Retreatment or prolonged antiviral therapy in severe acute respiratory syndrome Coronavirus-2 infection among immunocompromised patients during 2022-2023: A nationwide claims-based cohort study in Japan.

INTRODUCTION

Remdesivir (RDV), the standard treatment for hospitalized COVID-19, was ineffective in some immunocompromised individuals, requiring retreatment or prolonged antiviral therapy. However, the associated risk factors remain unclear.

METHODS

We conducted a retrospective cohort study using a nationwide administrative claims database encompassing 11 million individuals. Adult inpatients diagnosed with COVID-19 who received RDV for more than 5 days between July 2022, and June 2023, were included. The primary outcome was defined as either retreatment with any antiviral agent within 90 days or RDV administration beyond 10 days. Patient characteristics, underlying diseases, and recent immunosuppressive therapies were analyzed to identify risk factors.

RESULTS

Among 1067 adult inpatients with COVID-19 received RDV for more than 5 days, 2.5 % (27/1067) of patients received either retreatment or prolonged antiviral treatment. Patients with malignant lymphoma (15/72 [20.8 %] vs. 12/995 [1.2 %], Risk Ratio [RR] = 17.3 [95 % confidence interval 8.4-35.5]), hypogammaglobulinemia (5/15 [33.3 %] vs. 22/1052 [2.1 %], RR = 15.9 [7.0-36.4]), multiple myeloma (3/20 [15.0 %] vs. 24/1047 [2.3 %], RR = 6.5 [2.1-20.0]), who underwent anti-CD20 monoclonal antibody therapy within 365 days (12/34 [35.3 %] vs. 15/1033 [1.5 %], RR = 24.3 [12.3-47.9]), corticosteroid use equivalent to prednisolone ≧ 20 mg/day for >21 days (6/28 [21.4 %] vs. 21/1039 [2.0 %], RR = 10.6 [4.6-24.2]), were more likely to have received retreatment or prolonged antiviral therapy.

CONCLUSION

Our findings highlight a distinct subgroup of immunocompromised patients at elevated risk of retreatment or prolonged therapy. These findings underscore the need for early identification and personalized antiviral strategies in immunocompromised patients at risk of persistent COVID-19 infection.