Nirmatrelvir/ritonavir in COVID-19 patients with haematological malignancies: a report from the EPICOVIDEHA registry

• Authors: SALMANTON-GARCIA Jon; MARCHESI Francesco; GOMES da Silva Maria; FARINA Francesca; DAVILA-VALLS Julio; BILGIN Yavuz M; GLENTHOJ Andreas; FALCES-ROMERO Iker; JAAP Van Doesum; LABRADOR Jorge; BUQUICCHIO Caterina; EL-ASHWAH Shaimaa; PETZER Verena; JENS Van Praet; SCHOENLEIN Martin; DARGENIO Michelina; MENDEZ Gustavo-Adolfo; MEERS Stef; ITRI Federico; GIORDANO Antonio; PINCZES Laszlo Imre; ESPIGADO Ildefonso; STOJANOSKI Zlate; LOPEZ-GARCIA Alberto; PREZIOSO Lucia; JAKSIC Ozren; VENA Antonio; FRACCHIOLLA Nicola S; GONZALEZ-LOPEZ Tomas Jose; COLOVIC Natasa; DELIA Mario; WEINBERGEROVÁ Barbora; MARCHETTI Monia; MARQUES de Almeida Joyce; FINIZIO Olimpia; BESSON Caroline; BIERNAT Monika M; VALKOVIC Toni; LAHMER Tobias; CUCCARO Annarosa; ORMAZABAL-VELEZ Irati; BATINIC Josip; FERNANDEZ Noemi; NICK De Jonge; TASCINI Carlo; ANASTASOPOULOU Amalia N; DULERY Remy; ILARIA Del Principe Maria; PLANTEFEVE Gaetan; PAPA Mario Virgilio; NUCCI Marcio; JIMENEZ Moraima; AUJAYEB Avinash; HERNANDEZ-RIVAS Jose-angel; MERELLI Maria; CATTANEO Chiara; BLENNOW Ola; NORDLANDER Anna; CABIRTA Alba; VARRICCHIO Gina; SACCHI Maria Vittoria; CORDOBA Raul; ARELLANO Elena; GRAFE Stefanie K; WOLF Dominik; EMARAH Ziad; AMMATUNA Emanuele; HERSBY Ditte Stampe; MARTIN-PEREZ Sonia; RODRIGUES Raquel Nunes; RAHIMLI Laman; PAGANO Livio; CARTNEY Oliver A
• Year of publication: 2023
• Type: Article in Periodical
• Magazine / Source: EClinicalMedicine
• MU Faculty or unit: Faculty of Medicine
• Web: https://www.sciencedirect.com/science/article/pii/S2589537023001165?via%3Dihub
• Doi: http://dx.doi.org/10.1016/j.eclinm.2023.101939
• Keywords: Nirmatrelvir; SARS-CoV-2; Haematology; Malignancy; COVID-19
• Description: Background Nirmatrelvir/ritonavir treatment decreases the hospitalisation rate in immunocompetent patients with COVID-19, but data on efficacy in patients with haematological malignancy are scarce. Here, we describe the outcome of nirmatrelvir/ritonavir treatment in a large cohort of the latter patients. Methods This is a retrospective cohort study from the multicentre EPICOVIDEHA registry (NCT04733729) on pa-tients with haematological malignancy, who were diagnosed with COVID-19 between January and September 2022. Patients receiving nirmatrelvir/ritonavir were compared to those who did not. A logistic regression was run to determine factors associated with nirmatrelvir/ritonavir administration in our sample. Mortality between treatment groups was assessed with Kaplan-Meier survival plots after matching all the patients with a propensity score. Additionally, a Cox regression was modelled to detect factors associated with mortality in patients receiving nirmatrelvir/ritonavir. Findings A total of 1859 patients were analysed, 117 (6%) were treated with nirmatrelvir/ritonavir, 1742 (94%) were treated otherwise. Of 117 patients receiving nirmatrelvir/ritonavir, 80% had received >= 1 anti-SARS-CoV-2 vaccine dose before COVID-19 onset, 13% of which received a 2nd vaccine booster. 5% were admitted to ICU. Nirmatrelvir/ritonavir treatment was associated with the presence of extrapulmonary symptoms at COVID-19 onset, for example anosmia, fever, rhinitis, or sinusitis (aOR 2.509, 95%CI 1.448-4.347) and 2nd vaccine booster (aOR 3.624, 95%CI 1.619-8.109). Chronic pulmonary disease (aOR 0.261, 95%CI 0.093-0.732) and obesity (aOR 0.105, 95%CI 0.014-0.776) were not associated with nirmatrelvir/ritonavir use. After propensity score matching, day-30 mortality rate in patients treated with nirmatrelvir/ritonavir was 2%, significantly lower than in patients with SARS-CoV-2 directed treatment other than nirmatrelvir/ritonavir (11%, p = 0.036). No factor was observed explaining the mortality difference in patients after nirmatrelvir/ritonavir administration. Interpretation Haematological malignancy patients were more likely to receive nirmatrelvir/ritonavir when reporting extrapulmonary symptoms or 2nd vaccine booster at COVID-19 onset, as opposed to chronic pulmonary disease and obesity. The mortality rate in patients treated with nirmatrelvir/ritonavir was lower than in patients with targeted drugs other than nirmatrelvir/ritonavir. Funding EPICOVIDEHA has received funds from Optics COMMIT (COVID-19 Unmet Medical Needs and Asso-ciated Research Extension) COVID-19 RFP program by GILEAD Science, United States (Project 2020-8223). Copyright (c) 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).