Nirmatrelvir/ritonavir for patients with SARS-CoV-2 infection and impaired kidney function during the Omicron surge

Frontiers in Pharmacology

Pharmacology

Jieying Wang¹  Peiying Li¹  Bin Wu¹  Mingli Zhu²  Hong Cai³  Ping Li³  Leyi Gu³  Xiajing Che³  Jiayi Yan⁴  Shan Mou⁴ 

[1] Clinical Research Center, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China;Department of Critical Care Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China;Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China;Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Ren Ji Hospital, Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China;Academy of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China;

关键词: nirmatrelvir/ritonavir;    COVID-19;    SARS-CoV-2;    omicron;    outcomes;    impaired kidney function;   

DOI  :  10.3389/fphar.2023.1147980

 received in 2023-01-19, accepted in 2023-03-11,  发布年份 2023

来源: Frontiers

【 摘 要 】

Background: Nirmatrelvir/ritonavir has demonstrated effectiveness in high-risk patients with coronavirus disease 2019 (COVID-19). However, investigations on the efficacy and safety of nirmatrelvir/ritonavir in patients with kidney dysfunction are limited.Methods: Data were collected from the patients admitted to a COVID-19 referral center in Shanghai, China. Patients were at least 18 years of age and had a baseline estimated glomerular filtration rate (eGFR) of <60 ml/min/1·73 m2. The primary endpoint was a composite of all-cause mortality, intensive care unit admission, or cardiovascular events. The secondary endpoint was viral shedding.Results: Among the 195 participants, 73 received nirmatrelvir/ritonavir. A lower risk of the primary endpoint was observed in nirmatrelvir/ritonavir recipients compared with non-recipients [adjusted HR 0.56 (95% CI: 0.32–0.96); p = 0.035]. Nirmatrelvir/ritonavir recipients experienced a shorter duration of viral shedding [adjusted HR 3·70 (95%CI: 2.60–5.28); p < 0.001) and faster viral load clearance versus non-recipients. Among the nirmatrelvir/ritonavir users, earlier initiation of nirmatrelvir/ritonavir within 5 days since COVID-19 diagnosis was related with shorter viral shedding time (adjusted HR 7.84 [95% CI: 3.28–18.76]; p < 0.001) compared to late initiation. No patients reported serious adverse events during treatment.Conclusion: Our findings support the early initiation of nirmatrelvir/ritonavir for high-risk patients with impaired kidney function. This could improve patient outcomes and shorten the viral shedding period.

【 授权许可】

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Copyright © 2023 Yan, Cai, Wang, Zhu, Li, Li, Wu, Che, Gu and Mou.