AUTHOR=Yan Jiayi , Cai Hong , Wang Jieying , Zhu Mingli , Li Ping , Li Peiying , Wu Bin , Che Xiajing , Gu Leyi , Mou Shan 

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

JOURNAL=Frontiers in Pharmacology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2023.1147980

DOI=10.3389/fphar.2023.1147980

ISSN=1663-9812

ABSTRACT=<p><bold>Background:</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.</p><p><bold>Methods:</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 &lt;60 ml/min/1·73 m<sup>2</sup>. The primary endpoint was a composite of all-cause mortality, intensive care unit admission, or cardiovascular events. The secondary endpoint was viral shedding.</p><p><bold>Results:</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); <italic>p =</italic> 0.035]. Nirmatrelvir/ritonavir recipients experienced a shorter duration of viral shedding [adjusted HR 3·70 (95%CI: 2.60–5.28); <italic>p</italic> &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]; <italic>p</italic> &lt; 0.001) compared to late initiation. No patients reported serious adverse events during treatment.</p><p><bold>Conclusion:</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.</p>