Combination regimen of nirmatrelvir/ritonavir and molnupiravir for the treatment of persistent SARS-CoV-2 infection: A case report and a scoping review of the literature

Int J Infect Dis. 2023 Aug:133:53-56. doi: 10.1016/j.ijid.2023.04.412. Epub 2023 May 5.

Abstract

Immunocompromised patients still experience unpredictable courses of COVID-19, despite that effective vaccines and drugs against SARS-CoV-2 are now available. Antiviral combination regimens may have a role in SARS-CoV-2 infection in immunocompromised hosts, but current knowledge is still limited. We describe the case of a 73-year-old Italian man affected by follicular lymphoma with persistent SARS-CoV-2 infection who was successfully treated with co-administration of oral antivirals (10-day molnupiravir and nirmatrelvir/ritonavir). The therapy was well tolerated both from a clinical and biochemical standpoint, with no signs of toxicity. We also performed a scoping review, to sum up available knowledge on combined antiviral regimens including remdesivir, molnupiravir, or nirmatrelvir/ritonavir. Pending further studies on larger cohorts of patients, our report is consistent with available pre-clinical and clinical data, supporting the possible use of combination therapy in selected difficult-to-treat COVID-19 cases.

Keywords: Antiviral; Association; COVID-19; Relapsing; Remdesivir.

Publication types

  • Review
  • Case Reports

MeSH terms

  • Aged
  • Antiviral Agents / therapeutic use
  • COVID-19 Drug Treatment
  • COVID-19*
  • Humans
  • Male
  • Ritonavir* / therapeutic use
  • SARS-CoV-2

Substances

  • nirmatrelvir
  • molnupiravir
  • Ritonavir
  • Antiviral Agents