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Clin J Am Soc Nephrol . Early Experience with Modified Dose Nirmatrelvir/Ritonavir in Dialysis Patients with Coronavirus Disease 2019

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  • Clin J Am Soc Nephrol . Early Experience with Modified Dose Nirmatrelvir/Ritonavir in Dialysis Patients with Coronavirus Disease 2019


    Clin J Am Soc Nephrol


    . 2023 Feb 1.
    doi: 10.2215/CJN.0000000000000107. Online ahead of print.
    Early Experience with Modified Dose Nirmatrelvir/Ritonavir in Dialysis Patients with Coronavirus Disease 2019


    Swapnil Hiremath 1 , Peter G Blake 2 3 , Angie Yeung 3 , Michaeline McGuinty 4 , Doneal Thomas 3 , Jane Ip 3 , Pierre Antoine Brown 1 , Michael Pandes 5 , Andrew Burke 6 , Qazi Zain Sohail 2 , Karen To 7 , Lindsay Blackwell 8 , Matthew Oliver 9 , Arsh K Jain 2 , Zain Chagla 10 , Rebecca Cooper 3 11



    Affiliations

    Abstract

    Background: Nirmatrelvir/Ritonavir was approved for use in high risk outpatients with coronavirus disease 2019 (COVID-19). However, patients with severe chronic kidney disease, were excluded from the phase 3 trial, and the drug is not recommended for those with a glomerular filtration rate < 30 ml/min/1.73m2. Based on available pharmacological data, we developed a modified low dose regimen of nirmatrelvir/ritonavir 300/100 mg on day one, followed by 150/100 mg daily from day two to five. In this study, we report our experience with this modified dose regimen in dialysis patients, in the Canadian province of Ontario.
    Methods: We included dialysis patients who developed COVID-19 and were treated with the modified dose nirmatrelvir/ritonavir regimen during a 60-day period between April 1 and May 31, 2022. Details of nirmatrelvir/ritonavir use and outcomes were captured manually and demographic data were obtained from a provincial database. Data are presented with descriptive statistics. The principal outcomes we describe are 30-day hospitalization, 30-day mortality, and required medication changes with the modified dose regimen.
    Results: 134 dialysis patients with COVID-19 received nirmatrelvir/ritonavir during the period of study. 56% were men, and the mean age was 64 years. Most common symptoms were cough and/or sore throat (60%). Medication interactions were common with calcium channel blockers and statins being the most frequent. Most patients (128, 96%) were able to complete the course of nirmatrelvir/ritonavir and none of the patients who received nirmatrelvir/ritonavir died of COVID-19 in the 30 days of follow up.
    Conclusions: A modified dose of nirmatrelvir/ritonavir use was found to be safe and well tolerated in terms of no serious adverse events being observed in a small sample of maintenance dialysis patients.


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