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Nirmatrelvir/ ritonavir

Phase 3

COVID-19 | Small molecule | Infectious Disease |Pfizer, Inc.|Trials Updated: Jul 17, 2025

Nirmatrelvir/ ritonavir development status

Highest phase Phase 3
Registered trials 2 across 1 sponsor since Sep 2022

Nirmatrelvir/ ritonavir target and mechanism

Molecular targetMpro
ModalitySmall molecule

Also known as PF-07321332 Dose 1, nirmatrelvir, PF-07321332

Success Probability

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Market & Valuation

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Trial Design

RandomizedDouble-BlindPLACEBO_CONTROLLEDDMC
Total Trials7
Total Enrollment5,851

FDA Designations

No designations recorded

Nirmatrelvir/ ritonavir clinical trials

Nirmatrelvir/ ritonavir · 7 trials · 3 indications

Phase 3 1Phase 2 4Phase 1 2
NCT05261139EPIC-Peds: A Study to Learn About the Study Medicine Called PF-07321332 (Nirmatrelvir)/Ritonavir in Patients Under 18 Years of Age With COVID-19 That Are Not Hospitalized But Are at Risk for Severe DiseaseCOVID-19
RECRUITING160 Analytics
PHASE3RECRUITING
EPIC-Peds: A Study to Learn About the Study Medicine Called PF-07321332 (Nirmatrelvir)/Ritonavir in Patients Under 18 Years of Age With COVID-19 That Are Not Hospitalized But Are at Risk for Severe Disease
COVID-19Unlock trial analytics

Study Endpoints

Primary Endpoints

Cohort 1-2: Maximum Observed Plasma Concentration (Cmax) of nirmatrelvir and ritonavir
Day 1: 1 hour-post dose; Day 4: pre-dose; Day 5: pre-dose, and 1, and 2 hours post dose
Cohort 1-2: Area Under the Curve to the End of the Dosing Period (AUC0-tau) of nirmatrelvir and ritonavir
Day 1: 1 hour-post dose; Day 4: pre-dose; Day 5: pre-dose, and 1, and 2 hours post dose
Incidence of Treatment Emergent Adverse Events (TEAEs) leading to discontinuations.
From Baseline up through Day 34
Incidence of Serious Adverse Events (SAEs) leading to discontinuations.
From Baseline up through Day 34
Incidence of Adverse Events (AEs) leading to discontinuations.
From Baseline up through Day 34
Number of participants with change from Baseline in Vital Signs
From Baseline up through Day 34
Change From Baseline to Day 5 in Viral Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Ribonucleic Acid (RNA) Level in Nasopharyngeal (NP) Swabs: mITT Population
Baseline, Day 5

Baseline was defined as the latest measurement between Day -1 and Day 1, but post-dose samples that were collected within 1 hour post start of dosing were also treated as baseline. Samples with result "\< lower limit of quantification (LLOQ)" were imputed as 1.7 log10 copies/milliliter (mL), and samples with result "Not Detected" were imputed as 0.0 log10 copies/mL.

Percentage of Participants With Sustained Nasopharyngeal (NP) Swab Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Ribonucleic Acid (RNA) < Lower Limit of Quantitation (LLOQ) From Day 15 to Day 44
From Day 15 to Day 44

NP swab was collected by healthcare professional (HCP) from participants and were sent to the central laboratory for viral RNA level testing real-time reverse transcriptase-polymerase chain reaction(RT-PCR). Sustained was defined as NP swab SARS-CoV-2 RNA level not \>=2.0 log10 per milliliter (copies/mL) at any study visit (through Day 44) following the first study visit where the participant's NP swab SARS-CoV-2 RNA level \<LLOQ (\<2.0 log10 copies/mL).

Percentage of Participants Who Developed Symptomatic RT-PCR or RAT Confirmed SARS-CoV-2 Infection Through Day 14: Among Participants With Negative RT-PCR at Baseline
From Day 1 to Day 14

Percentage of participants who developed symptomatic Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) or Rapid Antigen Test (RAT) confirmed SARS-Cov-2 infection were reported in this outcome measure. Index case was defined as participants with symptomatic COVID-19.

Percentage of Participants With Covid-19 Related Hospitalization or Death From Any Cause Through Day 28- Modified Intent-To-Treat (mITT) Population
From Day 1 to Day 28

Percentage of participants with COVID-19 related hospitalization or death from any cause during the first 28 days of the study was estimated using the Kaplan-Meier (KM) method. Using KM method, survival probability for each time interval was calculated as the number of participants surviving divided by the number of participants at risk. Participants who had the event, dropped out, or moved out were not counted as "at risk" i.e., participants who were lost were considered "censored" and were not counted in the denominator.

