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Terapia combinada antiviral en pacientes gravemente inmunocomprometidos con COVID-19 persistente o recurrente
Keitaro Omori1, Hiroki Kitagawa2, Ayako Takamori3
1Department of Infectious Diseases, Hiroshima University Hospital, 1-2-3 Kasumi, Hiroshima, 734-8551, Japan; Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Hiroshima, 734-8551, Japan.
Resumen
Para pacientes con inmunodeficiencia severa con COVID-19, la terapia antiviral combinada demostró tasas de éxito más altas que la monoterapia después del fracaso del tratamiento inicial. Este enfoque puede ser beneficioso para el manejo de infecciones persistentes.
Área de la Ciencia:
- Enfermedades infecciosas
- Inmunología
- Farmacología
Sus antecedentes:
- La enfermedad por coronavirus 2019 (COVID-19) se trata principalmente con agentes antivirales.
- Los pacientes gravemente inmunocomprometidos pueden enfrentar enfermedades persistentes o recurrencias a pesar de la terapia antiviral, lo que requiere estrategias de manejo optimizadas.
- La eficacia de la monoterapia convencional frente a la terapia antiviral combinada en este grupo de pacientes aún no está clara.
Objetivo del estudio:
- Evaluar la eficacia de la monoterapia convencional en comparación con la terapia antiviral combinada en pacientes con inmunodeficiencia severa con COVID-19.
- Evaluar las tasas de éxito del tratamiento en los ciclos terapéuticos secundarios y posteriores tras el fracaso del tratamiento inicial.
Principales métodos:
- Un estudio de cohorte retrospectivo en un solo centro incluyó a pacientes con inmunodeficiencia severa con COVID-19 que no respondieron al tratamiento inicial.
- Se analizaron las tasas de éxito de la monoterapia convencional y la terapia combinada (≥2 agentes antivirales, secuenciales o concurrentes) para los ciclos de tratamiento posteriores.
- Se utilizó un modelo mixto lineal generalizado para identificar los factores asociados con el éxito del tratamiento.
Principales resultados:
- El estudio incluyó a 23 pacientes, predominantemente con neoplasias hematológicas (87,0%) y en tratamiento depletor de células B (69,6%).
- Las tasas generales de éxito fueron del 50,0% para 22 ciclos de monoterapia y del 91,7% para 12 ciclos de terapia combinada.
- La terapia combinada se asoció significativamente con el éxito del tratamiento (p=0,036), con un éxito del 100% en el segundo curso en comparación con el 56,3% para la monoterapia.
Conclusiones:
- La monoterapia antiviral convencional tiene una tasa de fracaso de aproximadamente el 50% en pacientes gravemente inmunocomprometidos con COVID-19 persistente después del fracaso del tratamiento inicial.
- La terapia antiviral combinada demuestra una alta tasa de éxito clínico en esta desafiante población de pacientes.
- La terapia combinada representa una estrategia potencialmente valiosa para el manejo del COVID-19 refractario en individuos gravemente inmunocomprometidos.
Palabras clave:
Terapia que agota las células BTerapia combinadaTumor maligno hematológicoInmunocompromisoCOVID-19 recurrenteMás Videos Relacionados
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