Does prolonged nirmatrelvir/ritonavir monotherapy lead to viral resistance in immunocompromised patients with SARS-CoV-2?
Prolonged nirmatrelvir/ritonavir monotherapy in immunocompromised patients can lead to the development of resistance mutations and treatment failure.
Resistance of SARS-CoV-2 to antivirals was shown to develop in immunocompromised individuals receiving remdesivir. We describe an immunocompromised patient who was treated with repeated and prolonged courses of nirmatrelvir and developed de-novo E166V/L50F mutations in the Mpro region. These mutations were associated with clinical and virological treatment failure.
Zuckerman et al. (Sat,) studied this question.