Current and Emerging Therapies for COVID-19 in Lung Transplantation

Abstract

Purpose of Review The landscape of the coronavirus disease 2019 (COVID-19) pandemic has rapidly changed over the past 3 years. Paralleling this evolution, the scientific and medical communities have reported many novel findings relating to the infection’s epidemiology, transmission, diagnosis, and treatment. We review pertinent studies of COVID-19 therapeutics with an emphasis on their application to lung transplant recipients. Recent Findings Agents that have been well-studied for treating COVID-19 include antivirals (remdesivir, nirmatrelvir/ritonavir, molnupiravir), monoclonal antibodies, and immunomodulators (for example, corticosteroids and tocilizumab). Summary Remdesivir remains an essential therapy for managing mild-moderate COVID-19. Though highly efficacious for mild-moderate COVID-19 for outpatient therapy, ritonavir-boosted nirmatrelvir has limited use in lung transplant recipients due to significant drug-drug interactions. Monoclonal antibodies, though useful, are the most affected by the emergence of new viral variants.

Low Mortality Associated with COVID-19 Infection in Lung Transplant Recipients at a Single Center

“…Mortality rates for LTRs who contracted COVID-19 infection ranged from 8-39% in observational case series [2,[4][5][6][7][8][9][10][11][12][13] In fact, current literature reports up to 8 times higher mortality rates associated with COVID in recipients of solid organ transplants, when compared to the general population [14]. Most of the observational studies on LTR with COVID-19 are from the earlier COVID-19 variant eras of the pandemic at which point treatment modalities were substantially more limited than there are available today.…”