# Comparative Effectiveness of Antiviral Agents and Monoclonal Antibodies for Early SARS-CoV-2 Therapy in Immunocompromised Patients: A Multicenter Retrospective Cohort Study (March 2021–March 2022)

## TL;DR

This study compares how well antiviral drugs and monoclonal antibodies work in treating early COVID-19 in patients with weakened immune systems.

## Contribution

The study provides new evidence on the effectiveness of antiviral agents versus monoclonal antibodies in immunocompromised patients with SARS-CoV-2.

## Key findings

- Antiviral agents were associated with faster viral clearance compared to monoclonal antibodies.
- Monoclonal antibody-treated patients had a higher risk of sustained SARS-CoV-2 positivity on day 7 and day 30.
- There was no significant difference in hospitalization or mortality rates between the two treatment groups.

## Abstract

Immunocompromised (IC) patients continue to be at risk of severe COVID-19 despite vaccination and anti-SARS-CoV-2 therapies. The comparative effectiveness of antiviral agents (AVAs) and monoclonal antibodies (MoAbs) as early treatment of SARS-CoV-2 in IC patients is described in this work. This retrospective multicenter cohort study included IC outpatients diagnosed with SARS-CoV-2 between March 2021 and March 2022 at the National Institute for Infectious Diseases “Lazzaro Spallanzani” and Santa Maria Goretti University Hospital, Italy. Patients received either AVAs or MoAbs based on national guidelines. The primary outcome was time to negative nasopharyngeal swab (NPS). The secondary outcomes were COVID-19-related hospitalization or death by day 30. Among 1472 IC patients (with a median age of 58 years, 45% male), 688 (46%) were treated with MoAbs, and 783 (54%) were treated with AVAs. The patients treated with MoAbs had a higher duration to negative NPS (17 vs. 11 days, p < 0.05) and a higher risk of sustained SARS-CoV-2 positivity on day 7 (OR: 3.0, 95% CI: 1.72–5.23, p < 0.01) and day 30 (OR: 6.0, 95% CI: 3.7–10.5, p < 0.01) than those treated with AVAs. There were no differences in hospitalization or mortality. AVAs were associated with a more rapid viral clearance than MoAbs, suggesting a potential advantage for reducing infectious duration in IC patients. Additional studies are necessary to further optimize the early treatment of COVID-19 in this high-risk population.