Risk of serious COVID-19 outcomes among adults and children with moderate-to-severe asthma: a systematic review and meta-analysis

Lee, Bohee; Lewis, Grace; Agyei-Manu, Eldad; Atkins, Nadege; Bhattacharyya, Urmila; Dozier, Marshall; Rostron, Jasmin; Sheikh, Aziz; McQuillan, Ruth; Τheodoratou, Evropi

doi:10.1183/16000617.0066-2022

Cited by 18 publications

(11 citation statements)

References 38 publications

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“…Coronavirus disease 2019 (COVID-19) is caused by SARS-CoV-2 infection, which in most individuals is mild to moderate; however, older people and those with chronic diseases are at higher risk to develop severe disease. Although primary and boosted vaccination against SARS-CoV-2 has significantly reduced the risk of severe disease and death [ 1–4 ], COVID-19 remains a significant problem for highly vulnerable populations, including the elderly and those who are immunocompromised or have chronic diseases [ 5–7 ]. Thus, the availability of oral antiviral agents that are effective against SARS-CoV-2 might further reduce the risk of hospitalization, disease progression, and death, particularly among patients at high risk.…”

mentioning

confidence: 99%

Real-world Effectiveness of Molnupiravir and Nirmatrelvir/Ritonavir as Treatments for COVID-19 in Patients at High Risk

Paraskevis,

Gkova,

Mellou

et al. 2023

The Journal of Infectious Diseases

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Background We aimed to evaluate the effectiveness of molnupiravir and nirmatrelvir/ritonavir in highly vulnerable SARS-CoV-2 patients using a retrospective cohort study design. Methods The impact of each drug was determined via comparisons with age-matched control groups of SARS-CoV-2-positive patients who did not receive oral antiviral therapy. Results Administration of molnupiravir significantly reduced the risk of hospitalization (Odds Ratio [OR] = 0.40, p < 0.001) and death (OR = 0.31, p < 0.001) among these patients based on data adjusted for age, previous SARS-CoV-2 infection, vaccination status, and time elapsed since the most recent vaccination. The reductions in risk were most profound among elderly patients (≥75 years old) and among those with high levels of drug adherence. Administration of nirmatrelvir/ritonavir also resulted in significant reductions in the risk of hospitalization (OR = 0.31, p < 0.001) and death (OR = 0.28, p < 0.001). Similar to molnupiravir, the impact of nirmatrelvir/ritonavir was more substantial among elderly patients and in those with high levels of drug adherence. Conclusions Collectively, these real-world findings suggest that although the risks of hospitalization and death due to COVID-19 have been reduced, antivirals can provide additional benefits to members of highly vulnerable patient populations.

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mentioning

confidence: 99%

Real-world Effectiveness of Molnupiravir and Nirmatrelvir/Ritonavir as Treatments for COVID-19 in Patients at High Risk

Paraskevis,

Gkova,

Mellou

et al. 2023

The Journal of Infectious Diseases

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“…In school-aged children and adolescents, no association was observed between asthma and the risk of COVID-19 infection or severity 4–6. However, patients with severe asthma requiring high-dose inhaled corticosteroids (ICS) or oral corticosteroids had increased odds of hospital admission, but not intensive care unit (ICU) admission or mortality, whereas data on children are scarce 7. Importantly, patients with severe asthma treated with biologics, do not appear more likely to experience adverse outcomes due to COVID-19 infection, compared with the general population 8.…”

Section: Direct Effects Of Sars-cov-2 On Allergic Individualsmentioning

confidence: 99%

How does the pandemic shape the future of allergies?

