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Head of Department of Infectious Diseases and Tropical Medicine
Full Professor of Infectious Diseases
Infectious Diseases Clinics, University Hospital
University of Modena and Reggio Emilia
Cristina Mussini, MD, has disclosed that she has received consulting fees from AbbVie, Angelini, Gilead Sciences, Janssen, MSD, and ViiV Healthcare and funds for research support from Gilead Sciences, Janssen, MSD, and ViiV Healthcare.
COVID-19 data at the 2022 European Congress of Clinical Microbiology and Infectious Diseases (ECCMID 2022) expanded our knowledge and confirmed many best practices related to treatment, vaccination, and long COVID.
Monoclonal Antibody Combination for Prevention and Treatment
Tixagevimab/cilgavimab was evaluated for treatment of nonhospitalized adult patients with mild to moderate COVID-19 who had been experiencing symptoms for ≤7 days. Researchers found that the antibody combination reduced the risk of developing severe COVID-19 or death by 50% vs placebo when administered within 7 days of symptom onset. Of importance, there was a trend toward earlier treatment initiation being associated with an even greater risk reduction. This confirms our approach that, when it comes to COVID-19 treatment initiation, the earlier the better.
This study is practice changing because it provides the first data to demonstrate the efficacy of a monoclonal antibody combination for both prevention and treatment of COVID-19. Before this study, tixagevimab/cilgavimab was authorized only as pre-exposure prophylaxis of COVID-19. This study also highlights the importance of administering the medication as soon as possible to achieve optimal efficacy.
Continued Efficacy of Antiviral Agents
We have reached the point in the pandemic where we have several available direct-acting antiviral treatment options for COVID-19. Most new data emerging on these agents are subanalyses of their landmark trials.
At ECCMID 2022, separate subanalyses of remdesivir and molnupiravir use in nonhospitalized patients confirmed several themes, including efficacy at reducing SARS-CoV-2 viral load in infected individuals and the beneficial effects of early use of these agents.
Hospitalized Patients: What Works
Retrospective data from a single-center, case-control study of hospitalized patients in southeast Michigan added to our body of knowledge that COVID-19 vaccination is protective against critical COVID-19 illness in patients with breakthrough infections. This is key to ensuring continued vaccination—including boosters—of everyone who is eligible.
Drug shortages are frequent in hospitals and have continued to be an issue throughout the pandemic. Data from a single center in Miami showed that, when an immunomodulator was unavailable, substituting another (in this case, baricitinib for tocilizumab) in a largely unvaccinated, critically ill population resulted in a survival rate of nearly 60%. This real-world experience with unvaccinated, critically ill patients underscores both the need for vaccination and the need for ready access to and early use of effective treatments to improve patient outcomes in our sickest patients.
Long COVID Symptoms 1 Year Post Infection
Also of interest at ECCMID 2022 was the topic of long COVID. Self-reported symptom data demonstrate an association between incidence of a moderate/severe acute COVID-19 infection and prevalence of having ≥1 long COVID symptom 1 year later. Data are continuing to evolve in this area, but fatigue and shortness of breath are commonly reported long COVID symptoms.
This will be a topic to watch as we understand more about the risk factors and symptomatology of long COVID, as well as how to treat it.
What did you think were the most exciting new COVID-19 data presented at ECCMID 2022? Answer the polling question and join the conversation by posting a comment.