ArticleBMJ open respiratory research2025
Prevalence of potentially inappropriate use of antiviral therapy with simnotrelvir-ritonavir versus nirmatrelvir-ritonavir in hospitalised patients: a retrospective study in Beijing, China.
Article in BMJ open respiratory research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundWhile simnotrelvir-ritonavir and nirmatrelvir-ritonavir, the oral antiviral agents targeting the 3C-like proteases, are widely used in China, robust data on their appropriate use remain limited in hospitalised patients. We therefore examined the appropriateness of simnotrelvir-ritonavir versus nirmatrelvir-ritonavir in the inpatient setting.
methodsA retrospective study was conducted to compare the potentially inappropriate use of simnotrelvir-ritonavir and nirmatrelvir-ritonavir in hospitalised patients between 1 July 2023 and 31 December 2023 in Beijing, China. Four factors are taken into consideration when defining and critiquing potentially inappropriate use: indications, dosage and timing of administration, contraindications and drug-drug interactions.
resultsWe have identified 278 simnotrelvir-ritonavir and nirmatrelvir-ritonavir prescriptions in 226 hospitalised COVID-19 patients, of which 49.6% (138 prescriptions) satisfied all the criteria for appropriate use. Nirmatrelvir-ritonavir prescriptions were more likely to have potentially inappropriate indications (12.4% vs 3.2%, p=0.006) or dosage and timing of administration (13.1% vs 4.0%, p=0.009) than simnotrelvir-ritonavir prescriptions. Nirmatrelvir-ritonavir was prescribed to two patients in the presence of contraindications (severe renal impairment). No significant differences were identified in drug-drug interactions (DDIs) (p=0.657) and contraindicated DDIs (p=0.670) between simnotrelvir-ritonavir and nirmatrelvir-ritonavir. The most common contraindicated co-medication was estazolam, followed by quetiapine and clopidogrel.
conclusionsAbout half of the patients use simnotrelvir-ritonavir and nirmatrelvir-ritonavir that might potentially be inappropriate. More extensive research is required to supplement the empirical evidence supporting COVID-19 therapeutics. Additionally, appropriate therapy requires collaboration with pharmacists and education on the appropriate use of COVID-19 therapeutics among physicians and patients.
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