1
|
Nichols CN, Lustberg M, Sobhanie MME, Niermann LJ, Gordon M, Kman N, Parsons J, Conroy M, Dick M, Allen J, Reed E, Lehman J, Malvestutto C. Clinical outcomes in patients with mild to moderate coronavirus disease 2019 treated with monoclonal antibody therapy versus an untreated control cohort. Antivir Ther 2024; 29:13596535241264694. [PMID: 39066463 DOI: 10.1177/13596535241264694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
BACKGROUND Monoclonal antibody therapy (MAT) received Food and Drug Administration (FDA) Emergency Use Authorization (EUA) for mild to moderate COVID-19 treatment in adults at a high-risk for progression to severe disease in November 2020. This study assessed the impact of MAT on clinical outcomes. METHODS We conducted a single-center, retrospective study comparing 30-day COVID-19-related emergency department (ED) visits, admissions, and mortality in patients receiving MAT (bamlanivimab, bamlanivimab-etesevimab, or casirivimab-imdevimab) between 16 November 2020 and 19 June 2021, compared to a control group of high-risk adults diagnosed with mild to moderate COVID-19 prior to MAT availability between 16 May 2020 and 15 November 2020. Statistical analysis used logistic regression analysis with backward selection to determine the odds ratios and 95% confidence interval evaluating the relationship between clinical characteristics and outcomes. RESULTS 1187 patients who received MAT were compared to 1103 patients not treated with MAT. Multivariable regression model adjusted for possible confounders showed patients who received MAT had lower rates of ED visits (3.2% vs 7.4%, OR = 0.46, 95% CI = 0.31-0.70, p < .001) and hospital admissions (4.3% vs 7.8%, OR = 0.42, 95% CI = 0.29-0.62, p < .001) compared to the control group. After adjusting for confounders, MAT was associated with decreased mortality (OR = 0.36, p = .035). In the MAT group, those treated within 2 days of COVID-19 diagnosis had lower mortality than those treated more than 2 days post-diagnosis (unadjusted OR = 0.152, 95% CI = 0.031-0.734, p = .019). CONCLUSIONS Individuals treated with MAT had lower rates of 30-day COVID-19-related ED visits and hospital admissions compared to those not receiving MAT. Early MAT resulted in lower 30-day mortality compared to receipt >2 days post COVID-19 diagnosis.
Collapse
Affiliation(s)
- Courtney N Nichols
- Department of Internal Medicine, Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mark Lustberg
- Division of Infectious Diseases, Yale New Haven Hospital, New Haven, CT, USA
| | - Mohammed Mahdee E Sobhanie
- Department of Internal Medicine, Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lucia J Niermann
- Department of Internal Medicine, Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Melissa Gordon
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nicholas Kman
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jonathan Parsons
- Department of Internal Medicine, Division of Pulmonary Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mark Conroy
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael Dick
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - James Allen
- Department of Internal Medicine, Division of Pulmonary Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Erica Reed
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Joy Lehman
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Carlos Malvestutto
- Department of Internal Medicine, Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| |
Collapse
|
2
|
Amani B, Khodavirdilou L, Rajabkhah K, Kardan Moghaddam V, Akbarzadeh A, Amani B. Efficacy and safety of bamlanivimab in patients with COVID-19: A systematic review and meta-analysis. World J Virol 2024; 13:88660. [PMID: 38616851 PMCID: PMC11008398 DOI: 10.5501/wjv.v13.i1.88660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/09/2023] [Accepted: 12/29/2023] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Monoclonal antibodies (mAbs) have shown clinical benefits against coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several studies have reported the use of bamlanivimab as a promising treatment option for COVID-19. AIM To synthesize the latest evidence for the efficacy and safety of bamlanivimab alone in the treatment of adult patients with COVID-19. METHODS A literature search was conducted in PubMed, Cochrane Library, Web of Science, medRxiv, and Google Scholar using "SARS-CoV-2", "COVID-19", "LY-CoV555", and "Bamlanivimab" keywords up to January 25, 2023. The quality of included studies was assessed using the Cochrane bias tools. The Comprehensive Meta-Analysis software version 3.0 was used to analyze the data. RESULTS A total of 30 studies involving 47368 patients were included. A significant difference was observed between the bamlanivimab and standard of care/placebo groups in terms of mortality rate [risk ratio (RR) = 50, 95% confidence interval (CI): 0.36-0.70], hospitalization rate (RR = 0.51; 95%CI: 0.39-0.68), and emergency department (ED) visits (RR = 0.69; 95%CI: 0.47-0.99); while the two groups exhibited no significant difference in terms of intensive care unit (ICU) admission (P > 0.05). Compared to other mAbs, bamlanivimab was associated with a higher rate of hospitalization (RR = 1.44; 95%CI: 1.07-1.94). However, no significant difference was detected between the bamlanivimab and other mAbs groups in terms of mortality rate, ICU admission, and ED (P > 0.05). The incidence of any adverse events was similar between the bamlanivimab and control groups (P > 0.05). CONCLUSION Although the results suggest the efficacy and safety of bamlanivimab in COVID-19 patients, further research is required to confirm the efficacy of this drug for the current circulating SARS-CoV-2 variants.
