(094) Concomitant prescribing of nirmatrelvir/ritonavir (NMV-r) and medications with potential risk for drug-drug interaction – a feasibility assessment of Truveta Electronic Health Records Database.

Background: Nirmatrelvir/ritonavir (NMV-r) is indicated for the treatment of adult and pediatric patients with mild-to-moderate SARS-CoV-2 who are at risk for severe SARS-CoV-2, including hospitalization or death. However, there are >100 drugs to treat comorbid conditions that are not recommended or contraindicated for use in combination with NMV-r as they may result in serious reactions.

Objectives: To assess the feasibility and capacity of Truveta electronic health records (Truveta) to measure, in near real-time, the magnitude of concomitant prescribing among patients prescribed NMV-r.

Methods: A descriptive study was performed, using Truveta, to identify patients’ first NMV-r prescription (index date) from 12/22/2021 - 1/24/2024. To be included, patients were ≥12 years of age with ≥1 health system encounter within 365 days prior to index date. Using prescriptions as proxy for treatment, as they do not indicate concomitant administration, prescription dates were used to estimate the proportion of overlap in prescribing within 30-days prior- and 14-days post-index date. This was repeated among high-risk (HR) patients (≥1 of following: age >60 years, or history of smoking, immunosuppressive condition, chronic lung disease, hypertension, cardiovascular disease, diabetes, chronic kidney disease (CKD), sickle cell disease, or cancer). Patients were excluded if pregnant, on dialysis, or received a diagnosis of chronic liver disease at index date.

Results: In total, 631,234 patients were prescribed NMV-r in Truveta. Patients were majority female (60%) and White (75%) [with a mean age: 59 years (SD=16)]. The most commonly described comorbidities were hypertension (49%), obesity (29%), diabetes (19%), chronic lung disease (11%), mild to moderate CKD (9%), immunosuppressive condition (4%), and severe CKD (0.7%). Of NMV-r treated patients, < 5% and approximately 31% (n=194,105) had previously received ≥1 prescription(s) for a contraindicated drug or a drug with a potential interaction, respectively, within 30-days prior to the index date. When assessing prescribing patterns 14-days post index date, 1% and 23% of the total patient population were prescribed contraindicated drugs or drugs with potential interactions, respectively. Of the total population, 521,269 (83%) HR patients were identified with a similar demographic, clinical, and concomitant prescription profile.

Conclusions: This study demonstrated Truveta’s feasibility and capacity to measure potential polypharmacy among COVID-19 patients prescribed NMV-r. Additional studies are needed to better understand the impact of NMV-r drug-drug interactions on potential increased risk of serious adverse events and reduced patient compliance.