A pilot study on Paxlovid therapy for hemodialysis patients with severe acute respiratory syndrome coronavirus 2 infections

Abstract

We aimed to investigate the safety and efficacy of nirmatrelvir/ritonavir (Paxlovid) therapy for hemodialysis-dependent patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Thirteen hemodialysis patients infected with the Omicron variant of SARS-CoV-2 from April 3 to May 30, 2022, were recruited. Laboratory parameters and chest CT (computed tomography) imaging were analyzed. The treatment group included six patients who received 150 mg/100 mg of Paxlovid orally once daily for 5 days, whereas the control group included seven patients who received basic treatment. No serious adverse reactions or safety events were recorded. Four control patients progressed to moderate disease, and none in the treatment group showed progression of chest CT findings (P < 0.05). Paxlovid therapy tended toward early viral clearance and low viral load on Day 8. Moreover, 83.3% of the patients in the treatment group and 57.1% of the patients in the control group turned negative within 22 days. In the Paxlovid treatment group, we found significantly increased levels of lymphocytes (P=0.03) and eosinophils (P=0.02) and decreased levels of D-dimer on Day 8 compared with those on Day 1. Paxlovid therapy showed a potential therapeutic effect with good tolerance in hemodialysis patients. The optimal dose and effectiveness evaluation must be further investigated in a largeer cohort.

Keywords

Paxlovid / hemodialysis / SARS-CoV-2 / viral load / chest CT scan

Xu Hao et al.

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Acknowledgements

We thank all patients who agreed to participate in the study. This work is funded by grants from Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory of Infectious Diseases (No. 20dz2261100).

Electronic Supplementary Material

Supplementary material is available in the online version of this article at https://doi.org/10.1007/s11684-023-1011-0 and is accessible for authorized users.

Compliance with ethics guidelines

Conflicts of interest Xu Hao, Zhiyao Bao, Ranran Dai, Xiaojing Wu, Xin Li, Muyin Zhang, Hao Li, Lili Xu, Panpan Qiao, Xuefei Liu, Weiting Hu, Ze Zhang, Jie Fang, Min Zhou, Weiming Wang, and Jieming Qu declared that they had no conflicts of interest.

The study was approved by the Clinical Trial Ethics Committee of the Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine and the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all patients for being included in the study.

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