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Use of Oral Antivirals Ritonavir-Nirmatrelvir and Molnupiravir in Patients with Multiple Myeloma Is Associated with Low Rates of Severe COVID-19: A Single-Center, Prospective Study
In patients with multiple myeloma (MM), SARS-CoV-2 infection has been associated with a severe clinical course and high mortality rates due to the concomitant disease- and treatment-related immunosuppression. Specific antiviral treatment involves viral replication control with monoclonal antibodies...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10054373/ https://www.ncbi.nlm.nih.gov/pubmed/36992413 http://dx.doi.org/10.3390/v15030704 |
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author | Spiliopoulou, Vassiliki Ntanasis-Stathopoulos, Ioannis Malandrakis, Panagiotis Gavriatopoulou, Maria Theodorakakou, Foteini Fotiou, Despina Migkou, Magdalini Roussou, Maria Eleutherakis-Papaiakovou, Evangelos Kastritis, Efstathios Dimopoulos, Meletios A. Terpos, Evangelos |
author_facet | Spiliopoulou, Vassiliki Ntanasis-Stathopoulos, Ioannis Malandrakis, Panagiotis Gavriatopoulou, Maria Theodorakakou, Foteini Fotiou, Despina Migkou, Magdalini Roussou, Maria Eleutherakis-Papaiakovou, Evangelos Kastritis, Efstathios Dimopoulos, Meletios A. Terpos, Evangelos |
author_sort | Spiliopoulou, Vassiliki |
collection | PubMed |
description | In patients with multiple myeloma (MM), SARS-CoV-2 infection has been associated with a severe clinical course and high mortality rates due to the concomitant disease- and treatment-related immunosuppression. Specific antiviral treatment involves viral replication control with monoclonal antibodies and antivirals, including molnupiravir and the ritonavir-boosted nirmatrelvir. This prospective study investigated the effect of these two agents on SARS-CoV-2 infection severity and mortality in patients with MM. Patients received either ritonavir-nirmatrelvir or molnupiravir. Baseline demographic and clinical characteristics, as well as levels of neutralizing antibodies (NAbs), were compared. A total of 139 patients was treated with ritonavir-nirmatrelvir while the remaining 30 patients were treated with molnupiravir. In total, 149 patients (88.2%) had a mild infection, 15 (8.9%) had a moderate infection, and five (3%) had severe COVID-19. No differences in the severity of COVID-19-related outcomes were observed between the two antivirals. Patients with severe disease had lower neutralizing antibody levels before the COVID-19 infection compared to patients with mild disease (p = 0.04). Regarding treatment, it was observed that patients receiving belantamab mafodotin had a higher risk of severe COVID-19 (p < 0.001) in the univariate analysis. In conclusion, ritonavir-nirmatrelvir and molnupiravirmay prevent severe disease in MM patients with SARS-CoV-2 infection. This prospective study indicated the comparable effects of the two treatment options, providing an insight for further research in preventing severe COVID-19 in patients with hematologic malignancies. |
format | Online Article Text |
id | pubmed-10054373 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-100543732023-03-30 Use of Oral Antivirals Ritonavir-Nirmatrelvir and Molnupiravir in Patients with Multiple Myeloma Is Associated with Low Rates of Severe COVID-19: A Single-Center, Prospective Study Spiliopoulou, Vassiliki Ntanasis-Stathopoulos, Ioannis Malandrakis, Panagiotis Gavriatopoulou, Maria Theodorakakou, Foteini Fotiou, Despina Migkou, Magdalini Roussou, Maria Eleutherakis-Papaiakovou, Evangelos Kastritis, Efstathios Dimopoulos, Meletios A. Terpos, Evangelos Viruses Communication In patients with multiple myeloma (MM), SARS-CoV-2 infection has been associated with a severe clinical course and high mortality rates due to the concomitant disease- and treatment-related immunosuppression. Specific antiviral treatment involves viral replication control with monoclonal antibodies and antivirals, including molnupiravir and the ritonavir-boosted nirmatrelvir. This prospective study investigated the effect of these two agents on SARS-CoV-2 infection severity and mortality in patients with MM. Patients received either ritonavir-nirmatrelvir or molnupiravir. Baseline demographic and clinical characteristics, as well as levels of neutralizing antibodies (NAbs), were compared. A total of 139 patients was treated with ritonavir-nirmatrelvir while the remaining 30 patients were treated with molnupiravir. In total, 149 patients (88.2%) had a mild infection, 15 (8.9%) had a moderate infection, and five (3%) had severe COVID-19. No differences in the severity of COVID-19-related outcomes were observed between the two antivirals. Patients with severe disease had lower neutralizing antibody levels before the COVID-19 infection compared to patients with mild disease (p = 0.04). Regarding treatment, it was observed that patients receiving belantamab mafodotin had a higher risk of severe COVID-19 (p < 0.001) in the univariate analysis. In conclusion, ritonavir-nirmatrelvir and molnupiravirmay prevent severe disease in MM patients with SARS-CoV-2 infection. This prospective study indicated the comparable effects of the two treatment options, providing an insight for further research in preventing severe COVID-19 in patients with hematologic malignancies. MDPI 2023-03-08 /pmc/articles/PMC10054373/ /pubmed/36992413 http://dx.doi.org/10.3390/v15030704 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Communication Spiliopoulou, Vassiliki Ntanasis-Stathopoulos, Ioannis Malandrakis, Panagiotis Gavriatopoulou, Maria Theodorakakou, Foteini Fotiou, Despina Migkou, Magdalini Roussou, Maria Eleutherakis-Papaiakovou, Evangelos Kastritis, Efstathios Dimopoulos, Meletios A. Terpos, Evangelos Use of Oral Antivirals Ritonavir-Nirmatrelvir and Molnupiravir in Patients with Multiple Myeloma Is Associated with Low Rates of Severe COVID-19: A Single-Center, Prospective Study |
title | Use of Oral Antivirals Ritonavir-Nirmatrelvir and Molnupiravir in Patients with Multiple Myeloma Is Associated with Low Rates of Severe COVID-19: A Single-Center, Prospective Study |
title_full | Use of Oral Antivirals Ritonavir-Nirmatrelvir and Molnupiravir in Patients with Multiple Myeloma Is Associated with Low Rates of Severe COVID-19: A Single-Center, Prospective Study |
title_fullStr | Use of Oral Antivirals Ritonavir-Nirmatrelvir and Molnupiravir in Patients with Multiple Myeloma Is Associated with Low Rates of Severe COVID-19: A Single-Center, Prospective Study |
title_full_unstemmed | Use of Oral Antivirals Ritonavir-Nirmatrelvir and Molnupiravir in Patients with Multiple Myeloma Is Associated with Low Rates of Severe COVID-19: A Single-Center, Prospective Study |
title_short | Use of Oral Antivirals Ritonavir-Nirmatrelvir and Molnupiravir in Patients with Multiple Myeloma Is Associated with Low Rates of Severe COVID-19: A Single-Center, Prospective Study |
title_sort | use of oral antivirals ritonavir-nirmatrelvir and molnupiravir in patients with multiple myeloma is associated with low rates of severe covid-19: a single-center, prospective study |
topic | Communication |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10054373/ https://www.ncbi.nlm.nih.gov/pubmed/36992413 http://dx.doi.org/10.3390/v15030704 |
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