慢性または再発性COVID-19の重症免疫低下患者の抗ウイルス併用療法
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.
まとめ
COVID-19 の重度の免疫低下患者の場合,併用抗ウイルス治療は,初期治療の失敗後に単独治療よりも高い成功率を示しました. このアプローチは,持続的な感染症の管理に有益である可能性があります.
科学分野:
- 感染症
- 免疫学
- 薬理学について
背景:
- 2019年新型コロナウイルス病 (COVID-19) は主に抗ウイルス剤で治療されます.
- 重度の免疫低下患者は,抗ウイルス療法にもかかわらず,持続的な病気や再発に直面し,最適化された管理戦略を必要とします.
- この患者群における従来の単独治療と併用抗ウイルス治療の有効性は不明である.
研究 の 目的:
- 重度の免疫低下のCOVID-19患者の併用抗ウイルス療法と比較して,従来の単体療法の有効性を評価する.
- 最初の治療が失敗した後の第2回およびその後の治療の成功率を評価する.
主な方法:
- 単一センターでの遡及的なコホート研究では,初期治療に反応しなかったCOVID-19の重度の免疫低下患者も含まれていました.
- 従来の単独療法と併用療法 (≥2種類の抗ウイルス薬,連続または同時) の成功率は,その後の治療コースで分析されました.
- 治療の成功に関連する要因を特定するために,一般化された線形混合モデルを使用した.
主要な成果:
- この研究には,主に血液性悪性腫瘍 (87. 0%) とB細胞減少治療 (69. 6%) を受けている患者23人が参加した.
- 総合的な成功率は,単独治療の22コースで50. 0%,併用治療の12コースで91. 7%でした.
- 併用療法は治療の成功率と有意に関連していた (p=0. 036),第2回の治療では100%の成功率で,単独治療では56. 3%の成功率であった.
結論:
- 従来の抗ウイルス単独治療は,初期治療の失敗後に持続的なCOVID-19の重度の免疫低下患者の約50%の失敗率があります.
- 抗ウイルス併用治療は,この困難な患者集団において高い臨床成功率を示しています.
- コンビネーション・セラピーは,重症で免疫力が低下した患者に耐性のあるCOVID-19の管理に有効な戦略です.
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