Nirmatrelvir/ritonavir for the treatment of immunocompromised adult patients with early‐stage symptomatic COVID‐19: A real‐life experience

Abstract Regardless of vaccination status, progression to severe coronavirus disease 2019 (COVID‐19) is still a relevant cause of morbidity among immunocompromised patients. Despite the proven efficacy of nirmatrelvir/ritonavir (NMV/r), concerns remain regarding the potential for drug‐to‐drug intera...

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Published in:Journal of medical virology 2023-09, Vol.95 (9), p.e29082-e29082
Main Authors: Caso, José María, Fernández‐Ruiz, Mario, López‐Medrano, Francisco, Caro‐Teller, José Manuel, Lizasoain, Manuel, San‐Juan, Rafael, Fayos Pérez, Marina, Rodríguez‐Goncer, Isabel, Silva, Jose Tiago, Aguado, José María
Format: Article
Language:English
Subjects:
Chemotherapy
Coronaviruses
COVID-19
Drug interaction
Health services
Hematopoietic stem cells
Hodgkin's lymphoma
Immunocompromised hosts
Immunosuppression
Lymphoma
Malignancy
Morbidity
Multiple myeloma
Observational studies
Patients
Polymerase chain reaction
Ritonavir
Safety
Severe acute respiratory syndrome coronavirus 2
Stem cell transplantation
Stem cells
Transplantation
Vaccination
Viral diseases
Virology
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Summary:Abstract Regardless of vaccination status, progression to severe coronavirus disease 2019 (COVID‐19) is still a relevant cause of morbidity among immunocompromised patients. Despite the proven efficacy of nirmatrelvir/ritonavir (NMV/r), concerns remain regarding the potential for drug‐to‐drug interactions (DDIs) and the safety in this at‐risk population. We aimed to evaluate the clinical outcomes of immunocompromised patients treated with NMV/r, as well as the occurrence of DDIs and treatment‐emergent adverse events (TEAEs). This retrospective observational study included all the patients with some form of immunosuppression and laboratory‐confirmed COVID‐19 that received NMV/r at our center from April to August 2022. The main outcome was worsening of the clinical status (increase of ≥1 point from baseline in a validated clinical progression scale) by Days +7 and +28 after the initiation of therapy. Safety outcomes included the rates of any TEAE and potentially severe DDIs. We included 110 patients. Main causes of immunosuppression were hematological malignancy (58.2%) (mainly multiple myeloma [22.7%] and non‐Hodgkin lymphoma [13.6%]), active chemotherapy (30.0%) and hematopoietic stem cell transplantation (14.5%). Clinical worsening by Days +7 and +28 was observed in four (3.6%) and five patients (4.5%), respectively. Only one patient had a positive SARS‐CoV‐2 polymerase chain reaction test at Day +28. At least one potentially severe DDI was observed in 56.4% of the patients. The rate of attributable TEAEs was 10.9%, although only two patients (1.8%) required premature discontinuation of NMV/r. Early initiation of NMV/r therapy should be considered in immunocompromised patients with COVID‐19, with particular attention to interacting medications.
ISSN:0146-6615
1096-9071
DOI:10.1002/jmv.29082