Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Microbiology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Transplantation. 2022 Nov 1;106(11):2200-2204. doi: 10.1097/TP.0000000000004306. Epub 2022 Aug 2.
Recently, different therapeutic lines have been tried in the initial stage of the disease of COVID-19, including remdesivir and molnupiravir. There is scarce evidence on the efficacy and safety of molnupiravir in kidney transplant recipients (KTRs).
ingle-center prospective cohort study' all adult KTRs diagnosed with COVID-19 and treated with molnupiravir or remdesivir from January to April 2022 were included.
Nine KTRs with SARS-CoV-2 (Omicron variant) infection and mild symptoms received molnupiravir in an outpatient basis and were compared with a cohort of similar patients treated with remdesivir (n = 7). Three patients in the molnupiravir cohort were in the early posttransplant period and received a basiliximab (n = 2) or antithymocite globulin-based induction (n = 1). One of the patients had been treated with methylprednisolone bolus and antithymocite globulin for an episode of acute rejection in the previous months. They were all vaccinated with mRNA vaccines' and all but 1 had serological response. Only one of the patients experienced clinical worsening despite molnupiravir treatment and developed pneumonia requiring hospital admission. None of the patients suffered adverse effects attributed to molnupiravir' and no adjustment of tacrolimus dose was needed. None of the patients treated with remdesivir progressed in COVID-19 severity.
Our study suggests that KTRs with SARS-CoV-2 infection under treatment with molnupiravir have a good clinical evolution with a probable lower risk for hospitalization and no adverse effects. At the renal level, molnupiravir was well tolerated, with no evidence of nephrotoxicity secondary to the drug nor interactions with the immunosuppressive therapy.
最近，在 COVID-19 疾病的初始阶段尝试了不同的治疗方案，包括瑞德西韦和莫努匹韦。在肾移植受者（KTR）中，莫努匹韦的疗效和安全性证据稀缺。
这项单中心前瞻性队列研究纳入了 2022 年 1 月至 4 月期间因 COVID-19 诊断而接受莫努匹韦或瑞德西韦治疗的所有成年 KTR。
9 例 SARS-CoV-2（Omicron 变体）感染且症状轻微的 KTR 接受莫努匹韦门诊治疗，并与接受瑞德西韦治疗的相似患者队列进行比较（n=7）。莫努匹韦组的 3 例患者处于移植后早期，接受了巴利昔单抗（n=2）或抗胸腺细胞球蛋白诱导治疗（n=1）。1 例患者因前几个月的急性排斥反应接受了甲泼尼龙冲击和抗胸腺细胞球蛋白治疗。他们均接种了 mRNA 疫苗，除 1 例外，其余均产生了血清学反应。尽管接受了莫努匹韦治疗，仍有 1 例患者病情恶化并发展为肺炎，需要住院治疗。莫努匹韦组无患者出现不良反应，也无需调整他克莫司剂量。接受瑞德西韦治疗的患者均未使 COVID-19 病情加重。
我们的研究表明，接受莫努匹韦治疗的 SARS-CoV-2 感染 KTR 具有良好的临床转归，住院风险可能较低，且无不良反应。在肾脏方面，莫努匹韦耐受良好，未发现药物引起的肾毒性或与免疫抑制治疗的相互作用。
