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. 2023 Mar 22:14:1147980.
doi: 10.3389/fphar.2023.1147980. eCollection 2023.

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

Jiayi Yan  1   2 , Hong Cai  1 , Jieying Wang  3 , Mingli Zhu  4 , Ping Li  1 , Peiying Li  3 , Bin Wu  3 , Xiajing Che  1 , Leyi Gu  1 , Shan Mou  1   2
Affiliations

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

Jiayi Yan et al. Front Pharmacol. .

Abstract

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.

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

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Kaplan-Meier analyses of time to the combined primary endpoint and the secondary endpoint in patients with SARS-CoV-2 infection and impaired kidney function with or without nirmatrelvir/ritonavir therapy. The Kaplan-Meier estimate of the duration from the respective index date to the combined primary endpoint and the secondary endpoint. The index date corresponded to the day of nirmatrelvir/ritonavir initiation for patients who received nirmatrelvir/ritonavir therapy, while for patients who did not receive nirmatrelvir/ritonavir, index date corresponded to the day of diagnosis of SARS-CoV-2 infection.
FIGURE 2
FIGURE 2
Changes of ORF1ab gene cycle threshold values in patients with SARS-CoV-2 infection and impaired kidney function with or without nirmatrelvir/ritonavir therapy. Data are mean (standard error of mean). ***p < 0.001; **p < 0.01; *p < 0.05.
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References

    1. Arbel R., Wolff Sagy Y., Hoshen M., Battat E., Lavie G., Sergienko R., et al. (2022). Nirmatrelvir use and severe covid-19 outcomes during the omicron surge. N. Engl. J. Med. 387 (9), 790–798. 10.1056/NEJMoa2204919 - DOI - PMC - PubMed
    1. Carlson N., Nelveg-Kristensen K. E., Freese Ballegaard E., Feldt-Rasmussen B., Hornum M., Kamper A. L., et al. (2021). Increased vulnerability to COVID-19 in chronic kidney disease. J. Intern Med. 290 (1), 166–178. 10.1111/joim.13239 - DOI - PMC - PubMed
    1. Christensen P. A., Olsen R. J., Long S. W., Snehal R., Davis J. J., Ojeda Saavedra M., et al. (2022). Signals of significantly increased vaccine breakthrough, decreased hospitalization rates, and less severe disease in patients with coronavirus disease 2019 caused by the omicron variant of severe acute respiratory syndrome coronavirus 2 in houston, Texas. Am. J. Pathol. 192 (4), 642–652. 10.1016/j.ajpath.2022.01.007 - DOI - PMC - PubMed
    1. Dejnirattisai W., Huo J., Zhou D., Zahradnik J., Supasa P., Liu C., et al. (2022). SARS-CoV-2 Omicron-B.1.1.529 leads to widespread escape from neutralizing antibody responses. Cell 185 (3), 467–484.e15. 10.1016/j.cell.2021.12.046 - DOI - PMC - PubMed
    1. Fact Sheet for Healthcare Providers (2022). Emergency use authorization for Paxlovid. Maryland: FDA.