Cohort study reveals high safety and tolerability of oral COVID-19 antivirals in advanced chronic kidney disease, suggesting their viable use despite exclusion from initial trials.
Patients with advanced chronic kidney disease (CKD) and kidney failure were excluded from clinical trials that led to approval of molnupiravir and nirmatrelvir/ritonavir for COVID-19. Between November 2022 and February 2024 there were 100 patients with advanced CKD (N = 81) or kidney failure (N = 19) who received either molnupiravir (N = 40) or nirmatrelvir/ritonavir (N = 60) for COVID-19 within a large healthcare network. Ten (10%) patients were hospitalized within 30 days; 5 hospitalizations were COVID-19 related and 5 were unrelated to COVID-19. Adverse events documented in the electronic health record were uncommon and all were mild to moderate (grade 1 or 2). Despite use of numerous concomitant medications known to interact with nirmaltrelvir/ritonavir, we found no adverse events attributed to a drug-drug interaction. All patients survived >30 days and 3 (3%) died prior to 90 days. Molnupiravir and nirmatrelvir/ritonavir were safe and well tolerated in patients with advanced CKD and kidney failure.
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Sawtell et al. (2025) studied this question.
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