PDF(Pubmed)
Abstract：
(1) Background: Geriatric patients are at high risk of complications of Coronavirus disease-2019 (COVID-19) and are good candidates for antiviral drugs. (2) Methods: A retrospective study of electronic health records (EHRs) aiming to describe antiviral (nirmatrelvir and ritonavir (nirmatrelvir/r) or remdesivir) use, drug-drug interactions (DDIs) and adverse drug reactions (ADRs) in elderly patients (75 and over), hospitalized with mild-to-moderate COVID-19 between July 2022 and June 2023. (3) Results: Out of 491 patients (mean age: 86.9 years), 180 (36.7%) received nirmatrelvir/r, 78 (15.9%) received remdesivir, and 233 (47.4%) received no antiviral therapy. No association was found between the choice of antiviral and the demographic or medical data. No serious ADR was observed. Nirmatrelvir/r dosage adjustment was inadequate in 65% of patients with renal impairment. In total, 128 patients (71%) on nirmatrelvir/r had potential pharmacokinetic DDIs, with 43 resulting in a possibly related ADR. In the remdesivir group, pharmacodynamic DDIs were more frequent, with QTc prolongation risk in 56 patients (72%). Only 20 patients underwent follow-up ECG, revealing QTc prolongation in 4. (4) Conclusions: There is an underutilization of antivirals despite their justified indications. Nirmatrelvir/r dosage was rarely adjusted to renal function. Dose adjustments and closer monitoring are needed due to the high risk of drug interactions.
摘要：
（1）背景：老年患者患冠状病毒病-2019（COVID-19）并发症的风险很高，是抗病毒药物的良好候选药物。（2）方法：对电子健康记录（EHRs）进行回顾性研究，旨在描述抗病毒药物（尼马特雷韦和利托那韦（尼马特雷韦/r）或雷德西韦）的使用，老年患者（75岁及以上）的药物-药物相互作用（DDI）和药物不良反应（ADR），2022年7月至2023年6月期间因轻度至中度COVID-19住院。（3）结果：491例患者（平均年龄：86.9岁），180人（36.7%）接受了尼玛特雷韦/r，78人（15.9%）接受了雷姆德西韦，233（47.4%）未接受抗病毒治疗。抗病毒药物的选择与人口统计学或医学数据之间没有发现关联。没有观察到严重的ADR。65％的肾功能损害患者的Nirmatrelvir/r剂量调整不足。总的来说,128名患者（71%）在尼马特雷韦/r有潜在的药代动力学DDIs，43导致可能相关的ADR。在Remdesivir组,药效学DDI更频繁，56例患者有QTc延长风险(72%)。只有20例患者接受了心电图随访,4.显示QTc延长。（4）结论：尽管有合理的适应症，但抗病毒药物的利用不足。Nirmatrelvir/r剂量很少根据肾功能进行调整。由于药物相互作用的高风险，需要剂量调整和更密切的监测。
