Improving the Outcomes of Immunocompromised Patients With Coronavirus Disease 2019.
Improving the Outcomes of Immunocompromised Patients With Coronavirus Disease 2019.
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DOI：
10.1093/cid/ciab397
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发表时间：
2021-09-15
期刊：
影响因子：
--
通讯作者：
Mellors JW
中科院分区：
文献类型：
--
作者：
Haidar G;Mellors JW
最近的案例研究强调了这样一个事实：某些免疫功能低下的个体面临着SARS-CoV-2长期复制、多重突变变体的宿主内病毒进化以及不良临床结果的风险。这种风险的免疫学决定因素，传染性的持续时间，以及免疫功能低下宿主的最佳治疗和预防策略尚不明确。另一个令人担忧的问题是广泛使用免疫抑制药物治疗COVID-19，这可能会在免疫缺陷的情况下增强和延长病毒复制。我们概述了4种相互关联的方法的基本原理，以开创循证医学的时代，以优化免疫功能低下的COVID-19患者的管理：多中心发病机制和结果研究，以将严重疾病的风险与免疫缺陷的类型和程度联系起来，研究评估对SARS-CoV-2疫苗的免疫应答，研究评估单克隆抗体用于初级预防的有效性，以及新型抗病毒药物治疗COVID-19的临床试验。免疫功能低下的患者存在严重和持久的严重急性呼吸综合征冠状病毒2型感染的风险，并有可能产生和传播多重突变变体。我们概述了应实施的4项关键策略，以填补重要的知识空白并改善这些患者的结局。
Recent case studies have highlighted the fact that certain immunocompromised individuals are at risk for prolonged SARS-CoV-2 replication, intrahost viral evolution of multiply-mutated variants, and poor clinical outcomes. The immunologic determinants of this risk, the duration of infectiousness, and optimal treatment and prevention strategies in immunocompromised hosts are ill defined. Of additional concern is the widespread use of immunosuppressive medications to treat COVID-19, which may enhance and prolong viral replication in the context of immunodeficiency. We outline the rationale for 4 interrelated approaches to usher in an era of evidence-based medicine for optimal management of immunocompromised patients with COVID-19: multicenter pathogenesis and outcomes studies to relate the risk of severe disease to the type and degree of immunodeficiency, studies to evaluate immunologic responses to SARS-CoV-2 vaccines, studies to evaluate the efficacy of monoclonal antibodies for primary prophylaxis, and clinical trials of novel antiviral agents for the treatment of COVID-19. Immunocompromised patients are at risk for severe and protracted severe acute respiratory syndrome coronavirus 2 infection with the potential to generate and spread multiply-mutated variants. We outline 4 key strategies that should be implemented to fill important knowledge gaps and improve outcomes of these patients.
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DOI：
10.1056/nejmoa2021801
发表时间：
2021-02-04
期刊：
The New England journal of medicine
影响因子：
--
作者：
Mitjà O;Corbacho-Monné M;Ubals M;Alemany A;Suñer C;Tebé C;Tobias A;Peñafiel J;Ballana E;Pérez CA;Admella P;Riera-Martí N;Laporte P;Mitjà J;Clua M;Bertran L;Sarquella M;Gavilán S;Ara J;Argimon JM;Cuatrecasas G;Cañadas P;Elizalde-Torrent A;Fabregat R;Farré M;Forcada A;Flores-Mateo G;López C;Muntada E;Nadal N;Narejos S;Nieto A;Prat N;Puig J;Quiñones C;Ramírez-Viaplana F;Reyes-Urueña J;Riveira-Muñoz E;Ruiz L;Sanz S;Sentís A;Sierra A;Velasco C;Vivanco-Hidalgo RM;Zamora J;Casabona J;Vall-Mayans M;González-Beiras C;Clotet B;BCN-PEP-CoV2 Research Group
通讯作者：
BCN-PEP-CoV2 Research Group
影响因子：
4.4
作者：
Ison, Michael G.
通讯作者：
Ison, Michael G.
影响因子：
158.5
作者：
Boulware, David R.;Pullen, Matthew F.;Hullsiek, Kathy H.
通讯作者：
Hullsiek, Kathy H.
影响因子：
5.4
作者：
Dagotto, Gabriel;Mercado, Noe B.;Barouch, Dan H.
通讯作者：
Barouch, Dan H.
DOI：
10.1093/cid/ciab072
发表时间：
2021-08-02
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Hensley MK;Bain WG;Jacobs J;Nambulli S;Parikh U;Cillo A;Staines B;Heaps A;Sobolewski MD;Rennick LJ;Macatangay BJC;Klamar-Blain C;Kitsios GD;Methé B;Somasundaram A;Bruno TC;Cardello C;Shan F;Workman C;Ray P;Ray A;Lee J;Sethi R;Schwarzmann WE;Ladinsky MS;Bjorkman PJ;Vignali DA;Duprex WP;Agha ME;Mellors JW;McCormick KD;Morris A;Haidar G
通讯作者：
Haidar G