Successful treatment by doravirine with cobicistat-boosted darunavir for end-stage renal failure under chronic haemodialysis

Abstract

Sir, Doravirine is an NNRTI that was newly approved for use in Japan on 14 January 2020. The pharmacokinetics of doravirine are not greatly influenced by sex, age, race or hepatic impairment.1,2 Doravirine is primarily metabolized by cytochrome P450 3A4 and its clearance is reduced by strong inhibitors of this enzyme. However, no dose adjustment is recommended when administered in combination with PIs such as ritonavir or cobicistat.3 In addition, no dose adjustment is required for renal impairment;4 however, pharmacokinetic data during haemodialysis (HD) remain quite limited. Furthermore, doravirine has a relatively low molecular weight (425.75 g/mol, which is <500 g/mol) and exhibits low protein binding in plasma (0.76, which is <0.90),5 which suggests that doravirine may be removed by dialysis.6 Here, we present one case of end-stage renal failure treated with a doravirine-containing regimen where drug concentrations were measured during HD. This...