Strohbehn Ian A, Ouyang Tianqi, Lee Meghan D, Zhao Sophia, Harden Destiny, Mejia Sherley M, Cao Andrew, Bhattacharyya Roby P, Sise Meghan E
Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Analytica Now, Brookline, Massachusetts, USA.
Open Forum Infect Dis. 2024 Dec 31;12(1):ofae756. doi: 10.1093/ofid/ofae756. eCollection 2025 Jan.
Patients with kidney disease are at high risk for adverse outcomes after coronavirus disease 2019 (COVID-19) despite vaccination. Because patients with advanced chronic kidney disease (CKD) and kidney failure were excluded from registrational trials, the impact of the protease inhibitor nirmatrelvir-ritonavir in patients with kidney disease is unknown.
This was a cohort study evaluating adverse outcomes in patients with kidney disease who developed COVID-19. Patients prescribed nirmatrelvir-ritonavir for COVID-19 between March 16, 2022, and November 30, 2022, were propensity score-matched to comparators diagnosed with COVID-19 between July 15, 2021, and March 15, 2022 (before the use of nirmatrelvir-ritonavir in our health care network). We determined the association between nirmatrelvir-ritonavir and short- and long-term outcomes using Fine-Gray subdistribution hazard and Cox proportional hazard models, adjusting for potential confounders. Outcomes included 30-day risk of hospitalization and 1-year risk of a major adverse cardiovascular event (MACE), CKD progression, and death.
A total of 1095 nirmatrelvir-ritonavir-treated patients were matched to 584 comparators. Patients who received nirmatrelvir-ritonavir patients were less likely to be hospitalized within 30 days of diagnosis (adjusted subdistribution hazard ratio [sHR], 0.44; 95% CI, 0.26-0.73; < .01). At 1 year, nirmatrelvir-ritonavir-treated patients had a lower risk of hospitalization for MACE (adjusted sHR, 0.49; 95% CI, 0.36-0.67; < .01) and death (adjusted hazard ratio, 0.37; 95% CI, 0.21-0.65; < .01). Use of nirmatrelvir-ritonavir was not associated with decreased risk of CKD progression or attenuation of estimated glomerular filtration rate decline slope in the year following infection.
Nirmatrelvir-ritonavir was associated with decreased risk of hospitalization within 30 days and 1-year risk of MACE and death in patients with CKD and kidney failure.
尽管接种了疫苗，但肾病患者在感染2019冠状病毒病（COVID-19）后出现不良结局的风险仍然很高。由于晚期慢性肾脏病（CKD）和肾衰竭患者被排除在注册试验之外，蛋白酶抑制剂奈玛特韦-利托那韦对肾病患者的影响尚不清楚。
这是一项队列研究，评估感染COVID-19的肾病患者的不良结局。2022年3月16日至2022年11月30日期间因COVID-19开具奈玛特韦-利托那韦处方的患者，与2021年7月15日至2022年3月15日（在我们的医疗网络中使用奈玛特韦-利托那韦之前）被诊断为COVID-19的对照者进行倾向评分匹配。我们使用Fine-Gray亚分布风险模型和Cox比例风险模型确定奈玛特韦-利托那韦与短期和长期结局之间的关联，并对潜在混杂因素进行调整。结局包括30天住院风险、1年主要不良心血管事件（MACE）风险、CKD进展和死亡。
共有1095例接受奈玛特韦-利托那韦治疗的患者与584例对照者匹配。接受奈玛特韦-利托那韦治疗的患者在诊断后30天内住院的可能性较小（调整后的亚分布风险比[sHR]，0.44；95%可信区间[CI]，0.26-0.73；P<.01）。在1年时，接受奈玛特韦-利托那韦治疗的患者因MACE住院的风险较低（调整后的sHR，0.49；95%CI，0.36-0.67；P<.01），死亡风险也较低（调整后的风险比，0.37；95%CI，0.21-0.65；P<.01）。使用奈玛特韦-利托那韦与感染后一年内CKD进展风险降低或估计肾小球滤过率下降斜率变缓无关。
奈玛特韦-利托那韦与CKD和肾衰竭患者30天内住院风险降低以及1年MACE和死亡风险降低相关。
