Successful use of nirmatrelvir/ritonavir in immunocompromised patients with persistent and/or relapsing COVID-19

Combination regimen of nirmatrelvir/ritonavir and molnupiravir for the treatment of persistent SARS-CoV-2 infection: A case report and a scoping review of the literature

“…Previous reports highlighted the importance of oral antiviral drugs beyond the early stage of COVID-19, for the treatment of persistent and/or relapsing COVID-19 in immunocompromised hosts [19] . Pending larger clinical studies to furtherly investigate the efficacy and safety of antiviral combination regimens in the treatment of SARS-CoV-2 infection, this possibility should be considered at least in selected cases, such as immunocompromised patients who fail to achieve clinical cure and viral clearance with conventional strategies.…”

Dual combined antiviral treatment with remdesivir and nirmatrelvir/ritonavir in patients with impaired humoral immunity and persistent SARS‐CoV‐2 infection

“…Both these two patients (number 1 and number 8 in Table 1) had persisting cough and CTS signs of Prior to this study, few case reports and small case series have described the management of patients with persisting infection with a wide range of therapeutic approaches. Prolonged courses of remdesivir 13 or nirmatrelvir/ritonavir, 14 dual antiviral therapy with remdesivir and nirmatrelvir/ritonavir, [15][16][17] and combination therapy with antiviral and monoclonal antibodies [18][19][20][21][22] have been described as treatment options. These studies have shown encouraging results, and they have provided valuable information for clinicians considering the lack of recommendations for these patients.…”

“…[10][11][12] Therefore, in clinical practice, the predicted lack of evidence has resulted in the use of various off-label treatment approaches, including prolonged or reiterated single agent-based or combinationbased therapies. [13][14][15][16][17][18][19][20][21][22] In this scenario we introduced in our clinical practice the combination of two antiviral drugs, remdesivir and nirmatrelvir/ritonavir, in a selected subgroup of patients with severe impairment of adaptive humoral immunity and persistent SARS-CoV-2 infection. Patients urgently needing to resume the treatment of their original comorbidity were favored.…”

“…Therefore, in clinical practice, the predicted lack of evidence has resulted in the use of various off‐label treatment approaches, including prolonged or reiterated single agent‐based or combination‐based therapies 13–22 …”

Potential herb–drug interactions between anti-COVID-19 drugs and traditional Chinese medicine

“…At present, three antiviral drugs (Paxlovid™, Remdesivir, and Molnupiravir) have been authorized to manage patients with COVID-19 5 . Paxlovid™ (Nirmatrelvir/Ritonavir) is a combination therapy that showed near 90% efficacy in preventing hospitalizations and deaths in high-risk patients 6 . Nirmatrelvir is considered as a SARS-CoV-2 protease inhibitor, and Ritonavir, as an inhibitor of the prominent drug-metabolizing enzyme cytochrome P450 (CYP) 3A4, could slow down the hepatic metabolism and boost the concentration of Nirmatrelvir 7 .…”