Evaluation of a Protocol Managing the Cyclosporine and Nirmatrelvir/Ritonavir Interaction in Kidney Transplant Recipients
Notice bibliographique
Résumé
Key Points This is the first protocol managing this drug interaction with documented patient follow-up data. The protocol, applied empirically, was able to restore cyclosporine levels within 9 days of the drug interaction. There were no significant and negative patient safety outcomes associated with the application of the protocol. Background Nirmatrelvir/ritonavir (NRMr) has emerged as a crucial treatment for managing coronavirus disease 2019 (COVID-19) infections but interacts with calcineurin inhibitors. This study aims to assess the application of a standardized protocol managing this drug–drug interaction, specifically with cyclosporine, because current evidence is limited. Methods This retrospective study included recipients on cyclosporine undergoing therapy with NRMr between April 2022 and December 2023. As per protocol, cyclosporine doses were reduced by 80%, and levels were measured 2 days after course completion. For subtherapeutic or therapeutic levels, cyclosporine dose was reinstated at 100%, with cyclosporine levels reassessed 1 week later. For supratherapeutic levels, the reduced dosage was maintained for an additional 2 days before being reinitiated at 100% of the baseline cyclosporine dose. Protocol adherence and clinical parameters such as cyclosporine levels, AKI episodes, hospitalization, and mortality were monitored up to 30 days after completion of NRMr therapy. Results Thirty-five kidney transplant recipients met eligibility criteria. At baseline, 83% of recipients had therapeutic cyclosporine levels. At the first follow-up 2 days after completion of NRMr, there was a greater proportion of recipients with subtherapeutic and supratherapeutic levels compared with baseline (20% versus 9% and 31% versus 9%), which had improved by the second follow-up at 9 days after completion of NRMr (14% and 14%). Three recipients experienced AKI for reasons unrelated to COVID-19 treatment. There were four hospitalizations, none related to COVID-19 treatment. There was no graft rejection or death 30 days after completion of NRMr. Conclusions Although cyclosporine levels outside therapeutic range were common immediately after completion of NRMr treatment, levels were restored rapidly. No clinically relevant safety events occurred within the 30 days. Adherence to the protocol is crucial when using NRMr in kidney transplant recipients.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,013 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».