The effectiveness of nirmatrelvir/ritonavir regimen in hospitalized renal transplant patients with prolonged COVID-19 infection: a multicenter clinical experience

• Published in: Renal failure Vol. 46; no. 2; p. 2385724
• Main Authors: Zhang, Huanxi, Wu, Wenrui, Zheng, Yitao, Fu, Qian, Chen, Peisong, Li, Jianyi, Wu, Zixuan, Gu, Jincui, Li, Jun, Liu, Longshan, Wu, Chenglin, Long, Sizhe, Xu, Bowen, Ling, Liuting, Fu, Yingxin, Wang, Changxi
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis Ltd 01.12.2024; Taylor & Francis; Taylor & Francis Group
• Subjects: Adult; Aged; Antimetabolites; Antiviral Agents - administration & dosage; Antiviral Agents - therapeutic use; Calcineurin inhibitors; Corticosteroids; COVID-19; COVID-19 - complications; COVID-19 - mortality; COVID-19 Drug Treatment; Dialysis; Drug Combinations; efficacy; Female; Hospitalization - statistics & numerical data; Humans; Immunosuppressive agents; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Intravenous administration; Kidney Transplantation; Lopinavir - administration & dosage; Lopinavir - therapeutic use; Male; Mechanical ventilation; Middle Aged; Mortality; Nirmatrelvir/ritonavir; Patients; Retrospective Studies; Ritonavir; Ritonavir - administration & dosage; Ritonavir - therapeutic use; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Steroids; Transplant Recipients - statistics & numerical data; Transplantation; Treatment Outcome; COVID-19; SARS-CoV-2; Nirmatrelvir/ritonavir; efficacy; kidney transplantation
• DOI: 10.1080/0886022X.2024.2385724
• ISSN: 0886-022X; 1525-6049

Effectiveness of nirmatrelvir/ritonavir (NR) in kidney transplant recipients (KTRs) infected COVID-19 for more than 5 days has not been evaluated. In this multicenter retrospective study, 85 KTRs with COVID-19 were enrolled, including 50 moderate, 21 severe, and 14 critical patients. The median time from onset to starting NR treatment was 14 (IQR, 11-19) days. Before NR treatment, 96.5% patients reduced use of antimetabolites. They also stopped using calcineurin inhibitors (CNI) 12-24 hours before NR treatment, with CNI concentrations well-controlled during NR treatment. The use of intravenous corticosteroids increased with COVID-19 severity. The median time to reach viral negative conversion was 5 (IQR, 4-8) days for all patients. For moderate and severe COVID-19 patients, they had a low rate of ICU admission (1.4%), exacerbation requiring upgraded oxygen therapy (5.6%), and dialysis (2.8%); no intubation and mechanical ventilation, and no deaths were observed. Patients with critical COVID-19 had a low mortality rate (7.1%). A regimen including NR for clearing SARS-CoV-2 along with reducing immunosuppressants and using intravenous corticosteroids is associated with lower rates of exacerbation and mortality in KTRs who have moderate to critical SARS-CoV-2 infection and the virus still present after 5 days.