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Oral antivirals for COVID-19 among patients with cancer

Affiliations
  • 1Brown University, 69 Brown St. Providence, Providence, RI, 02912, USA. dorra_guermazi@brown.edu.
  • 2Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Gerry House 111, Providence, RI, 02903, USA. dorra_guermazi@brown.edu.
  • 3Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Gerry House 111, Providence, RI, 02903, USA.
  • 4Center for Clinical Cancer Informatics and Data Science, Legorreta Cancer Center, Brown University, Providence, RI, 02912, USA.
  • 5Lifespan Cancer Institute, Rhode Island Hospital, Providence, RI, 02906, USA.

Published on:

July 9, 2024

Abstract

PURPOSE

Immunocompromised individuals, such as those diagnosed with cancer, are at a significantly higher risk for severe illness and mortality when infected with SARS-CoV-2 (COVID-19) than the general population. Two oral antiviral treatments are approved for COVID-19: Paxlovid® (nirmatrelvir/ritonavir) and Lagevrio® (molnupiravir). There is a paucity of data regarding the benefit from these antivirals among immunocompromised patients with cancer, and recent studies have questioned their efficacy among vaccinated patients, even those with risk factors for severe COVID-19.

METHODS

We evaluated the efficacy and safety of nirmatrelvir/ritonavir and molnupiravir in preventing severe illness and death using our database of 457 patients with cancer and COVID-19 from Brown University-affiliated hospitals.

RESULTS

Sixty-seven patients received nirmatrelvir/ritonavir or molnupiravir and were compared to 45 concurrent controls who received no antiviral treatment despite being eligible to receive it. Administration of nirmatrelvir/ritonavir or molnupiravir was associated with improved survival and lower 90-day all-cause and COVID-19-attributed mortality (p < 0.05) and with lower peak O requirements (ordinal odds ratio [OR] 1.52, 95% confidence interval [CI] 0.92-2.56).

CONCLUSION

Acknowledging the small size of our sample as a limitation, we concluded that early antiviral treatment might be beneficial to immunocompromised individuals, particularly those with cancer, when infected with SARS-CoV-2. Larger-scale, well-stratified studies are needed in this patient population.

Keywords:

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