News in brief: Predictors of death for lymphoma patients with COVID; DOACS have lower fracture risk than warfarin; mAb no longer advised for immunocompromised COVID patients

Thursday, 27 Jan 2022

Researchers identify predictors of death for lymphoma patients with COVID

New research has identified four key factors linked with risk of death in lymphoma patients with COVID-19, applicable in both the outpatient and hospitalised setting.

Researchers from Italy undertook a multicentre, non-interventional study involving 856 adult patients (388 outpatient, 468 hospitalised) with various lymphoma subtypes and COVID-19 infection, with the aim of identifying predictors of death.

Overall, in lymphoma patients with a confirmed SARS-CoV-2 diagnosis they found 30- and 100-days mortality rates of 13% and 23%, respectively. However, while that for hospitalised patients was high (33.4%), that for those managed as outpatients was low (3.8%).

While antilymphoma treatment, including anti-CD20 containing regimens, did not impact survival, multivariable analysis identified four “easy-to-use factors” of age of 65 years plus (HR 3.51), being of male gender (HR 2.04), an absolute lymphocyte count of 650 or less (HR 2.14), and a platelet count of 100 or less (2.14) that were associated with a higher risk of death, both in the admitted and in the not-admitted cohort.

The researchers also highlighted that an initial lymphoma diagnosis of 3 or more years before the COVID-19 infection “was significantly associated with better clinical behaviour and inferior fatality rate”, an observation which “may facilitate the screening of patients that may be candidates to early vaccination strategies.”

Lower fracture risk with DOACs vs warfarin

DOACs have a lower risk of fractures than the warfarin, at least in females, a new systematic review suggests.

A meta-analysis that included six studies comprising 351,208 patients receiving anticoagulants for atrial fibrillation found that those using a DOAC had 18% lower risk overall of any fracture compared with those treated with warfarin (relative ratio: 0.82, 95% confidence interval (CI): 0.74–0.91).

The decreased risk with DOACs was greatest in female patients and applied to  hip and vertebral fractures  but not upper extremity fractures, the study published

Sub-analyses showed that the significant difference in fracture risk was present in females but not males. It also revealed that new users of apixaban and rivaroxan tended to be at lower risk of any fracture compared with new users of warfarin. However, there is no statistically significant difference in the fracture risks between individual DOACs

The study authors said there were several possible mechanisms to explain why warfarin may have deleterious effects on bone metabolism compared to DOACs. Vitamin K inhibition may reduce the γ-carboxylation form of bone proteins, including osteocalcin and periostin, leading to abnormal bone mineralisation and formation, they noted. Warfarin had been shown to decreases the activity of osteoblasts and increase the activity of osteoclasts, leading to bone loss and a decrease in bone strength, they said.

“Conversely, DOACs produce their anticoagulant effects through a vitamin-K-independent process, and therefore, theoretically, do not affect bone metabolism,” they wrote in Age and Ageing.

mAb treatment no longer advised for immunocompromised COVID patients

US authorities have advised against using the monoclonal antibody Ronapreve (casirivimab/imdevimab) as prophylaxis treatment for immunocompromised patients newly diagnosed with COVID, although it remains approved for use in Australia.

In a statement released on 24 January, the Food and Drug Administration (FDA) said the antiviral was highly unlikely to be active against the omicron variant, and therefore it had withdrawn its authorisation for its use in the US.

The FDA said other antivirals were available with activity against omicron such as sotrovimab and Paxlovid (nirmatrelvir and ritonavir tablets). Sotrovimab (Xevudy) is also approved and available in Australia for use within the first five days of symptoms starting in patients aged 12 years or older with mild to moderate COVID-19.

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