دورية أكاديمية
Nirmatrelvir/ritonavir treatment in SARS-CoV-2 positive kidney transplant recipients – a case series with four patients
| العنوان: | Nirmatrelvir/ritonavir treatment in SARS-CoV-2 positive kidney transplant recipients – a case series with four patients |
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| المؤلفون: | Schneider, Johanna, Wobser, Rika, Kühn, Wolfgang, Wagner, Dirk, Tanriver, Yakup, Walz, Gerd |
| المصدر: | BMC nephrology. - 24, 1 (2023) , 99, ISSN: 1471-2369 |
| سنة النشر: | 2023 |
| المجموعة: | University of Freiburg: FreiDok |
| الوصف: | Background Despite vaccination coronavirus disease 2019 (COVID-19)-associated mortality caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains high in kidney transplant recipients. Nirmatrelvir is a protease inhibitor with activity against SARS-CoV-2. Nirmatrelvir reduces the risk for mortality and hospitalization, which is approved for treating adults at risk for severe disease. Nirmatrelvir is metabolized by the cytochrome P-450 (CYP) 3A4 isozyme CYP3A4 and is therefore co-administered with the irreversible CYP3A4 inhibitor ritonavir, which results in a drug interaction with tacrolimus. A limited number of patients with nirmatrelvir/ritonavir and tacrolimus therapy after kidney transplantation have been reported to date. It has been reported that tacrolimus was paused during the five-day nirmatrelvir/ritonavir therapy and subtherapeutic tacrolimus levels were observed after finishing nirmatrelvir/ritonavir in two patients. Therefore, optimization of tacrolimus dosing is urgently needed in transplant recipients receiving nirmatrelvir/ritonavir treatment. Case presentation Here, we present our first-hand experience with four patients receiving tacrolimus therapy following kidney transplantation and nirmatrelvir/ritonavir therapy due to COVID-19. Tacrolimus was paused during nirmatrelvir/ritonavir therapy in all patients, which resulted in stable therapeutic tacrolimus levels. Tacrolimus was continued directly after finishing nirmatrelvir/ritonavir to avoid subtherapeutic levels in the first patient treated. This patient received his usual tacrolimus maintenance dose, which resulted in toxic levels. Based on this observation, tacrolimus therapy was continued 24 h after finishing nirmatrelvir/ritonavir treatment at a reduced dose in the subsequent patients. In these patients, therapeutic to supratherapeutic tacrolimus levels were observed despite the therapeutic break and dose reduction. Discussion and conclusions Based on altered CYP3A4 metabolism, tacrolimus levels have to be closely ... |
| نوع الوثيقة: | article in journal/newspaper |
| وصف الملف: | |
| اللغة: | English |
| العلاقة: | https://freidok.uni-freiburg.de/data/235621Test |
| DOI: | 10.1186/s12882-023-03154-w |
| الإتاحة: | https://doi.org/10.1186/s12882-023-03154-wTest https://freidok.uni-freiburg.de/data/235621Test https://nbn-resolving.org/urn:nbn:de:bsz:25-freidok-2356212Test https://freidok.uni-freiburg.de/dnb/download/235621Test |
| حقوق: | free |
| رقم الانضمام: | edsbas.DE1DF2A3 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1186/s12882-023-03154-w |
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