Brad Pasternak, MD: Treating Pediatric COVID-19 Patients With IBD With Paxlovid

There is not much data available on the interaction between Paxlovid and tacrolimus.

A new case series analysis points to the decisions that tacrolimus could be withheld or decreasingly dosed for pediatric patients with inflammatory bowel disease (IBD) who contract COVID-19 and are treated with Paxlovid.

In an interview with HCPLive® during the Crohn’s and Colitis Congress 2023 in Denver, Brad Pasternak, MD, Pediatric Gastroenterology, Phoenix Children’s Hospital, explained the case study.

In the study, the investigators treated a 13-year old patients with ulcerative colitis that was prescribed Paxlovid for 5 days because of her immunosuppressive status, while withholding tacrolimus, an immunosuppressant commonly used for management of organ transplants that has been found to be effective treating IBD. However, this treatment also can lead to acute or chronic kidney disease.

The doctors restarted the tacrolimus 12 hours after the last dose of Paxlovid and she presented with symptoms and a level consistent with toxicity, showing there is an interaction between the 2 drugs.

“She still had a toxic level after restarting the medication,” Pasternak said. “One day was clearly too soon.”

Pasternak said a main challenge is that Paxlovid is a new drug, with not much data on how it might interact with different drugs.

“There’s really not a lot of data in our population,” he said.

Pasternak said there isn’t plans to study the interactions between the 2 drugs specifically in the IBD population, but it is likely they will continue to study it in the transplant population.