Early combination of sotrovimab with nirmatrelvir/ritonavir or remdesivir is associated with low rate of persisting SARS CoV-2 infection in immunocompromised outpatients with mild-to-moderate COVID-19: a prospective single center study.

BackgroundImmunocompromised patients are at high risk of developing persisting/prolonged COVID-19 Data concerning early combined use of antivirals and monoclonal antibodies in this population are scarce. Research design and methodsWe performed an observational, prospective study, enrolling immunocompromised outpatient adults with mild-to-moderate COVID-19 treated with a combination of sotrovimab plus one antiviral (remdesivir or nirmatrelvir/ritonavir) within 7 days from symptoms onset. ResultsWe enrolled 52 patients. No patient was hospitalized within 30 days from the disease onset, needed oxygen administration or died within 60 days, or experienced a reinfection or a clinical relapse within 90 days. Clearance rates were 67% and 97% at 14th day after the end of therapy and at the end of follow-up, respectively. Factors associated with longer infection were initiation of therapy after 3 days from symptoms onset, and enrollment more than 180 days from the beginning of the study. However, only the latter factor was independently associated with longer SARS-CoV-2 infection, suggesting a loss of efficacy of this strategy with the evolution of SARS-CoV-2 variants ConclusionsEarly administration of combination therapy with a direct antiviral and sotrovimab seems to be effective in preventing hospitalization, progression to severe COVID-19 and the development of prolonged/persisting SARS-CoV-2 infection in immunocompromised patients.