Frontiers in Medicine (Feb 2024)

B-cell-depleted patients with persistent SARS-CoV-2 infection: combination therapy or monotherapy? A real-world experience

  • Alessandra D’Abramo,
  • Serena Vita,
  • Alessia Beccacece,
  • Assunta Navarra,
  • Raffaella Pisapia,
  • Francesco Maria Fusco,
  • Giulia Matusali,
  • Enrico Girardi,
  • Fabrizio Maggi,
  • Delia Goletti,
  • Emanuele Nicastri,
  • ImmunoCOVID team,
  • Tommaso Ascoli Bartoli,
  • Nazario Bevilacqua,
  • Angela Corpolongo,
  • Patrizia De Marco,
  • Maria Letizia Giancola,
  • Gaetano Maffongelli,
  • Andrea Mariano,
  • Laura Scorzolini,
  • Claudia Palazzolo,
  • Silvia Rosati,
  • Virginia Tomassi,
  • Francesca Faraglia,
  • Lavinia Fabeni,
  • Martina Rueca,
  • Silvia Meschi,
  • Cesare Ernesto Maria Gruber

DOI
https://doi.org/10.3389/fmed.2024.1344267
Journal volume & issue
Vol. 11

Abstract

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ObjectivesThe aim of the study was to describe a cohort of B-cell-depleted immunocompromised (IC) patients with prolonged or relapsing COVID-19 treated with monotherapy or combination therapy.MethodsThis is a multicenter observational retrospective study conducted on IC patients consecutively hospitalized with a prolonged or relapsing SARS-CoV-2 infection from November 2020 to January 2023. IC COVID-19 subjects were stratified according to the monotherapy or combination anti-SARS-CoV-2 therapy received.ResultsEighty-eight patients were enrolled, 19 under monotherapy and 69 under combination therapy. The study population had a history of immunosuppression (median of 2 B-cells/mm3, IQR 1–24 cells), and residual hypogammaglobulinemia was observed in 55 patients. A reduced length of hospitalization and time to negative SARS-CoV-2 molecular nasopharyngeal swab (NPS) in the combination versus monotherapy group was observed. In the univariable and multivariable analyses, the percentage change in the rate of days to NPS negativity showed a significant reduction in patients receiving combination therapy compared to those receiving monotherapy.ConclusionIn IC persistent COVID-19 patients, it is essential to explore new therapeutic strategies such as combination multi-target therapy (antiviral or double antiviral plus antibody-based therapies) to avoid persistent viral shedding and/or severe SARS-CoV-2 infection.

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