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

Publication date: Sep 01, 2023

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.

Concepts Keywords
April Adult
August antiviral therapy
Coronavirus COVID-19
Myeloma COVID-19
Therapy COVID-19 Drug Treatment
Immunocompromised Host
immunocompromised patients


Type Source Name
drug DRUGBANK Ritonavir
disease MESH COVID-19
disease VO vaccination
disease MESH morbidity
disease MESH immunocompromised patients
disease MESH drug interactions
disease VO population
disease IDO immunosuppression
disease MESH clinical progression
disease MESH causes
disease MESH hematological malignancy
disease MESH multiple myeloma
disease MESH non-Hodgkin lymphoma
disease IDO cell
drug DRUGBANK Didanosine

Original Article

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