PMID- 38289075
OWN - NLM
STAT- MEDLINE
DCOM- 20240307
LR  - 20240308
IS  - 1098-6596 (Electronic)
IS  - 0066-4804 (Print)
IS  - 0066-4804 (Linking)
VI  - 68
IP  - 3
DP  - 2024 Mar 6
TI  - Effectiveness and safety of nirmatrelvir-ritonavir in kidney transplant 
      recipients with severe kidney dysfunction infected with COVID-19.
PG  - e0138423
LID - 10.1128/aac.01384-23 [doi]
LID - e01384-23
AB  - Transplant patients face an elevated risk of coronavirus disease 2019 (COVID-19) 
      morbidity and mortality and commonly encounter renal dysfunction. Nirmatrelvir is 
      primarily excreted through the kidneys. The dosage of nirmatrelvir/ritonavir (NR) 
      needs to be adjusted according to the degree of renal function impairment. 
      Nevertheless, NR is not recommended for patients with severe renal impairment 
      (estimated glomerular filtration rate < 30 mL/min) due to a dearth of associated 
      research. In this study, we focus on kidney transplant patients and document and 
      analyze the experiences of using NR in individuals with severe kidney 
      dysfunction. This was a retrospective multicenter study that included transplant 
      recipients hospitalized for COVID-19 in five major tertiary hospitals in China 
      from December 2022 to June 2023. The outcomes consisted of the disease 
      progression rate by day 28, individual disease progression events, safety 
      outcomes, information on adverse events (AEs), and the blood drug concentrations 
      of immunosuppressants. Data were presented with descriptive statistics. All 
      analyses were performed using SPSS version 22. In total, 40 patients were 
      included in the analysis. Considering the potential interaction between drugs, 
      all patients temporarily discontinued their immunosuppressants during the NR 
      treatment. None of the 32 moderate patients experienced disease progression. 
      However, among the eight patients with critical COVID-19, unfortunately, two of 
      them died. During the medication period, four patients experienced a total of six 
      AEs associated with NR. None of them experienced AEs with a maximum grade of >/=3. 
      Blood drug concentrations of immunosuppressants were monitored in 22 of 40 
      patients, and the blood drug concentrations of immunosuppressants did not show a 
      significant increase, but some patients experienced lower blood drug 
      concentrations. Our findings supported the use of NR therapy for the treatment of 
      COVID-19 in transplant patients with severe renal insufficiency. A modified dose 
      of NR was well-tolerated.
FAU - Yang, Hui
AU  - Yang H
AUID- ORCID: 0000-0002-1797-2215
AD  - Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, 
      Beijing, China.
AD  - National Alliance of Transplant Pharmacists, Zhejiang, China.
FAU - Yu, Xin
AU  - Yu X
AD  - Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, 
      Beijing, China.
AD  - Department of Pharmacy, Beijing Obstetrics and Gynecology Hospital, Capital 
      Medical University, Beijing, China.
FAU - Hou, Wenjing
AU  - Hou W
AD  - National Alliance of Transplant Pharmacists, Zhejiang, China.
AD  - Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, 
      Beijing, China.
FAU - Liu, Xiangduan
AU  - Liu X
AD  - National Alliance of Transplant Pharmacists, Zhejiang, China.
AD  - Department of Pharmacy, Fifth Clinical College of Henan University of Traditional 
      Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou, China.
FAU - Chen, Jiaojiao
AU  - Chen J
AD  - Yantai Yuhuangding Hospital, Yantai, China.
FAU - Zhang, Ying
AU  - Zhang Y
AD  - Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, 
      Beijing, China.
AD  - Department of Pharmacy, Beijing Obstetrics and Gynecology Hospital, Capital 
      Medical University, Beijing, China.
FAU - Wang, Ying
AU  - Wang Y
AD  - Department of Pharmacy, Fifth Clinical College of Henan University of Traditional 
      Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou, China.
FAU - Zhu, Ying
AU  - Zhu Y
AD  - Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, 
      Beijing, China.
FAU - Qian, Qing
AU  - Qian Q
AUID- ORCID: 0000-0001-6019-9187
AD  - National Alliance of Transplant Pharmacists, Zhejiang, China.
AD  - The First People's Hospital of Changzhou, Changzhou, Jiangsu, China.
FAU - Ma, Kuifen
AU  - Ma K
AUID- ORCID: 0000-0001-8547-4325
AD  - National Alliance of Transplant Pharmacists, Zhejiang, China.
AD  - Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang 
      University School of Medicine, Hangzhou, China.
FAU - An, Zhuoling
AU  - An Z
AUID- ORCID: 0000-0002-7996-5002
AD  - Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, 
      Beijing, China.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20240130
PL  - United States
TA  - Antimicrob Agents Chemother
JT  - Antimicrobial agents and chemotherapy
JID - 0315061
RN  - O3J8G9O825 (Ritonavir)
RN  - 0 (Immunosuppressive Agents)
RN  - 0 (Antiviral Agents)
SB  - IM
MH  - Humans
MH  - Transplant Recipients
MH  - *Kidney Transplantation
MH  - Ritonavir/adverse effects
MH  - *COVID-19
MH  - COVID-19 Drug Treatment
MH  - Kidney
MH  - Immunosuppressive Agents/adverse effects
MH  - *Renal Insufficiency
MH  - Disease Progression
MH  - Antiviral Agents/adverse effects
PMC - PMC10916375
OTO - NOTNLM
OT  - COVID-19
OT  - kidney transplant
OT  - nirmatrelvir/ritonavir
OT  - severe kidney dysfunction
COIS- The authors declare no conflict of interest.
EDAT- 2024/01/30 12:42
MHDA- 2024/03/07 06:43
PMCR- 2024/01/30
CRDT- 2024/01/30 09:04
PHST- 2024/03/07 06:43 [medline]
PHST- 2024/01/30 12:42 [pubmed]
PHST- 2024/01/30 09:04 [entrez]
PHST- 2024/01/30 00:00 [pmc-release]
AID - 01384-23 [pii]
AID - aac.01384-23 [pii]
AID - 10.1128/aac.01384-23 [doi]
PST - ppublish
SO  - Antimicrob Agents Chemother. 2024 Mar 6;68(3):e0138423. doi: 
      10.1128/aac.01384-23. Epub 2024 Jan 30.