Collapse
Affiliation(s)
- Behnam Amani
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran 1416634793, Iran
| | - Lida Khodavirdilou
- Department of Pharmaceutical Sciences, Jerry H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX 79106, United States
| | - Kourosh Rajabkhah
- Deputy of Research and Technology, Tehran University of Medical Sciences, Tehran 1416634793, Iran
| | - Vida Kardan Moghaddam
- School of Medicine and Dentistry, Griffith University, Queensland, Brisbane 4222, Australia
| | - Arash Akbarzadeh
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran 1416634793, Iran
| | - Bahman Amani
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran 1416634793, Iran
| |
Collapse
|
3
|
Marwah V, Choudhary R, Adhikari S, Pemmaraju A, Menon AS, Manrai M, Ajai Kumar T, Verma S. Real-world experience of monoclonal antibodies in mild-to-moderate COVID-19 patients at a tertiary care center. Med J Armed Forces India 2023:S0377-1237(23)00042-4. [PMID: 37360888 PMCID: PMC10193195 DOI: 10.1016/j.mjafi.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 03/17/2023] [Indexed: 06/28/2023] Open
Abstract
Background Neutralizing antibodies cocktail (casirivimab and imdevimab) has received emergency use authorization recommendation by Food and Drug Administration (FDA) and WHO for mild-to-moderate COVID-19 infection in specific high-risk groups. Antibodies cocktail has shown promising results in preventing progression to severe disease, but the real-world experience is still evolving. Herein, we present a retrospective analysis of 22 patients who were administered the antibodies cocktail between August 2021 and March 2022 at our tertiary care center. Methods We conducted an observational retrospective analysis of clinicoradiological, inflammatory parameters, progression of the disease, and outcome among 22 mild and moderate COVID-19 patients treated with antibodies cocktail. Results The mean age was 67.7 years (SD ± 18.3) and comprised of 13 males (59%), while 9 were females (40.9%). Nine (40.9%) patients were fully vaccinated with two doses, nine (40.9%) were partially vaccinated with one dose while four patients (18.2%) were unvaccinated, and the rest were unvaccinated. Diabetes and hypertension were the commonest comorbidities; hematological and solid organ malignancies were other comorbidities. Eight patients had radiological opacities consistent with COVID-19 pneumonia and had shown significant regression in four patients after the therapy. None of our patients required supplemental oxygen or progressed to severe acute respiratory distress syndrome. All patients were discharged in a stable condition within 6 days of the therapy. Conclusions The neutralizing antibodies cocktail has shown encouraging results in our analysis in preventing progression to severe disease in patients with high-risk conditions.
Collapse
Affiliation(s)
- Vikas Marwah
- Professor & Head (Pulmonary, Critical Care & Sleep Medicine), Army Institute of Cardiothoracic Sciences (AICTS), Pune, India
| | - Robin Choudhary
- Assistant Professor (Pulmonary Medicine, Critical Care & Sleep Medicine), Base Hospital, Delhi Cantt, India
| | | | - Arpita Pemmaraju
- Classified Specialist (Pathology), Army Institute of Cardiothoracic Sciences (AICTS), Pune, India
| | - A S Menon
- Brig Med, HQ 2 Corps, C/o 56 APO, India
| | - Manish Manrai
- Professor, Department of Medicine, Armed Forces Medical College, Pune, India
| | - Tentu Ajai Kumar
- Associate Professor (Pulmonary, Critical Care & Sleep Medicine), Army Institute of Cardiothoracic Sciences (AICTS), Pune, India
| | - Shipra Verma
- Graded Specialist (Pathology), Armed Forces Clinic, Delhi, India
| |
Collapse
|
4
|
Ravi G, Eerike M, Konda VR, Bisoi D, Raj GM, Priyadarshini R, Mali KR, Chaliserry LF. Efficacy and Safety of Anti-SARS-CoV-2 Monoclonal Antibodies: An Updated Review. Monoclon Antib Immunodiagn Immunother 2023; 42:77-94. [PMID: 37129306 DOI: 10.1089/mab.2022.0036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Monoclonal antibodies (mAbs) had received emergency use authorization for mild-to-moderate coronavirus disease 2019 (COVID-19) or for prophylaxis against COVID-19, including casirivimab plus imdevimab (C+I), bamlanivimab plus etesevimab (B+E), tixagevimab plus cilgavimab (T+CG), and sotrovimab (S) and bebtelovimab (BEB). This systematic review was done to assess the efficacy and safety of the same. PubMed, Embase, Scopus, medRxiv, bioRxiv, and FDA fact sheets were searched for