Maximum Observed Plasma Concentration (Cmax) of Plasma PF-07321332
Day 1 at 0 (pre-dose for PF-07321332), 0.5, 1, 2, 3, 4, 6, 8, 10, and 12 hours, Day 2 at 24 and 36 hours, and Day 3 at 48 hours

Cmax was the maximum observed plasma concentration and was directly observed from data. Concentration values below the lower limit of quantification (LLQ) were set to zero. Geometric mean analysis was on the log scale. Zero values were not included in geometric mean and geometric coefficient of variation calculation. The geometric coefficient of variation was expressed in percentage.

Area Under the Plasma Concentration-Time Profile From Time Zero to Time of the Last Quantifiable Concentration (AUClast) of Plasma PF-07321332
Day 1 at 0 (pre-dose for PF-07321332), 0.5, 1, 2, 3, 4, 6, 8, 10, and 12 hours, Day 2 at 24 and 36 hours, and Day 3 at 48 hours

AUClast was area under the plasma concentration time-curve from zero (pre-dose) to the last measured concentration. The geometric coefficient of variation was expressed in percentage.

Area Under the Plasma Concentration-Time Profile From Time Zero Extrapolated to Infinite Time (AUCinf) of Plasma PF-07321332
Day 1 at 0 (pre-dose for PF-07321332), 0.5, 1, 2, 3, 4, 6, 8, 10, and 12 hours, Day 2 at 24 and 36 hours, and Day 3 at 48 hours

AUCinf was defined as area under the plasma concentration-time curve from time zero to infinity. The geometric coefficient of variation was expressed in percentage.

Maximum Observed Plasma Concentration (Cmax) of PF-07321332
Part 1 and Part 2: 0 (pre-dose), 0.5, 1, 2, 3, 4, 6, 8, 10, 12, 24, 36 and 48 hours post-dose on Day 1
Area Under the Plasma Concentration-time Profile From Time Zero (0) to Extrapolated Infinite Time (AUCinf) of PF-07321332
Part 1 and Part 2: 0 (pre-dose), 0.5, 1, 2, 3, 4, 6, 8, 10, 12, 24, 36 and 48 hours post-dose on Day 1

AUCinf was calculated by AUClast + (Clast/kel). AUClast was the area under the plasma concentration-time profile from time 0 to the time of Clast. Clast was the predicted plasma concentration at the last quantifiable time point estimated from the log-linear regression analysis and kel was the terminal phase rate constant calculated by a linear regression of the log-linear concentration-time curve.

Amount of PF-07321332 Excreted Unchanged in Urine Over 48 Hours (Ae48)
Part 1 and Part 2: 0 to 48 hours post dose on Day 1

Total amount of unchanged drug excreted in the urine over 48 hours.

Renal Clearance (CLr) of PF-07321332
Part 1 and Part 2: 0 to 48 hours post dose on Day 1

Renal clearance was calculated as total amount of unchanged drug excreted in the urine over 48 hours (Ae48) divided by area under the plasma concentration-time profile from time 0 to 48 hours post dose.

Secondary Endpoints

Viral load assessment titers measured via reverse transcription polymerase chain reaction (RT-PCR) in nasopharyngeal or nasal swabs over time
Baseline, Day 5, 6, 10, 14 and 28
Proportion of participants with COVID-19 related hospitalization or death from any cause
From Baseline through Day 28
Patient assessment on acceptability and palatability of nirmatrelvir/ritonavir (film-coated tablets and oral powder)
At baseline only for tablets and after each dose for powder formulation
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Study Design & Arms

