Nirmatrelvir plus ritonavir in COVID-19: a profile of its use

Oral nirmatrelvir plus ritonavir (Paxlovid (TM)) is an effective treatment option for coronavirus disease 2019 (COVID-19), the illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Nirmatrelvir inhibits the main protease of SARS-CoV-2, with ritonavir acting as a pharmacokinetic booster. In the phase II/III EPIC-HR trial, nirmatrelvir plus ritonavir reduced the risk of progression to severe COVID-19 in symptomatic, unvaccinated, non-hospitalized adults with mild-to-moderate COVID-19 at high risk for progression to severe disease. The incidence of COVID-19-related hospitalization or death through day 28 was significantly lower with nirmatrelvir plus ritonavir than with placebo. The efficacy of nirmatrelvir plus ritonavir has also been demonstrated in the real-world setting. Nirmatrelvir plus ritonavir is generally well tolerated, with most adverse events being of mild or moderate severity. Plain Language Summary Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of the coronavirus disease 2019 (COVID-19) global pandemic. Nirmatrelvir plus ritonavir (Paxlovid((TM))) is an oral antiviral treatment for COVID-19 that reduces the ability of SARS-CoV-2 to multiply in the body. The active substance nirmatrelvir blocks the activity of an enzyme needed by the virus to multiply, while ritonavir slows the breakdown of nirmatrelvir to increase its therapeutic benefit. Nirmatrelvir plus ritonavir reduces the risk of hospitalization or death in patients who are at increased risk for progression to severe COVID-19. The drug is generally well tolerated; most adverse events were mild or moderate in severity. Drug-drug interactions are possible. Nirmatrelvir plus ritonavir is an important treatment option for COVID-19 in patients whose age or underlying health puts them at high risk for becoming severely ill.