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Quantitative Structure-Activity Relationship, Activity Prediction, and Molecular Dynamics of Non-nucleotide Reverse Transcriptase Inhibitors
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Early Experience with Modified Dose Nirmatrelvir/Ritonavir in Dialysis Patients with Coronavirus Disease 2019

Swapnil Hiremath1, Peter G Blake2,3, Angie Yeung3

  • 1Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

Clinical Journal of the American Society of Nephrology : CJASN
|February 1, 2023
PubMed

Insights

A modified low-dose nirmatrelvir/ritonavir regimen was safe and effective for dialysis patients with COVID-19. This approach allowed completion of treatment with no 30-day mortality observed in the study cohort.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Pharmacology

Background:

  • Nirmatrelvir/ritonavir is approved for high-risk COVID-19 outpatients.
  • Severe CKD patients were excluded from trials; use is not recommended for GFR <30 ml/min.
  • A modified low-dose regimen was developed based on pharmacological data.

Purpose of the Study:

  • To evaluate the safety and efficacy of a modified low-dose nirmatrelvir/ritonavir regimen.
  • To assess outcomes in maintenance dialysis patients with COVID-19 treated with the modified regimen.

Main Methods:

  • Retrospective study of 134 dialysis patients treated between April 1 and May 31, 2022.
  • Data collected on nirmatrelvir/ritonavir use, outcomes, and demographics.
  • Principal outcomes: 30-day hospitalization, 30-day mortality, and medication changes.

Main Results:

  • 134 dialysis patients received the modified regimen; 96% completed treatment.
  • Common symptoms included cough and sore throat (60%).
  • No 30-day mortality due to COVID-19 was observed.

Conclusions:

  • Modified-dose nirmatrelvir/ritonavir was safe and well-tolerated in maintenance dialysis patients.
  • No serious adverse events were reported.
  • The regimen facilitated treatment completion in this vulnerable population.
Abstract

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