Underutilization of nirmatrelvir/ritonavir in eligible COVID-19 patients

Nirmatrelvir/ritonavir (NMV/r) might reduce the risk of hospitalization or death due to SARS-CoV2. Indirect data suggest that antiviral use among non-hospitalized patients is low. The aim of the study is to determine the number of patients admitted for COVID-19 who met the criteria to receive NMV/r prior to admission but did not receive it. We analyzed clinical data from electronic medical records of 132 patients who were hospitalized due to Covid-19 from August to November 2023. Among the 88 patients eligible for NMV/r before hospitalization, only 3.8% received it, even though 24.3% had previous contact with the healthcare system. Among those who were eligible for treatment, a potential drug interaction was identified in 80.6%; NMV/r was contraindicated in only ten cases (11.3%) due to a serious interaction, as it was deemed impossible to stop or alter it. Of the patients who did not receive treatment, three died from Covid-19, while there were no deaths in the treatment group. Our data confirm that many patients who could benefit from early treatment with NMV/r are not receiving it. This limited use may be linked to missed opportunities to prevent hospitalization and mortality from Covid-19.