Papadopoulos,

Miligkos

2023

BMJNPH

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The COVID-19 pandemic posed an extraordinary challenge to societies and healthcare systems. Allergic individuals could not be an exception, being both directly and indirectly affected by the rapid and exponential spread of SARS-CoV-2. Although asthma was initially considered a risk factor for severe disease, evidence suggests that only poorly controlled asthmatics may constitute a high-risk group. A complex interplay between various factors involved in type 2 inflammation appears to determine an individual’s susceptibility to the virus and control of the infection. The impact of the pandemic on allergic patients’ mental health and trust in vaccines was also substantial, but through proper public health measures these effects are anticipated to abate. The implementation of innovative telemedical services was extensive and their use in everyday clinical practice will hopefully improve outcomes in various allergic diseases in the near future. Mitigation measures resulted in several changes in the exposome, including air quality and circulation of respiratory viruses, but also in human microbiome. The repercussions of these measures on the incidence and severity of allergic diseases are currently under study. Notwithstanding the detrimental consequences of SARS-CoV-2, the evolving pandemic offers the opportunity to investigate the long-term implications of various exposome changes; furthermore, it has provided opportunities towards improved care and public health measures to support the allergic individual.

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“…Omicron variants of SARS-CoV-2 have been related to reduced severity of illness and risk of death but increased incidence of breakthrough infections [1]. Primary and boosted vaccination against SARS-CoV-2 has also significantly reduced the risk for severe disease and death associated with COVID-19 [2][3][4][5], however, SARS-CoV-2 infection remains significant morbidity and mortality issue among the highly vulnerable populations including the elderly, immunocompromised people, and those with chronic diseases [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Real-world effectiveness of molnupiravir and nirmatrelvir/ritonavir among COVID-19 community, highly vaccinated patients with high risk for severe disease: Evidence that both antivirals reduce the risk for disease progression and death

Paraskevis

Gkova

Mellou

et al. 2023

Preprint

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Besides the significant benefits of vaccination against COVID-19, the risk of severe disease and death from COVID-19 among highly vulnerable populations remains of concern. Implementation of oral antiviral treatment has shown significant benefits for outpatients with high risk for severe disease, however, their effectiveness remains to be evaluated in real-life settings and in the presence of new Omicron subvariants. We aimed to investigate the effectiveness of molnupiravir and nirmatrelvir/ritonavir using a retrospective cohort design with outcomes hospital admission and death from COVID-19, in Greece. The effectiveness of each drug was estimated through a comparison of the antiviral's recipients with an age-matched control group of non-recipients, adjusted for age, previous SARS-CoV-2 infection, vaccination status, and vaccination recency. Our analysis showed that molnupiravir significantly reduced the risk for hospitalization (OR = 0.40, p < 0.001) and death from COVID-19 (OR = 0.31, p < 0.001), with the effect being more intense among elderly patients (>=75 years old). The effectiveness was higher among those with full adherence. Nirmatrelvir/ritonavir was found also to significantly reduce the risk of hospital admission (OR = 0.31, p < 0.001) and death (OR = 0.28, p < 0.001) and, similarly to molnupiravir, effectiveness was stronger among elderly patients and those with the highest levels of adherence. Analysis of the relative effectiveness of nirmatrelvir/ritonavir versus molnupiravir suggested that nirmatrelvir/ritonavir was associated with a reduced risk for hospital admission (OR = 0.58, p < 0.001) compared to molnupiravir, adjusted for age, previous SARS-CoV-2 infection, vaccination status, and co-morbidities. Our real-world study provides evidence about the reduced risk of hospitalization and death in highly vaccinated patients with a high risk for severe disease in Greece. These findings highlight that although the hospitalization and mortality risk has been reduced mainly due to vaccination and the emergence of Omicron variants, antivirals provide significant additional benefits in highly vulnerable patients and therefore their use is documented and strongly indicated.

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Risk of serious COVID-19 outcomes among adults and children with moderate-to-severe asthma: a systematic review and meta-analysis

Cited by 18 publications

References 38 publications

Real-world Effectiveness of Molnupiravir and Nirmatrelvir/Ritonavir as Treatments for COVID-19 in Patients at High Risk

Real-world Effectiveness of Molnupiravir and Nirmatrelvir/Ritonavir as Treatments for COVID-19 in Patients at High Risk

How does the pandemic shape the future of allergies?

Real-world effectiveness of molnupiravir and nirmatrelvir/ritonavir among COVID-19 community, highly vaccinated patients with high risk for severe disease: Evidence that both antivirals reduce the risk for disease progression and death

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