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Preclinical discovery and development of nirmatrelvir/ritonavir combinational therapy for the treatment of COVID-19 and the lessons learned from SARS-COV-2 variants

Preclinical discovery and development of nirmatrelvir/ritonavir combinational therapy for the treatment of COVID-19 and the lessons learned from SARS-COV-2 variants

Authors :
Pagliano, Pasquale
Spera, Annamaria
Sellitto, Carmine
Scarpati, Giuliana
Folliero, Veronica
Piazza, Ornella
Franci, Gianluigi
Conti, Valeria
Ascione, Tiziana
Source :
Expert Opinion on Drug Discovery; December 2023, Vol. 18 Issue: 12 p1301-1311, 11p
Publication Year :
2023

Abstract

ABSTRACTIntroductionNirmatrelvir/ritonavir (Paxlovid®) represent an oral antiviral therapy approved for the treatment of COVID-19. Extensive in vitroand in vivostudies have reported the promising activity of nirmatrelvir/ritonavir against numerous emerging viruses. This combination consists of nirmatrelvir, a protease reversible inhibitor of coronavirus 3CLpromainly metabolized by cytochrome P450 (CYP)3A4, and ritonavir, an inhibitor of the CYP3A isoforms that enhances the efficacy of nirmatrelvir by fixing its suboptimal pharmacokinetic properties.Areas coveredThis review comprehensively examines the efficacy of nirmatrelvir/ritonavir through rigorous analysis of in vitroand in vivostudies. Moreover, it thoroughly assesses its safety, tolerability, pharmacokinetics, and antiviral efficacy against SARS-COV-2 infection, based on the main pre-authorization randomized controlled trials.Expert opinionNirmatrelvir/ritonavir has a good tolerability profile. Its administration during the early stages of mild-to-moderate COVID-19 holds potential benefits, as it can help prevent the onset of an aberrant immune response that could lead to pulmonary and extra-pulmonary complications. However, its drug – drug interactions can be a factor limiting its use, at least in populations on some chronic therapies, along with the risk of infection relapse after treatment.

Details

Language :
English
ISSN :
17460441 and 1746045X
Volume :
18
Issue :
12
Database :
Supplemental Index
Journal :
Expert Opinion on Drug Discovery
Publication Type :
Periodical
Accession number :
ejs64387632
Full Text :
https://doi.org/10.1080/17460441.2023.2248879