Time to negative PCR conversion amongst high-risk patients with mild-to-moderate Omicron BA.1 and BA.2 COVID-19 treated with sotrovimab or nirmatrelvir - Sorbonne Université Access content directly
Journal Articles Clinical Microbiology and Infection Year : 2022

Time to negative PCR conversion amongst high-risk patients with mild-to-moderate Omicron BA.1 and BA.2 COVID-19 treated with sotrovimab or nirmatrelvir

1 Infinity - Institut Toulousain des Maladies Infectieuses et Inflammatoires
2 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
3 CHU Pitié-Salpêtrière [AP-HP]
4 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
5 ANRS - Agence Nationale de Recherches sur le Sida et les Hépatites Virales
6 Centre Hospitalier Sud Francilien
7 Service des Maladies infectieuses et tropicales [CHU Necker]
8 EA 4537 - Laboratoire de Virologie-Immunologie [Fort de France, Martinique]
9 Centre Hospitalier Universitaire de Martinique [Fort-de-France, Martinique]
10 CIC - Antilles Guyane - Centre d'Investigation Clinique Antilles-Guyane
11 PCCEI - Pathogenesis and Control of Chronic and Emerging Infections
12 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
13 AGEN - SAU - Service d'Accueil des Urgences
14 CHU Saint-Antoine [AP-HP]
15 Service Maladies infectieuses et tropicales [CHU Toulouse]
16 CHU Trousseau [Tours]
17 PHAR2 [Poitiers] - Pharmacologie des anti-infectieux et antibiorésistance [U 1070]
18 Université de Poitiers - Faculté de Médecine et de Pharmacie
19 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
20 IAME (UMR_S_1137 / U1137) - Infection, Anti-microbiens, Modélisation, Evolution
21 Imperial College London
22 Hôtel-Dieu de Nantes
23 CIC Nantes - Centre d’Investigation Clinique de Nantes
24 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
25 CIC-EC - Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques
26 Service de Médecine Interne [CHI Poissy-Saint-Germain]
27 CHU Tenon [AP-HP]
28 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
29 INCIT - Immunology and New Concepts in ImmunoTherapy
30 CHU Angers - Centre Hospitalier Universitaire d'Angers
31 CHR de Metz-Thionville
32 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
33 CHU Bordeaux
Gilles Pialoux
  • Function : Author
Charles Cazanave
  • Function : Author
Philippe Petua
  • Function : Author

Abstract

Objectives: Our aim was to compare the clinical and virological outcomes of Omicron BA.1 and BA.2-infected patients who received Sotrovimab or Nirmatrelvir to prevent severe COVID-19. Methods: In the multicentric prospective ANRS 0003S CoCoPrev cohort study, patients at high-risk for progression with mild-to-moderate BA.1 or BA.2 COVID-19 who received Sotrovimab or Nirmatrelvir were included. Proportion of patients with progression to severe COVID-19, time between the start of treatment to negative PCR, SARS-CoV-2 viral decay, and characterization of resistance variants were determined. A multivariable Cox proportional hazard model was used for time to negative PCR and a mixed effect model for the dynamics of viral decay. Results: Among the 255 included patients, of whom 199/255 (80%) received ≥3 vaccine doses, 195/255 (76%) received Sotrovimab and 60/255 (24%) received Nirmatrelvir. At day 28, new COVID-19-related hospitalization occurred in 4/193 (2%, 95%CI 1-5%) Sotrovimab-treated patients, and 0/55 Nirmatrelvir-treated patient (p=0.24). One out of 55 Nirmatrelvir-treated patients died (2%, 95%CI 0-10%). The median time to negative PCR was 11.5 days (95%CI 10.5-13) in Sotrovimab-treated patients vs. 4 days (95% CI 4-9) in Nirmatrelvir-treated patients (p<0.001). Viral decay was faster in patients who received Nirmatrelvir (p<0.001). In multivariable analysis Nirmatrelvir and nasopharyngeal PCR cycle threshold value were independently associated with a faster conversion to negative PCR (HR 2.35, 95%CI 1.56-3.56, p<0.0001, and HR 1.05, 95%CI 1.01-1.08, p=0.01, respectively). Conclusions: Early administration of Nirmatrelvir in high-risk patients, compared to Sotrovimab, was associated with a faster viral clearance. This may participate to decrease transmission and prevent viral resistance.
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hal-03947698 , version 1 (19-01-2023)

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Guillaume Martin-Blondel, Anne-Geneviève Marcelin, Cathia Soulié, Sofia Kaisaridi, Clovis Lusivika-Nzinga, et al.. Time to negative PCR conversion amongst high-risk patients with mild-to-moderate Omicron BA.1 and BA.2 COVID-19 treated with sotrovimab or nirmatrelvir. Clinical Microbiology and Infection, 2022, ⟨10.1016/j.cmi.2022.12.016⟩. ⟨hal-03947698⟩
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