"Saving lives with nirmatrelvir/ritonavir one transplant patient at a time".
"Saving lives with nirmatrelvir/ritonavir one transplant patient at a time".
复制标题
“用尼尔马瑞韦/利托那韦一次拯救一名移植患者的生命”。
DOI：
10.1111/tid.14037
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Coppock,Dagan
中科院分区：
文献类型：
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作者：
Belden,KatherineA;Yeager,Sarah;Schulte,Jamie;Cantarin,MariaPMartinez;Moss,Sean;Royer,Tricia;Coppock,Dagan
背景实体器官移植 (SOT) 接受者面临着 COVID-19 并发症的风险。 Nirmatrelvir/ritonavir (Paxlovid) 可以降低 COVID-19 死亡率，但禁忌用于接受依赖于细胞色素 p4503A (CY3PA) 的钙调神经磷酸酶抑制剂 (CI) 的患者。在本研究中，我们旨在展示对接受 CI 的 SOT 接受者给予尼马瑞韦/利托那韦的可行性，并协调药物管理和有限的他克莫司谷监测。方法我们回顾了 2022 年 4 月 14 日至 11 月 1 日期间接受尼马瑞韦/利托那韦治疗的成人 SOT 接受者，并评估了治疗后他克莫司谷和血清肌酐的变化。结果在 47 名患者中，28 名正在接受治疗他克莫司并进行了后续实验室检测。患者平均年龄为 55 岁，其中 17 人 (61%) 接受了肾移植，23 人 (82%) 接受了三剂或以上剂量的 SARS-CoV-2 mRNA 疫苗。患者患有轻度至中度 COVID-19，并在症状出现后 5 天内开始服用尼马瑞韦/利托那韦。中位基线他克莫司谷浓度为 5.6 ng/mL（四分位距 5.1-6.7），中位随访他克莫司谷浓度为 7.8 ng/mL（四分位距 5.7-11.5，p= 0.0017）。中位基线和随访血清肌酐水平分别为 1.21 mg/dL（四分位距 1.02-1.39）和 1.21 mg/dL（四分位距 1.02-1.44，p= 0.3162）。一名肾接受者的随访肌酐水平 > 基线的 1.5 倍。随访期间没有患者因 COVID-19 住院或死亡。结论虽然给予尼马曲韦/利托那韦导致他克莫司浓度显着增加，但这并没有导致显着的肾毒性。通过药物管理，SOT 接受者的早期口服抗病毒治疗是可行的，即使他克莫司谷监测有限。
BackgroundSolid organ transplant (SOT) recipients are at risk of complications from COVID‐19. Nirmatrelvir/ritonavir (Paxlovid) can reduce mortality from COVID‐19 but is contraindicated in patients receiving calcineurin inhibitors (CI), which depend on cytochrome p4503A (CY3PA). In this study, we aim to show the feasibility of nirmatrelvir/ritonavir administration to SOT recipients receiving CI with coordination of medication management and limited tacrolimus trough monitoring.MethodsWe reviewed adult SOT recipients treated with nirmatrelvir/ritonavir from 4/14 to 11/1/2022 and assessed for changes in tacrolimus trough and serum creatinine after therapy.ResultsOf 47 patients identified, 28 were receiving tacrolimus and had follow‐up laboratory testing. Patients had a mean age of 55 years, 17 (61%) received a kidney transplant and 23 (82%) received three or more doses of SARS‐CoV‐2 mRNA vaccine. Patients had mild‐moderate COVID‐19 and started nirmatrelvir/ritonavir within 5 days of symptom onset. Median baseline tacrolimus trough concentration was 5.6 ng/mL (Interquartile range 5.1–6.7), while median follow‐up tacrolimus trough concentration was 7.8 ng/mL (Interquartile range 5.7–11.5,p= 0.0017). Median baseline and follow‐up serum creatinine levels were 1.21 mg/dL (Interquartile range 1.02–1.39) and 1.21 mg/dL (interquartile range 1.02–1.44,p= 0.3162), respectively. One kidney recipient had a follow up creatinine level >1.5 times baseline. No patients were hospitalized or died from COVID‐19 in the follow up period.ConclusionWhile administration of nirmatrelvir/ritonavir resulted in a significant increase in tacrolimus concentration, this did not result in significant nephrotoxicity. Early oral antiviral treatment in SOT recipients is feasible with medication management, even with limited tacrolimus trough monitoring.