Original Research
Saturday, October 12, 2024
11:30 AM–01:00 PM
Abstract
Introduction:
When evaluating treatment options for any condition, clinicians consider polypharmacy, comorbidities, and other factors including the potential for drug-drug interactions (DDIs). COVID-19 treatment includes direct-acting antivirals (DAAs), some of which have the potential for DDIs with other medications that could be frequently used by immunocompromised patients.
Research Question or Hypothesis:
We describe the utilization of drugs that have a potential for DDIs with SARS-2-CoV DAAs among immunocompromised patients hospitalized for COVID-19.
Study Design:
Retrospective observational study.
Methods:
Patients with an immunocompromising condition and hospitalized with a primary diagnosis of COVID-19 between May’2020-December’2022 from the PINC AI Healthcare Database were included. We assessed the administration of medications during their COVID-19 hospitalization that could have potential DDIs with nirmatrelvir/ritonavir, remdesivir, and molnupiravir (per the Emergency Use Authorization factsheet or the package insert). For nirmatrelvir/ritonavir, multiple medications were listed as having potential DDIs categorized as contraindication, avoid concomitant use, or other DDIs (includes recommendation for dose modification, or clinical and laboratory monitoring). For remdesivir, potential DDIs were with chloroquine phosphate and hydroxychloroquine sulfate only. For molnupiravir, no drugs were listed as having potential DDIs.
Results:
Of the 90,558 immunocompromised patients hospitalized for COVID-19 in 883 hospitals, 72% were ³65 years of age and 58% had Charlson Comorbidity Index (CCI) =3. 93% received medications with potential DDI with nirmatrelvir/ritonavir, and in at least 55%, these DDIs would have been clinically problematic (13% “contraindicated,” and/or 49% “avoid concomitant use,” and further 90% “other DDI”). The medications utilized that were classified as potentially “contraindicated” to nirmatrelvir/ritonavir included: amiodarone (6%), simvastatin (2.3%) and colchicine (1.1%). Very few (2%) patients received medications with potential DDIs with remdesivir.
Conclusion:
A significant proportion of immunocompromised patients hospitalized for COVID-19 were administered medications during their hospitalization that had a potential DDI with DAAs; however, this was predominantly seen with nirmatrelvir/ritonavir while few with remdesivir or none with molnupiravir.
Presenting Author
Essy Mozaffari PharmD, MPH, MBAGilead Sciences
Authors
Neera Ahuja MD, FACP
Stanford University School of Medicine
Alpesh Amin MD, MBA, MACP, MHM, FACC, FRCP
AESARA
Mark Berry PhD
Gilead Sciences
Aastha Chandak PhD
Certara
Heng Jiang MPH
Certara
Jason F Okulicz MD
Gilead Sciences
Christina Rivera PharmD
Mayo Clinic Rochester
Andrew Ustianowski MD, PhD
North Manchester General Hospital