BACKGROUND AND PURPOSE:

• Data on safety and outcomes of Paxlovid treatment in pregnancy are limited
• Garneau et al. (JAMA Network Open, 2022) evaluated the clinical outcomes associated with nirmatrelvir and ritonavir use in pregnant patients

METHODS:

• Case series
• Population
  • Pregnant patients with COVID-19
  • Received nirmatrelvir and ritonavir
  • Delivered their offspring between December 2021 and August 2022
• Exposures
  • Treatment with nirmatrelvir and ritonavir for SARS-CoV-2 infection during pregnancy
• Primary outcome
  • Clinical characteristics and outcomes

RESULTS:

• 47 pregnant patients
  • Median age: 34 (range, 22 to 43) years
  • Median age of offspring: 28.4 (range 4.3 to 39.6) weeks
  • Medication initiated (median): 1 (range, 0 to 5) days after symptom onset
  • Had a comorbidity that was a risk factor for severe COVID-19: 63.8%
• Did not complete therapy due to adverse effects: 4.3% (2 patients)
• Delivered after treatment with nirmatrelvir and ritonavir: 53.2%
  • Cesarean delivery: 48.0%
  • Scheduled: 75.0%
• Hospitalized for conditions related to preexisting morbidities: 4.3% (2 patients)

CONCLUSION:

• Pregnant patients with COVID-19 tolerated nirmatrelvir and ritonavir
  • There was a high rate of cesarean deliveries among those treated
  • Serious adverse effects were rare
• The authors state

Findings of this case series support the safety and effectiveness of nirmatrelvir and ritonavir in pregnant patients with acute SARS-CoV-2

Although there are multiple effective therapies for outpatient treatment of acute SARS-CoV-2, all are either intravenous (remdesivir, convalescent plasma, and monoclonal antibodies) or contraindicated in pregnancy (molnupiravir)

Nirmatrelvir and ritonavir can be easily used as a first-line outpatient treatment for pregnant patients

Learn More – Primary Sources:

Analysis of Clinical Outcomes of Pregnant Patients Treated With Nirmatrelvir and Ritonavir for Acute SARS-CoV-2 Infection

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