Abstract: TH-PO1096
Outcomes of Nitrelmivir-Ritonavir in Patients with Advanced CKD and COVID-19
Session Information
- COVID-19 - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Coronavirus (COVID-19)
- 000 Coronavirus (COVID-19)
Authors
- Chan, Gordon Chun-Kau, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong, Hong Kong
- Ng, Jack Kit-Chung, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong, Hong Kong
- Szeto, Cheuk-Chun, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong, Hong Kong
- Chow, Kai Ming, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong, Hong Kong
Background
Patients with chronic kidney disease (CKD) are vulnerable to severe novel coronavirus-2019 infection (COVID-19). Nirmatrelvir-ritonavir is an effective oral antiviral therapy, but it is not recommended in patients with eGFR < 30 ml/min/1.73m2.
Methods
This is a prospective interventional trial that included COVID-19 patients with eGFR < 60 ml/min/1.73m2 including dialysis. A 5-day course of nirmatrelvir-ritonavir was prescribed at a modified dosage. The adverse event, viral response and disease rebound were compared between high (> 30 ml/min/1.73m2) and low eGFR (< 30 ml/min/1.73m2). We further compare the treatment failure rate with a cohort treated with molnupiravir.
Results
59 of the 85 participants had stage 5 CKD and were on dialysis. 9.4% had adverse events, which were comparable between eGFR groups. The viral load significantly reduced on day 5, 15 & 30 (p < 0.001 for all), including the low eGFR group (Fig 1). 10 patients had virological rebound, though was transient and asymptomatic. The rate of adverse clinical outcome was significantly lower compared to molnupiravir users (6.8% vs 21.7%, p = 0.01, Fig 2), and the significance persisted in the multivariate model (odds ratio 0.16, 95% confidence interval 0.04 – 0.71, p = 0.016).
Conclusion
Modified dose of nirmatrelvir-ritonavir is well-tolerated and effective in patients with COVID-19 and CKD including dialysis.
Figure 1
Figure 2
Funding
- Private Foundation Support