Related Experiment Video
Updated: May 30, 2025
Quantitative Structure-Activity Relationship, Activity Prediction, and Molecular Dynamics of Non-nucleotide Reverse Transcriptase Inhibitors
Published on: May 9, 2025
The Effect of Nirmatrelvir-Ritonavir on Short- and Long-term Adverse Outcomes From COVID-19 Among Patients With
Ian A Strohbehn1, Tianqi Ouyang1, Meghan D Lee1
1Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Insights
Nirmatrelvir-ritonavir reduced COVID-19 hospitalization and death risk in patients with kidney disease. However, it did not impact chronic kidney disease (CKD) progression.
Area of Science:
- Nephrology
- Infectious Diseases
- Cardiology
Background:
- Patients with kidney disease face elevated risks from COVID-19.
- Exclusion of advanced CKD and kidney failure patients from trials leaves nirmatrelvir-ritonavir's impact unknown in this group.
Purpose of the Study:
- To evaluate the effectiveness of nirmatrelvir-ritonavir in reducing adverse outcomes in kidney disease patients with COVID-19.
Main Methods:
- A cohort study matched patients receiving nirmatrelvir-ritonavir for COVID-19 with a control group.
- Propensity score matching and survival models (Fine-Gray, Cox) were used to assess outcomes.
Main Results:
- Nirmatrelvir-ritonavir use was linked to a 56% reduction in 30-day hospitalization.
- A significant decrease in 1-year risk for major adverse cardiovascular events (MACE) and death was observed.
Conclusions:
- Nirmatrelvir-ritonavir is associated with reduced hospitalization and death in kidney disease patients with COVID-19.
- The drug did not demonstrate a benefit in slowing CKD progression.
Background:
Patients with kidney disease are at high risk for adverse outcomes after coronavirus disease 2019 (COVID-19) despite vaccination. Because patients with advanced chronic kidney disease (CKD) and kidney failure were excluded from registrational trials, the impact of the protease inhibitor nirmatrelvir-ritonavir in patients with kidney disease is unknown.
Methods:
This was a cohort study evaluating adverse outcomes in patients with kidney disease who developed COVID-19. Patients prescribed nirmatrelvir-ritonavir for COVID-19 between March 16, 2022, and November 30, 2022, were propensity score-matched to comparators diagnosed with COVID-19 between July 15, 2021, and March 15, 2022 (before the use of nirmatrelvir-ritonavir in our health care network). We determined the association between nirmatrelvir-ritonavir and short- and long-term outcomes using Fine-Gray subdistribution hazard and Cox proportional hazard models, adjusting for potential confounders. Outcomes included 30-day risk of hospitalization and 1-year risk of a major adverse cardiovascular event (MACE), CKD progression, and death.
Results:
A total of 1095 nirmatrelvir-ritonavir-treated patients were matched to 584 comparators. Patients who received nirmatrelvir-ritonavir patients were less likely to be hospitalized within 30 days of diagnosis (adjusted subdistribution hazard ratio [sHR], 0.44; 95% CI, 0.26-0.73; P < .01). At 1 year, nirmatrelvir-ritonavir-treated patients had a lower risk of hospitalization for MACE (adjusted sHR, 0.49; 95% CI, 0.36-0.67; P < .01) and death (adjusted hazard ratio, 0.37; 95% CI, 0.21-0.65; P < .01). Use of nirmatrelvir-ritonavir was not associated with decreased risk of CKD progression or attenuation of estimated glomerular filtration rate decline slope in the year following infection.
Conclusions:
Nirmatrelvir-ritonavir was associated with decreased risk of hospitalization within 30 days and 1-year risk of MACE and death in patients with CKD and kidney failure.
More Related Videos
Related Concept Videos
01:11Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:25Antihypertensive Drugs: Direct Renin Inhibitors
01:31Factors Affecting Renal Clearance: Drug's Physicochemical Properties and Plasma Levels
One important factor is the drug's molecular size. The kidneys readily excrete smaller molecules below 300 Daltons (Da). On the other hand, molecules weighing between 300 and 500 Da are excreted through both urine and bile. Larger molecules above 500 Da tend to be excreted...
01:33Hormonal Regulation