{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T03:52:50Z","timestamp":1789876370906,"version":"4.0.1"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2023,3,28]],"date-time":"2023-03-28T00:00:00Z","timestamp":1679961600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Severely immunocompromised patients are at risk for prolonged or relapsed Coronavirus Disease 2019 (COVID-19), leading to increased morbidity and mortality. We aimed to evaluate efficacy and safety of combination treatment in immunocompromised COVID-19 patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We included all immunocompromised patients with prolonged\/relapsed COVID-19 treated with combination therapy with 2 antivirals (remdesivir plus nirmatrelvir\/ritonavir, or molnupiravir in case of renal failure) plus, if available, anti-spike monoclonal antibodies (mAbs), between February and October 2022. The main outcomes were virological response at day 14 (negative Severe Acute Respiratory Syndrome Coronavirus 2 [SARS-CoV-2] swab) and virological and clinical response (alive, asymptomatic, with negative SARS-CoV-2 swab) at day 30 and the last follow-up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Overall, 22 patients (Omicron variant in 17\/18) were included: 18 received full combination of 2 antivirals and mAbs and 4 received 2 antivirals only; in 20 of 22 (91%) patients, 2 antivirals were nirmatrelvir\/ritonavir plus remdesivir. Nineteen (86%) patients had hematological malignancy, and 15 (68%) had received anti-CD20 therapy. All were symptomatic; 8 (36%) required oxygen. Four patients received a second course of combination treatment. The response rate at day 14, day 30, and last follow-up was 75% (15\/20 evaluable), 73% (16\/22), and 82% (18\/22), respectively. Day 14 and 30 response rates were significantly higher when combination therapy included mAbs. Higher number of vaccine doses was associated with better final outcome. Two patients (9%) developed severe side effects (bradycardia leading to remdesivir discontinuation and myocardial infarction).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Combination therapy including 2 antivirals (mainly remdesivir and nirmatrelvir\/ritonavir) and mAbs was associated with high rate of virological and clinical response in immunocompromised patients with prolonged\/relapsed COVID-19.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciad181","type":"journal-article","created":{"date-parts":[[2023,3,29]],"date-time":"2023-03-29T00:23:34Z","timestamp":1680049414000},"page":"280-286","source":"Crossref","is-referenced-by-count":134,"title":["Triple Combination Therapy With 2 Antivirals and Monoclonal Antibodies for Persistent or Relapsed Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Immunocompromised Patients"],"prefix":"10.1093","volume":"77","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5535-4602","authenticated-orcid":false,"given":"Malgorzata","family":"Mikulska","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Health Sciences, University of Genoa , Genoa , Italy"},{"name":"Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino , Genova , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Sepulcri","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Health Sciences, University of Genoa , Genoa , Italy"},{"name":"Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino , Genova , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Dentone","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino , Genova , 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Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Labate","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Health Sciences, University of Genoa , Genoa , Italy"},{"name":"Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino , Genova , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Russo","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Health Sciences, University of Genoa , Genoa , Italy"},{"name":"Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino , Genova , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Mirabella","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino , Genova , 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Roberto","family":"Giacobbe","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Health Sciences, University of Genoa , Genoa , Italy"},{"name":"Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino , Genova , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Vena","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Health Sciences, University of Genoa , Genoa , Italy"},{"name":"Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino , Genova , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina","family":"Beltramini","sequence":"additional","affiliation":[{"name":"Pharmacy Unit, IRCCS Ospedale Policlinico San Martino , Genova , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca","family":"Bruzzone","sequence":"additional","affiliation":[{"name":"Department of Health 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