Early clinical experience with nirmatrelvir/ritonavir for the treatment of COVID-19 in solid organ transplant recipients.
Am J Transplant
; 22(8): 2083-2088, 2022 08.
Article
in English
| MEDLINE | ID: covidwho-1741322
ABSTRACT
Nirmatrelvir/ritonavir (NR) use has not yet been described in solid organ transplant recipients (SOTRs) with mild COVID-19. The objective was to evaluate outcomes among SOTR and describe the drug-drug interaction of NR. This is an IRB-approved, retrospective study of all adult SOTR on a calcineurin inhibitor (CNI) or mammalian target of rapamycin inhibitor who were prescribed NR between December 28, 2021 and January 6, 2022. A total of 25 adult SOTR were included (n = 21 tacrolimus, n = 4 cyclosporine, n = 3 everolimus, n = 1 sirolimus). All patients were instructed to follow the following standardized protocol during treatment with 5 days of NR hold tacrolimus or mTOR inhibitor or reduce cyclosporine dose to 20% of baseline daily dose. Four patients (16%) were hospitalized by day 30; one for infectious diarrhea and three for symptoms related to COVID-19. No patients died within 30 days of receipt of NR. Median tacrolimus level pre- and post-NR were 7.4 ng/ml (IQR, 6.6-8.6) and 5.2 (IQR, 3.6-8.7), respectively. Four patients experienced a supratherapeutic tacrolimus concentration after restarting tacrolimus post-NR. Our results show the clinically significant interaction between NR and immunosuppressive agents can be reasonably managed with a standardized dosing protocol. Prescribers should carefully re-introduce CNI after the NR course is complete.
Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Proline
/
Ritonavir
/
Transplant Recipients
/
COVID-19 Drug Treatment
/
Lactams
/
Leucine
/
Nitriles
Type of study:
Experimental Studies
/
Observational study
/
Prognostic study
Limits:
Adult
/
Humans
Language:
English
Journal:
Am J Transplant
Journal subject:
Transplantation
Year:
2022
Document Type:
Article
Affiliation country:
Ajt.17027
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