Antiviral Use in Mild-to-Moderate SARS-CoV-2 Infections during the Omicron Wave in Geriatric Patients

• Published in: Viruses 2024-05, Vol.16 (6), p.864
• Main Authors: Exquis, Nadia, Dionisi, Benjamin, Samer, Caroline Flora, Rollason, Victoria, Curtin, François, Zekry, Dina, Graf, Christophe, Prendki, Virgnie, Ing Lorenzini, Kuntheavy
• Format: Article
• Language: English
• Subjects: Adenosine - analogs & derivatives; Adenosine Monophosphate - adverse effects; Adenosine Monophosphate - analogs & derivatives; Adenosine Monophosphate - therapeutic use; Aged; Aged patients; Aged, 80 and over; Alanine - adverse effects; Alanine - analogs & derivatives; Alanine - therapeutic use; Antiviral agents; Antiviral Agents - adverse effects; Antiviral Agents - therapeutic use; Antiviral drugs; Coronaviruses; COVID-19; COVID-19 - virology; COVID-19 Drug Treatment; COVID-19 vaccines; Dosage; Drug development; Drug dosages; Drug interaction; Drug Interactions; Drug therapy; Electronic health records; Electronic medical records; Ethics; Evaluation; FDA approval; Female; Geriatrics; Heart failure; Hospitalization; Hospitals; Humans; Immunization; Infections; Male; Metabolism; Mortality; nirmatrelvir; Patient outcomes; Patients; Pharmacodynamics; Pharmacokinetics; Prognosis; remdesivir; Renal function; Retrospective Studies; Ritonavir; Ritonavir - adverse effects; Ritonavir - therapeutic use; SARS-CoV-2 - drug effects; Severe acute respiratory syndrome coronavirus 2
• ISSN: 1999-4915; 1999-4915
• DOI: 10.3390/v16060864

(1) Background: Geriatric patients are at high risk of complications of Coronavirus disease-2019 (COVID-19) and are good candidates for antiviral drugs. (2) Methods: A retrospective study of electronic health records (EHRs) aiming to describe antiviral (nirmatrelvir and ritonavir (nirmatrelvir/r) or remdesivir) use, drug-drug interactions (DDIs) and adverse drug reactions (ADRs) in elderly patients (75 and over), hospitalized with mild-to-moderate COVID-19 between July 2022 and June 2023. (3) Results: Out of 491 patients (mean age: 86.9 years), 180 (36.7%) received nirmatrelvir/r, 78 (15.9%) received remdesivir, and 233 (47.4%) received no antiviral therapy. No association was found between the choice of antiviral and the demographic or medical data. No serious ADR was observed. Nirmatrelvir/r dosage adjustment was inadequate in 65% of patients with renal impairment. In total, 128 patients (71%) on nirmatrelvir/r had potential pharmacokinetic DDIs, with 43 resulting in a possibly related ADR. In the remdesivir group, pharmacodynamic DDIs were more frequent, with QTc prolongation risk in 56 patients (72%). Only 20 patients underwent follow-up ECG, revealing QTc prolongation in 4. (4) Conclusions: There is an underutilization of antivirals despite their justified indications. Nirmatrelvir/r dosage was rarely adjusted to renal function. Dose adjustments and closer monitoring are needed due to the high risk of drug interactions.