Navigating COVID-19 in vulnerable patients: insights from dual antiviral therapy studies in the Omicron era

In managing COVID-19, researchers in Germany have delved into the challenges faced by immunocompromised patients, shedding light on effective strategies during the Omicron era. Dual antiviral therapy was the subject of two distinct studies run by Orth et al. and Götz et al. to combat prolonged viral shedding in people at high risk for serious illness.

Orth et al. observed 144 patients, with a significant 85% classified as immunocompromised, primarily due to factors such as solid organ transplantation (SOT) or hematologic malignancy (HM). Treatment regimens included a combination of direct-acting antivirals (DAAs) with or without anti-SARS-CoV-2 monoclonal antibodies (mAbs). Their findings revealed that the time to achieve a viral load below 106 copies/mL was notably prolonged in patients who initiated treatment more than 5 days after diagnosis and among those with immunocompromised conditions, particularly HM.

Multivariate analysis identified HM and delayed treatment initiation as significant factors associated with prolonged viral shedding. Similarly, Götz et al. managed 36 patients with diverse immunocompromising conditions, such as B-cell depletion and SOT.

Their study revealed that SOT recipients exhibited less prolonged viral shedding compared to B-cell-depleted patients. Notably, viral RNA was much harder to find in people who were getting dual antiviral therapy, which shows that it might work. Additionally, the duration of treatment played a crucial role, with therapy for over 10 days proving more effective in controlling symptoms.

These studies provide valuable insights into tailored approaches for managing COVID-19 in immunocompromised individuals during the current Omicron era.