Lessons learned and implications of early therapies for coronavirus disease in a territorial service centre in the Calabria region: a retrospective study
Authors: Scaglione Vincenzo , Rotundo Salvatore , Marascio Nadia , De Marco Carmela , Lionello Rosaria , Veneziano Claudia , Berardelli Lavinia , Quirino Angela , Olivadese Vincenzo , Serapide Francesca , Tassone Bruno , Morrone Helen Linda , Davoli Chiara , La Gamba Valentina , Bruni Andrea , Cesana Bruno Mario , Matera Giovanni , Russo Alessandro , Costanzo Francesco Saverio , Viglietto Giuseppe , Trecarichi Enrico Maria , Torti Carlo ,   IDTM U. M. G. COVID-19 Group, Trecarichi Enrico Maria , Russo Alessandro , Serapide Francesca , Tassone Bruno , Fusco Paolo , Scaglione Vincenzo , Davoli Chiara , Lionello Rosaria , Gamba Valentina La , Rotundo Salvatore , Morrone Helen , Berardelli Lavinia , Tassone Maria Teresa , Olivadese Vincenzo , Serraino Riccardo , Costa Chiara , Alcaro Stefano , Filippo Caterina De , Sarro Giovambattista De , Pujia Arturo , Quattrone Aldo , Costanzo Francesco Saverio , Cuda Giovanni , Foti Daniela Patrizia , Viglietto Giuseppe , Matera Giovanni , Longhini Federico , Bruni Andrea , Garofalo Eugenio , Biamonte Eugenio , Brescia Vincenzo , Laganà Domenico , Petullà Maria , Bertucci Bernardo , Quirino Angela , Barreca Giorgio Settimo , Giancotti Aida , Gallo Luigia , Lamberti Angelo , Marascio Nadia , Francesco Adele Emanuela De , Mirarchi Simona , Torti Carlo 
Published: October 2022

Abstract
Background
Monoclonal antibodies (mAbs) and antivirals have been approved for early therapy of coronavirus disease (COVID-19), however, in the real-life setting, there are difficulties to prescribe these therapies within few days from symptom onset as recommended, and effectiveness of combined use of these drugs have been hypothesised in most-at-risk patients (such as those immunocompromised) but data supporting this strategy are limited.

Methods
We describe the real-life experience of SARS-CoV-2 antivirals and/or monoclonal antibodies (mAbs) and focus on the hospitalisation rate due to the progression of COVID-19. Clinical results obtained through our risk-stratification algorithm and benefits achieved through a strategic proximity territorial centre are provided. We also report a case series with an in-depth evaluation of SARS-CoV-2 genome in relationship with treatment strategy and clinical evolution of patients.

Results
Two hundred eighty-eight patients were analysed; 94/288 (32.6%) patients were treated with mAb monotherapy, 171/288 (59.4%) patients were treated with antivirals, and 23/288 (8%) patients received both mAbs and one antiviral drug. Haematological malignancies were more frequent in patients treated with combination therapy than in the other groups (p = 0.0003). There was a substantial increase in the number of treated patients since the opening of the centre dedicated to early therapies for COVID-19. The provided disease-management and treatment appeared to be effective since 98.6% patients recovered without hospital admission. Moreover, combination therapy with mAbs and antivirals seemed successful because all patients admitted to the hospital for COVID-19 did not receive such therapies, while none of the most-at-risk patients treated with combination therapy were hospitalized or reported adverse events.

Conclusions
A low rate of COVID-19 progression requiring hospital admission was observed in patients included in this study. The dedicated COVID-19 proximity territorial service appeared to strengthen the regional sanitary system, avoiding the overwhelming of other services. Importantly, our results also support early combination therapy: it is possible that this strategy reduces the emergence of escape mutants of SARS-CoV-2, thereby increasing efficacy of early treatment, especially in immunocompromised individuals.