Targeted treatments

Sotrovimab is available since 21st January 2022 at our centre. The dose regimen used was 500 mg administered intravenously.

Nirmatrelvir/ritonavir is available in our centre since 4th February 2022. The dose regimen used was 300 mg of nirmatrelvir and 100 mg of ritonavir administered orally twice daily for 5 days. In patients with moderate renal impairment (eGFR ≥ 30 to < 60 mL/min), the dose of nirmatrelvir was halved (150 mg per intake) while the dose of ritonavir remained unchanged. Nirmatrelvir/ritonavir was not used in patients with severe renal impairment (eGFR < 30 mL/min).

The tixagevimab/cilgavimab association was available in compassionate use for the treatment of COVID-19 since 14th January 2022 in France. The dose regimen used for curative treatment was 300 mg of tixagevimab and 300 mg of cilgavimab administered intravenously.

Remdesivir is available since 2020 at our centre. The dose used was 200 mg once a day at day 1, then 100 mg once a day on day 2 and day 3, given by intravenous infusion.

None of patient was treated by molnupiravir due to its unavailability in France.

The choice of the treatment was made by the treating physician, advised by infectious disease physicians and clinical pharmacists. It depended on the knowledge of the main circulating Omicron subvariants in France at that time, the availability of the different targeted treatments at our center, and on patient's contraindications, notably drug-drug interactions for nirmatrelvir/ritonavir.

French guidelines recommended to start the treatment as soon as possible, ideally within five days, after symptoms onset/positive testing¹⁵. For some patients, the treatment was started later because they were considered at high risk of progressing to severe disease and the risk/benefit balance of a late treatment was deemed favourable by the treating physicians.