-0048-1Levy, Bacharier, Bateman, Boulet, Brightling et al., Guidelines for the prevention and management of children and adolescents with COVID-19, Eur J Pediatr,
doi:10.1007/s00431-022-04615-4Li, None
Liu, Chen, Hu, Huang, Geng et al., An ultra-sensitive and specific nanoplasmonic-enhanced isothermal amplification platform for the ultrafast point-of-care testing of SARS-CoV-2, Chem Eng J,
doi:10.1016/j.cej.2022.138822Lucchini, Furness, Lawson, Gibson, Wynn et al., COVID-19 infection in paediatric recipients of allogeneic stem cell transplantation: the UK experience, Br J Haematol,
doi:10.1111/bjh.17547Magro, Zanella, Pescarolo, Castelli, Quiros-Roldan, Lopinavir/ ritonavir: repurposing an old drug for HIV infection in COVID-19 treatment
Malden, Hong, Lewin, Ackerson, Lipsitch et al., Hospitalization and emergency department encounters for COVID-19 after Li et
Najjar-Debbiny, Gronich, Weber, Khoury, Amar et al., Effectiveness of paxlovid in reducing severe COVID-19 and mortality in high risk patients, Clin Infect Dis,
doi:10.1093/cid/ciac443Robert, Wong, Wright, Lemaitre, Budde et al., Therapeutic drug monitoring and dosage adjustments of immunosuppressive drugs when combined with nirmatrelvir/ritonavir in patients with COVID-19, Cochrane Database Syst Rev,
doi:10.1097/FTD.0000000000001014Sanft, Day, Peterson, Rodriguez, Ansbaugh et al., NCCN Guidelines ® insights: survivorship, version 1.2022, J Natl Compr Canc Netw,
doi:10.6004/jnccn.2022.0052Saravolatz, Depcinski, Sharma, Molnupiravir and nirmatrelvir-ritonavir: oral coronavirus disease 2019 antiviral drugs, Clin Infect Dis,
doi:10.1093/cid/ciac180Shah, Joyce, Plumb, Sahakian, Feldstein et al., Paxlovid associated with decreased hospitalization rate among adults with COVID-19-united States, MMWR Morb Mortal Wkly Rep,
doi:10.15585/mmwr.mm7148e2Siddiqi, Mehra, COVID-19 illness in native and immunosuppressed states: a clinical-therapeutic staging proposal, J Heart Lung Transplant,
doi:10.1016/j.healun.2020.03.012Tiseo, Barbieri, Galfo, Occhineri, Matucci et al., Efficacy and safety of nirmatrelvir/ritonavir, molnupiravir, and remdesivir in a realworld cohort of outpatients with COVID-19 at high risk of progression: the PISA outpatient clinic experience, Infect Dis Ther,
doi:10.1007/s40121-022-00729-2Tulimilli, Dallavalasa, Basavaraju, Rao, Chikkahonnaiah et al., Variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and vaccine effectiveness. Vaccines (Basel),
doi:10.3390/vaccines10101751Vicent, Martinez, Del Castillo, Molina, Sisini, None
Vogel, Voigt, Michaelis, Sudhop, Wolff et al., Management of drug-to-drug interactions between cyclosporine A and the proteaseinhibitor lopinavir/ritonavir in liver-transplanted HIV-infected patients, Liver Transpl,
doi:10.1002/lt.20165Yan, Zhou, Zhu, Chen, Lu et al., The feasibility, safety, and efficacy of paxlovid treatment in SARS-CoV-2-infected children aged 6-14 years: a cohort study, Ann Transl Med. (2022),
doi:10.21037/atm-22-2791Zimmermann, Curtis, Why is COVID-19 less severe in children? A review of the proposed mechanisms underlying the age-related difference in severity of SARS-CoV-2 infections, Arch Dis Child,
doi:10.1136/archdischild-2020-320338
