Safety, Efficacy and Relapse of Nirmatrelvir-Ritonavir in Kidney Transplant Recipients Infected with SARS-CoV-2
Résumé
INTRODUCTION: Nirmatrelvir-ritonavir (NR) has demonstrated its efficacy to decrease the risk of progression to severe COVID-19 in high-risk patients. However, evidence in infected kidney transplant recipients (KTRs) is lacking. Moreover, NR has significant and potentially harmful interactions with calcineurin inhibitors (CNIs). METHODS: In this single-center retrospective study, we included all KTRs treated with NR from April 28(th) to June 3(th), 2022. A standard management strategy of CNIs dose adaptation (discontinuation of tacrolimus 12 hours before the start of NR and administration of 20% the cyclosporine dose) and laboratory follow-up was applied. RESULTS: Fourteen patients were included. Compared to day-0 (day before NR initiation), day-7 plasma creatinine concentrations and SARS-CoV-2 viral loads were similar (p = 0.866) and decreased (p=0.002), respectively. CNIs trough concentrations at the end of the treatment were satisfactory, with nevertheless high individual variability. After a median follow-up time of 34 days, no death nor viral pneumonia were observed. However, 2 patients experienced early SARS-CoV-2 infection relapses (at day-10 and day-21) associated with an increase in SARS-CoV-2 viral loads. CONCLUSIONS: NR can be used in KTRs but requires a strict protocol of drug adaptation. We observed two cases of early relapse after NR treatment that need further investigations.
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