Efficacy of initial combination therapy with anti-SARS-CoV-2 antivirals targeting viral clearance in COVID-19 patients with B-cell lymphoma treated with anti-CD20 antibodies: A retrospective single-centre study in Japan.

Objective: There is no clear treatment strategy for persistent COVID-19 infection that enables clinicians to effectively achieve viral clearance, determine the optimal time to discontinue treatment, and prevent virus reactivation. This retrospective, single-centre study aimed to analyse the effectiveness of antiviral therapies in COVID-19 patients with B-cell lymphoma receiving anti-CD20 therapy.

Methods: Conducted at Kansai Medical University Medical Center between January 2022 and October 2024, the study examined the impact of various antiviral regimens and factors on time to viral clearance, defined as SARS-CoV-2 viral load <1 copy/μL by nasopharyngeal swab.

Results: Sixty-seven cases met the inclusion criteria, with 40 having a history of bendamustine use, and 33 with combination antiviral therapy as the initial treatment. A multivariable Cox proportional hazards model revealed combination antiviral therapy as the initial regimen (HR 0.37, 95% CI 0.21-0.65, p<0.001) significantly shortened time to viral clearance, while bendamustine use (HR 2.70, 95% CI 1.49-4.87, p<0.001) significantly prolonged time to viral clearance.

Conclusions: This study showed the potential of early combination antiviral therapy to shorten the time to viral clearance in this high-risk patient population.