Safety and tolerability of molnupiravir and nirmatrelvir/ritonavir in patients with advanced chronic kidney disease and kidney failure; a cohort study

Patients with advanced chronic kidney disease (CKD) and kidney failure were excluded from clinical trials that led to approval of molnupiravir and nirmatrelvir/ritonavir for COVID-19. Between November 2022 and February 2024 there were 100 patients with advanced CKD (<i>N</i> = 81) or kidney failure (<i>N</i> = 19) who received either molnupiravir (<i>N</i> = 40) or nirmatrelvir/ritonavir (<i>N</i> = 60) for COVID-19 within a large healthcare network. Ten (10%) patients were hospitalized within 30 days; 5 hospitalizations were COVID-19 related and 5 were unrelated to COVID-19. Adverse events documented in the electronic health record were uncommon and all were mild to moderate (grade 1 or 2). Despite use of numerous concomitant medications known to interact with nirmaltrelvir/ritonavir, we found no adverse events attributed to a drug-drug interaction. All patients survived >30 days and 3 (3%) died prior to 90 days. Molnupiravir and nirmatrelvir/ritonavir were safe and well tolerated in patients with advanced CKD and kidney failure.