Objective: Chemoprophylaxis to mitigate the severity of COVID-19 outbreaks in nursing homes is not yet available. We assessed the feasibility of remdesivir, nirmatrelvir/ritonavir, and molnupiravir as potential chemoprophylaxis for nursing home residents.
Design: We conducted a national, cross-sectional study of residents of Department of Veterans Affairs (VA) Community Living Centers (CLCs) in 2021-2022.
Settings and participants: Veterans living in 134 CLCs on 4 census dates: January 1, 2021, July 1, 2021, January 1, 2022, and July 1, 2022.
Methods: Estimated glomerular filtration rates (eGFRs) were used to determine the proportion of residents who would require dose adjustment for antiviral agents. Medications issued in the 14 days before the census date were assessed for potential drug-drug interactions (pDDIs) with remdesivir, nirmatrelvir/ritonavir, and molnupiravir. We determined the number of residents at risk for pDDI and characterized their possible severity and mitigating actions.
Results: Remdesivir and molnupiravir would not have required dose adjustments based on renal insufficiency, but 29% of CLC residents had eGFR values that would require adjustment for nirmatrelvir/ritonavir. The proportion of CLC residents at risk for pDDIs for remdesivir, nirmatrelvir/ritonavir, and molnupiravir was <1%, 91%, and 0%, respectively. Atorvastatin, tamsulosin, and amlodipine were the most frequently prescribed medications with a pDDI to nirmatrelvir/ritonavir. Therapy modification was required to address pDDIs among 61% of CLC residents; an additional 29% were taking ≥1 medication with an absolute contraindication to nirmatrelvir/ritonavir.
Conclusions and implications: Given their tolerability among people with renal insufficiency and limited pDDIs, remdesivir and molnupiravir are both potential chemoprophylactic agents for COVID-19 outbreaks in nursing homes. Availability as oral capsules increases the feasibility for molnupiravir. Further work is needed to assess their efficacy to mitigate COVID-19 outbreaks in nursing homes.
Keywords: COVID-19 prophylaxis; Veterans; antiviral administration potential; outbreak.
Published by Elsevier Inc.