Successful Treatment of Persistent Symptomatic Coronavirus Disease 19 Infection With Extended-Duration Nirmatrelvir-Ritonavir Among Outpatients With Hematologic Cancer

Overview

Journal Open Forum Infect Dis

Specialty Infectious Diseases

Date 2023 Jun 29

PMID 37383248

Authors

Catherine Liu

Leah H Yoke

Pooja Bhattacharyya

Ryan D Cassaday

Guang-Shing Cheng

Zahra Kassamali Escobar

Cristina Ghiuzeli

Denise J McCulloch

Steven A Pergam

Pavitra Roychoudhury

Frank Tverdek

Joshua T Schiffer

Emily S Ford

Affiliations

Soon will be listed here.

Abstract

Persistent symptomatic coronavirus disease 2019 (COVID-19) is a distinct clinical entity among patients with hematologic cancer and/or profound immunosuppression. The optimal medical management is unknown. We describe 2 patients who had symptomatic COVID-19 for almost 6 months and were successfully treated in the ambulatory setting with extended courses of nirmatrelvir-ritonavir.

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References

Helleberg M, Niemann C, Moestrup K, Kirk O, Lebech A, Lane C . Persistent COVID-19 in an Immunocompromised Patient Temporarily Responsive to Two Courses of Remdesivir Therapy. J Infect Dis. 2020; 222(7):1103-1107. PMC: 7454684. DOI: 10.1093/infdis/jiaa446. View

Ford E, Simmons W, Karmarkar E, Yoke L, Braimah A, Orozco J . Successful Treatment of Prolonged, Severe Coronavirus Disease 2019 Lower Respiratory Tract Disease in a B cell Acute Lymphoblastic Leukemia Patient With an Extended Course of Remdesivir and Nirmatrelvir/Ritonavir. Clin Infect Dis. 2022; 76(5):926-929. PMC: 10226728. DOI: 10.1093/cid/ciac868. View

Laracy J, Kamboj M, Vardhana S . Long and persistent COVID-19 in patients with hematologic malignancies: from bench to bedside. Curr Opin Infect Dis. 2022; 35(4):271-279. PMC: 9922441. DOI: 10.1097/QCO.0000000000000841. View

Gao C, Cuttica M, Malsin E, Argento A, Wunderink R, Smith S . Comparing Nasopharyngeal and BAL SARS-CoV-2 Assays in Respiratory Failure. Am J Respir Crit Care Med. 2020; 203(1):127-129. PMC: 7781122. DOI: 10.1164/rccm.202008-3137LE. View

Chaguza C, Hahn A, Petrone M, Zhou S, Ferguson D, Breban M . Accelerated SARS-CoV-2 intrahost evolution leading to distinct genotypes during chronic infection. Cell Rep Med. 2023; 4(2):100943. PMC: 9906997. DOI: 10.1016/j.xcrm.2023.100943. View

Lee C, Shah M, Hoyos D, Solovyov A, Douglas M, Taur Y . Prolonged SARS-CoV-2 Infection in Patients with Lymphoid Malignancies. Cancer Discov. 2021; 12(1):62-73. PMC: 8758535. DOI: 10.1158/2159-8290.CD-21-1033. View

Breeden M, Aitken S, Baang J, Gravelin M, Kaul D, Lauring A . Successful Treatment of Prolonged Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Patients With Immunodeficiency With Extended Nirmatrelvir/Ritonavir: Case Series. Open Forum Infect Dis. 2023; 10(4):ofad189. PMC: 10114524. DOI: 10.1093/ofid/ofad189. View

Kemp S, Collier D, Datir R, Ferreira I, Gayed S, Jahun A . SARS-CoV-2 evolution during treatment of chronic infection. Nature. 2021; 592(7853):277-282. PMC: 7610568. DOI: 10.1038/s41586-021-03291-y. View

Martinez M, Chen T, Choi H, Hwang M, Navarathna D, Hao L . Extended Remdesivir Infusion for Persistent Coronavirus Disease 2019 Infection. Open Forum Infect Dis. 2022; 9(8):ofac382. PMC: 9384609. DOI: 10.1093/ofid/ofac382. View

10.

Choi B, Choudhary M, Regan J, Sparks J, Padera R, Qiu X . Persistence and Evolution of SARS-CoV-2 in an Immunocompromised Host. N Engl J Med. 2020; 383(23):2291-2293. PMC: 7673303. DOI: 10.1056/NEJMc2031364. View

11.

Trottier C, Wong B, Kohli R, Boomsma C, Magro F, Kher S . Dual Antiviral Therapy for Persistent Coronavirus Disease 2019 and Associated Organizing Pneumonia in an Immunocompromised Host. Clin Infect Dis. 2022; 76(5):923-925. PMC: 9620374. DOI: 10.1093/cid/ciac847. View

12.

Nussenblatt V, Roder A, Das S, de Wit E, Youn J, Banakis S . Yearlong COVID-19 Infection Reveals Within-Host Evolution of SARS-CoV-2 in a Patient With B-Cell Depletion. J Infect Dis. 2021; 225(7):1118-1123. PMC: 8755281. DOI: 10.1093/infdis/jiab622. View

13.

Corey L, Beyrer C, Cohen M, Michael N, Bedford T, Rolland M . SARS-CoV-2 Variants in Patients with Immunosuppression. N Engl J Med. 2021; 385(6):562-566. PMC: 8494465. DOI: 10.1056/NEJMsb2104756. View

14.

Graziani L, Gori L, Manciulli T, Basile G, Campolmi I, Borchi B . Successful use of nirmatrelvir/ritonavir in immunocompromised patients with persistent and/or relapsing COVID-19. J Antimicrob Chemother. 2022; 78(2):555-558. PMC: 9890247. DOI: 10.1093/jac/dkac433. View

15.

Lynch M, Macori G, Fanning S, ORegan E, Hunt E, OCallaghan D . Genomic Evolution of SARS-CoV-2 Virus in Immunocompromised Patient, Ireland. Emerg Infect Dis. 2021; 27(9):2499-2501. PMC: 8386806. DOI: 10.3201/eid2709.211159. View

16.

Dulery R, Lamure S, Delord M, Di Blasi R, Chauchet A, Hueso T . Prolonged in-hospital stay and higher mortality after Covid-19 among patients with non-Hodgkin lymphoma treated with B-cell depleting immunotherapy. Am J Hematol. 2021; 96(8):934-944. PMC: 8212109. DOI: 10.1002/ajh.26209. View