Nirmatrelvir Resistance-de Novo E166V/L50V Mutations in an Immunocompromised Patient Treated With Prolonged Nirmatrelvir/Ritonavir Monotherapy Leading to Clinical and Virological Treatment Failure-a Case Report

Neta S Zuckerman; Efrat Bucris; Danielle Keidar-Friedman; Muriel Amsalem; Tal Brosh-Nissimov

doi:10.1093/cid/ciad494

Nirmatrelvir Resistance-de Novo E166V/L50V Mutations in an Immunocompromised Patient Treated With Prolonged Nirmatrelvir/Ritonavir Monotherapy Leading to Clinical and Virological Treatment Failure-a Case Report

Clin Infect Dis. 2024 Feb 17;78(2):352-355. doi: 10.1093/cid/ciad494.

Authors

Neta S Zuckerman¹, Efrat Bucris¹, Danielle Keidar-Friedman^{2

3}, Muriel Amsalem², Tal Brosh-Nissimov^{4

5}

Affiliations

¹ Central Virology Laboratory, Ministry of Health, Tel Hashomer, Israel.
² Microbiology Laboratory, Samson Assuta Ashdod University Hospital, Ashdod, Israel.
³ Emerging Infectious Diseases Laboratory, Samson Assuta Ashdod University Hospital, Ashdod, Israel.
⁴ Infectious Diseases Unit, Samson Assuta Ashdod University Hospital, Ashdod, Israel.
⁵ Faculty of Health Sciences, Ben Gurion University in the Negev, Beer Sheba, Israel.

PMID: 37596935
DOI: 10.1093/cid/ciad494

Abstract

Resistance of SARS-CoV-2 to antivirals was shown to develop in immunocompromised individuals receiving remdesivir. We describe an immunocompromised patient who was treated with repeated and prolonged courses of nirmatrelvir and developed de-novo E166V/L50F mutations in the Mpro region. These mutations were associated with clinical and virological treatment failure.

Keywords: E166V/L50F; Mpro; immunocompromised; nirmatrelvir; resistance.

Publication types

Case Reports

MeSH terms

Antiviral Agents / therapeutic use
Humans
Immunocompromised Host*
Mutation
Ritonavir* / therapeutic use
SARS-CoV-2 / genetics

Substances

Ritonavir
Antiviral Agents