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

DOI record: { "DOI": "10.3389/fphar.2023.1147980", "ISSN": [ "1663-9812" ], "URL": "http://dx.doi.org/10.3389/fphar.2023.1147980", "abstract": "<jats:p><jats:bold>Background:</jats:bold> 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.</jats:p><jats:p><jats:bold>Methods:</jats:bold> 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 &amp;lt;60 ml/min/1·73 m<jats:sup>2</jats:sup>. The primary endpoint was a composite of all-cause mortality, intensive care unit admission, or cardiovascular events. The secondary endpoint was viral shedding.</jats:p><jats:p><jats:bold>Results:</jats:bold> 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); <jats:italic>p =</jats:italic> 0.035]. Nirmatrelvir/ritonavir recipients experienced a shorter duration of viral shedding [adjusted HR 3·70 (95%CI: 2.60–5.28); <jats:italic>p</jats:italic> &amp;lt; 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]; <jats:italic>p</jats:italic> &amp;lt; 0.001) compared to late initiation. No patients reported serious adverse events during treatment.</jats:p><jats:p><jats:bold>Conclusion:</jats:bold> 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.</jats:p>", "alternative-id": [ "10.3389/fphar.2023.1147980" ], "author": [ { "affiliation": [], "family": "Yan", "given": "Jiayi", "sequence": "first" }, { "affiliation": [], "family": "Cai", "given": "Hong", "sequence": "additional" }, { "affiliation": [], "family": "Wang", "given": "Jieying", "sequence": "additional" }, { "affiliation": [], "family": "Zhu", "given": "Mingli", "sequence": "additional" }, { "affiliation": [], "family": "Li", "given": "Ping", "sequence": "additional" }, { "affiliation": [], "family": "Li", "given": "Peiying", "sequence": "additional" }, { "affiliation": [], "family": "Wu", "given": "Bin", "sequence": "additional" }, { "affiliation": [], "family": "Che", "given": "Xiajing", "sequence": "additional" }, { "affiliation": [], "family": "Gu", "given": "Leyi", "sequence": "additional" }, { "affiliation": [], "family": "Mou", "given": "Shan", "sequence": "additional" } ], "container-title": "Frontiers in Pharmacology", "container-title-short": "Front. Pharmacol.", "content-domain": { "crossmark-restriction": true, "domain": [ "frontiersin.org" ] }, "created": { "date-parts": [ [ 2023, 3, 22 ] ], "date-time": "2023-03-22T04:57:51Z", "timestamp": 1679461071000 }, "deposited": { "date-parts": [ [ 2023, 3, 22 ] ], "date-time": "2023-03-22T04:57:55Z", "timestamp": 1679461075000 }, "funder": [ { "DOI": "10.13039/501100001809", "award": [ "81970574 82170685" ], "doi-asserted-by": "publisher", "name": "National Natural Science Foundation of China" }, { "DOI": "10.13039/100017950", "award": [ "18ZXY001" ], "doi-asserted-by": "publisher", "name": "Shanghai Municipal Health Commission" } ], "indexed": { "date-parts": [ [ 2023, 3, 23 ] ], "date-time": "2023-03-23T04:58:22Z", "timestamp": 1679547502953 }, "is-referenced-by-count": 0, "issued": { "date-parts": [ [ 2023, 3, 22 ] ] }, "license": [ { "URL": "https://creativecommons.org/licenses/by/4.0/", "content-version": "vor", "delay-in-days": 0, "start": { "date-parts": [ [ 2023, 3, 22 ] ], "date-time": "2023-03-22T00:00:00Z", "timestamp": 1679443200000 } } ], "link": [ { "URL": "https://www.frontiersin.org/articles/10.3389/fphar.2023.1147980/full", "content-type": "unspecified", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "1965", "original-title": [], "prefix": "10.3389", "published": { "date-parts": [ [ 2023, 3, 22 ] ] }, "published-online": { "date-parts": [ [ 2023, 3, 22 ] ] }, "publisher": "Frontiers Media SA", "reference": [ { "DOI": "10.1056/NEJMoa2204919", "article-title": "Nirmatrelvir use and severe covid-19 outcomes during the omicron surge", "author": "Arbel", "doi-asserted-by": "publisher", "first-page": "790", "journal-title": "N. 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