Covid-19, early use of Paxlovid reduces viral load in patients with hematological tumors

COVID-19

oncology

09 April 2024

Patients with hematological cancers and non-severe Covid-19 infection treated with the nirmatrelvir/ritonavir (Paxlovid) combination have a rapid reduction in viral load and a shorter spread of the virus in the body. This is what was highlighted by research published in Influenza and Other Respiratory Viruses and led by Tommaso Francesco Aiello from the University of Barcelona, ​​Spain, who compared the clinical characteristics, viral load and outcomes in patients with Omicron variant infection and different types of blood cancer.

Covid-19 infections in patients with hematological malignancies
Blood cancer patients, whether they have received a stem cell transplant or not, have been significantly affected by Covid-19. The therapies they receive, in fact, lead to a compromise of the immune system which leads, in turn, to an inability to produce sufficient responses as a consequence of the Covid-19 vaccination.
The suboptimal immune response to vaccinations against Covid-19 thus leads both to the manifestation of a more serious and prolonged disease and to a delay in the management of previous haematological diseases.

The Spanish study
Aielli and colleagues enrolled 83 adult patients, 39.8% of whom were over 65, with high-risk hematological tumors who had been diagnosed with Covid-19 early and who received antiretroviral treatment. Furthermore, all included patients were not receiving oxygen therapy. Hematologic cancers included acute leukemia, lymphoma, multiple myeloma, chronic lymphocytic leukemia, myelodysplastic syndrome, and myelofibrosis.
Furthermore, among the patients involved, 94% had received a vaccine against Covid-19, while 18.1% had had a previous diagnosis of viral infection.

The evidence that emerged
90.4% of participants had symptoms such as fever, cough, pharyngitis and rhinorrhea and approximately half were treated with nirmatrelvir/ritonavir within one day of diagnosis, while the other half received remdesivir, within one to two days of diagnosis . The analysis of the results showed that the average viral shedding was 11 days after treatment with nirmatrelvir/ritonavir versus 18 days after therapy with remdesivir. Furthermore, the mean Ct value, which is inversely related to viral load and is represented by the number of cycles needed to detect viral load, was 33 with nirmatrelvir/ritonavir compared to 26 with remdesvir, after 5 days of treatment.

Aiello TF et al., Real-life comparison of antivirals for SARS-CoV-2 omicron infection in patients with hematologic malignancies. Influenza Other Respir Viruses (2024); 18(3):e13264

TAGS: COVID-19, HEMATOLOGY, PAXLOVID, CANCER