Early clinical experience with nirmatrelvir/ritonavir for the treatment of COVID-19 in solid organ transplant recipients.

Content Provider	Europe PMC
Author	Salerno, David M. Jennings, Douglas L. Lange, Nicholas W. Kovac, Danielle (Bley) Shertel, Tara Chen, Justin K. Hedvat, Jessica Scheffert, Jenna Brown, Robert S. Pereira, Marcus R.
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.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC9111190&blobtype=pdf
Page Count	6
ISSN	16006135
Journal	American Journal of Transplantation [Am J Transplant]
Volume Number	22
DOI	10.1111/ajt.17027
PubMed Central reference number	PMC9111190
Issue Number	8
PubMed reference number	35278260
e-ISSN	16006143
Language	English
Publisher	John Wiley and Sons Inc.
Publisher Date	2022-03-21
Publisher Place	Hoboken
Access Restriction	Open
Rights License	This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency. © 2022 The American Society of Transplantation and the American Society of Transplant Surgeons
Subject Keyword	clinical research/practice drug interaction immunosuppressant immunosuppression/immune modulation infection and infectious agents—viral: SARS‐CoV‐2/COVID‐19 pharmacology solid organ transplantation
Content Type	Text
Resource Type	Article
Subject	Immunology and Allergy Transplantation Pharmacology (medical)