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Clinical characteristics and pharmacokinetics of PAXLOVID in COVID-19 patients with hematological tumor

Liu et al., Medical Review, doi:10.1515/mr-2023-0068, Mar 2024
https://c19early.org/liu29.html
Retrospective 12 hospitalized COVID-19 patients with hematological malignancies showing one death and two cases of liver injury with paxlovid treatment. The study focused on pharmacokinetics, finding nirmatrelvir concentrations approximately 3-fold higher than those observed in clinical trials, with substantial individual variability. Two patients experienced liver injury with ALT levels increased 2.2 and 7.5 times baseline, with one patient having extremely high nirmatrelvir concentrations. Eight patients experienced viral rebound with a median of 7 days. No correlation was found between nirmatrelvir concentration and duration of viral shedding.
Resistance. Variants may be resistant to paxlovid1-7. Use may promote the emergence of variants that weaken host immunity and potentially contribute to long COVID8.
Confounding by contraindication. Hoertel et al. find that over 50% of patients that died had a contraindication for the use of Paxlovid9. Retrospective studies that do not exclude contraindicated patients may significantly overestimate efficacy.
Black box warning. The FDA notes that severe, life-threatening, and/or fatal adverse reactions due to drug interactions have been reported in patients treated with paxlovid10.
Kidney and liver injury. Studies show significantly increased risk of acute kidney injury11 and liver injury12.
Liu et al., 4 Mar 2024, retrospective, China, peer-reviewed, 7 authors. Contact: libozhao2011@163.com, zhaorongsheng@bjmu.edu.cn.
Clinical characteristics and pharmacokinetics of PAXLOVID in COVID-19 patients with hematological tumor
Wei Liu, Ping Yang, Ping Yang, Li Yang, Hongmei Jing, Libo Zhao, Rongsheng Zhao
Medical Review, doi:10.1515/mr-2023-0068
min means collected from different cycle of Paxlovid use. d All patients were treated with corticosteroid.
References
Lamers, Beumer, Van Der Vaart, Knoops, Puschhof et al., SARS-CoV-2 productively infects human gut enterocytes, Science
Liu, Clinical characteristics and pharmacokinetics of PAXLOVID
Liu, Zhu, Cao, Boucetta, Song et al., Simultaneous determination of nirmatrelvir and ritonavir in human plasma using LC-MS/MS and its pharmacokinetic application in healthy Chinese volunteers, Biomed Chromatogr
Mikulska, Sepulcri, Dentone, Magne, Balletto et al., Triple combination therapy with 2 antivirals and monoclonal antibodies for persistent or relapsed severe acute respiratory syndrome coronavirus 2 infection in immunocompromised patients, Clin Infect Dis
Singh, Toussi, Hackman, Chan, Rao et al., Innovative randomized Phase I study and dosing regimen selection to accelerate and inform pivotal COVID-19 trial of nirmatrelvir, Clin Pharmacol Ther
Sun, Lin, Wang, Gao, Ye, Paxlovid in patients who are immunocompromised and hospitalised with SARS-CoV-2 infection, Lancet Infect Dis
Xiong, Ying, Zhang, Liu, Lu et al., Simultaneous determination of nirmatrelvir, ritonavir and baricitinib concentrations in human plasma by LC-MS/MS (in Chinese), Chinese Pharm J
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