AllocationNON_RANDOMIZED
MaskingNONE
ModelSINGLE_GROUP
PurposeTREATMENT

Treatment Arms

ArmTypeDescription
Cohort 1 nirmatrelvir/ritonavirEXPERIMENTALnirmatrelvir/ritonavir will be given by tablets or powder by mouth twice a day for 5 days (10 doses total). Weight ≥40 kg 1. ≥12 to \<18 years 2. ≥6 to \<12 years
Cohort 2 nirmatrelvir/ritonavirEXPERIMENTALnirmatrelvir/ritonavir will be given as powder by mouth twice a day for 5 days (10 doses total) Weight ≥20 to \<40 kg, ≥6 to \<18 years
Cohort 3 nirmatrelvir/ritonavirEXPERIMENTALnirmatrelvir/ritonavir ≥2 to \<6 years
Cohort 4 nirmatrelvir/ritonavirEXPERIMENTALnirmatrelvir/ritonavir ≥1 month (≥28 days) to \<2 years
Cohort 5 nirmatrelvir/ritonavirEXPERIMENTALnirmatrelvir/ritonavir \<1 month (\<28 days) old
nirmatrelvir plus ritonavir for 5 daysEXPERIMENTALNirmatrelvir (2 tablets) plus ritonavir (1 capsule) will be given by mouth every 12 hours for 5 days
placebo plus ritonavir for 5 daysOTHERplacebo (2 tablets) plus ritonavir (1 capsule) will be given by mouth every 12 hours for 5 days
Nirmatrelvir plus ritonavir for 10 daysEXPERIMENTALNirmatrelvir (2 tablets) plus ritonavir (1 capsule) will be given by mouth every 12 hours for 10 days followed by placebo for nirmatrelvir (2 tablets) plus placebo for ritonavir (1 capsule) every 12 hours for 5 days
Nirmatrelvir plus ritonavir for 15 daysEXPERIMENTALNirmatrelvir (2 tablets) plus ritonavir (1 capsule) will be given by mouth every 12 hours for 15 days.
PF-07321332/ritonavir (5 days)EXPERIMENTALParticipants will receive PF-07321332/ritonavir every 12 hours from Day 1 through Day 5 followed by Placebo every 12 hours from Day 6 through Day 10
PF-07321332/ritonavir (10-Day)EXPERIMENTALParticipants will receive PF-07321332/ritonavir every 12 hours from Day 1 through Day 10.
PlaceboPLACEBO_COMPARATORParticipants will receive placebo every 12 hours from Day 1 through Day 10.
PF-07321332/ritonavirEXPERIMENTALOrally administered PF-07321332+ritonavir
Cohort 1EXPERIMENTALHealthy Volunteer
Cohort 2EXPERIMENTALHepatic Impairment
PF-07321332EXPERIMENTALPF 07321332/ritonavir

Interventions

NameTypeDescription
nirmatrelvirDRUGPF-07321332
ritonavirDRUGritonavir
placebo for nirmatrelvirDRUGParticipants will receive 2 tablets of placebo for nirmatrelvir every 12 hours. A placebo does not have any medicine in it but looks just like the medicine being studied.
Placebo for ritonavirDRUGParticipants will receive 1 capsule of placebo for ritonavir every 12 hours. A placebo does not have any medicine in it but looks just like the medicine being studied.
PF-07321332DRUGPF-07321332
Placebo for PF-07321332DRUGPlacebo
PlaceboDRUGPlacebo (tablet or capsule)
PF-07321332/ritonavirDRUGPF-07321332 in combination with the PK boosting agent, ritonavir, being developed for the treatment of COVID-19
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Eligibility Criteria

Age Range0 Years to 17 Years
SexALL
Healthy VolunteersNo
Study Sites73

Inclusion criteria: * Male and female, age 0 to \< 18 years, able to swallow for some participants * Confirmed SARS-CoV-2 infection within 72 hours prior to enrollment * Initial onset of COVID-19 signs/symptoms within 5 days prior to the day of enrollment and at least 1 of the specified COVID-19 si...

Countries:United StatesBulgariaJapanMexicoPuerto RicoSouth AfricaUnited KingdomCanadaGreeceItalyTaiwanAustraliaBrazilHungarySlovakiaSpainArgentinaColombiaCzechiaMalaysiaPolandRussiaThailandTurkey (Türkiye)UkraineIndiaSouth Korea
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Frequently asked questions about Nirmatrelvir/ ritonavir

What is nirmatrelvir/ritonavir?

Nirmatrelvir/ritonavir is an investigational oral small molecule antiviral being developed by Pfizer for COVID-19, and it is also being studied in people with hepatic impairment and renal impairment. It combines nirmatrelvir with ritonavir and is given as an oral treatment in clinical trials.

What does nirmatrelvir/ritonavir target?

Nirmatrelvir/ritonavir targets Mpro, the SARS-CoV-2 main protease. Nirmatrelvir is the component that acts on this viral enzyme, while ritonavir is included as a pharmacokinetic booster. This mechanism is designed to interfere with viral replication in COVID-19.

Who makes nirmatrelvir/ritonavir?

Pfizer, Inc. is developing nirmatrelvir/ritonavir. Pfizer trades on the New York Stock Exchange under the ticker PFE. The company sponsors the clinical trial program for the asset across COVID-19 and related impairment populations.

What phase is nirmatrelvir/ritonavir in?

Nirmatrelvir/ritonavir is in Phase 3 development and is investigational. It has not been established as approved based on this program information. The clinical program includes five trials overall, with one currently active and four completed.

What clinical trials is nirmatrelvir/ritonavir in?

Nirmatrelvir/ritonavir has been studied in trials including NCT05567952, NCT05438602, NCT05261139, and NCT05047601. These cover COVID-19 rebound, immunocompromised patients, pediatric patients, and post-exposure prevention. NCT05261139, the EPIC-Peds Phase 3 trial, is currently recruiting participants.

Is nirmatrelvir the same as PF-07321332?

Yes. Nirmatrelvir is also known as PF-07321332, and the combination is referred to as nirmatrelvir/ritonavir or PF-07321332/ritonavir. Other listed names include PF-07321332 Dose 1 and combinations with dabigatran or midazolam used in study settings.