the studies published between January 2021 and May 2022, and appropriate search terms related to the mentioned mAbs were used for data collection. Review included original research including randomized clinical trials and observational studies published or preprints. Studies included in the review had compared with placebo or standard of care or no treatment or mAbs with each other and also of various doses. Data extraction was done and reviewed the same for both efficacy and safety. Total of 20 studies were included in this review. The rate of hospitalization within 30 days showed ∼2% in comparison to ∼7% with placebo. Significant reduction in viral load was more observed with combination mAbs. Combination therapy showed faster virological cure against the Gamma variant. With C + I as postexposure prophylaxis (PEP), 29.0% of asymptomatic participants developed symptomatic COVID-19. Pre-exposure prophylaxis with T+CG reduced the incidence of infection by 77%. Infusion-related reaction was the most common adverse event (AE). The neutralizing mAbs reduced hospitalization in mild-to-moderate patients with infusion-related reactions as common AE. The response was better in the seronegative patients. Most of these studies were conducted in unvaccinated individuals and against Alpha, Gamma, and Delta variants.
Collapse
Affiliation(s)
- Gandham Ravi
- Department of Pharmacology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | - Madhavi Eerike
- Department of Pharmacology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | - Venugopala Rao Konda
- Department of Pharmacology, TRR Institute of Medical Sciences, Patancheru, India
| | - Debasis Bisoi
- Department of Pharmacology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | - Gerard Marshall Raj
- Department of Pharmacology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | - Rekha Priyadarshini
- Department of Pharmacology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | - Kalpana Ramanna Mali
- Department of Pharmacology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | - Leo Francis Chaliserry
- Department of Pharmacology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| |
Collapse
|
5
|
Tai YL, Lee MD, Chi H, Chiu NC, Lei WT, Weng SL, Liu LYM, Chen CC, Huang SY, Huang YN, Lin CY. Effects of bamlanivimab alone or in combination with etesevimab on subsequent hospitalization and mortality in outpatients with COVID-19: a systematic review and meta-analysis. PeerJ 2023; 11:e15344. [PMID: 37180576 PMCID: PMC10174063 DOI: 10.7717/peerj.15344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) has caused an enormous loss of life worldwide. The spike protein of the severe acute respiratory syndrome coronavirus 2 is the cause of its virulence. Bamlanivimab, a recombinant monoclonal antibody, has been used alone or in combination with etesevimab to provide passive immunity and improve clinical outcomes. A systematic review and meta-analysis was conducted to investigate the therapeutic effects of bamlanivimab with or without etesevimab (BAM/ETE) treatment. Methods Our study was registered in PROSPERO (registry number CRD42021270206). We searched the following electronic databases, without language restrictions, until January 2023: PubMed, Embase, medRxiv, and the Cochrane database. A systematic review and meta-analysis was conducted based on the search results. Results Eighteen publications with a total of 28,577 patients were identified. Non-hospitalized patients given bamlanivimab with or without etesevimab had a significantly lower risk of subsequent hospitalization (18 trials, odds ratio (OR): 0.37, 95% confidence interval (CI): [0.29-0.49], I2: 69%; p < 0.01) and mortality (15 trials, OR: 0.27, 95% CI [0.17-0.43], I2: 0%; p = 0.85). Bamlanivimab monotherapy also reduced the subsequent risk of hospitalization (16 trials, OR: 0.43, 95% CI [0.34-0.54], I2: 57%; p = 0.01) and mortality (14 trials, OR: 0.28, 95% CI [0.17-0.46], I2: 0%; p = 0.9). Adverse events from these medications were uncommon and tolerable. Conclusions In this meta-analysis, we found the use of bamlanivimab with or without etesevimab contributed to a significantly-reduced risk of subsequent hospitalization and mortality in non-hospitalized COVID-19 patients. However, resistance to monoclonal antibodies was observed in COVID-19 variants, resulting in the halting of the clinical use of BAM/ETE. Clinicians' experiences with BAM/ETE indicate the importance of genomic surveillance. BAM/ETE may be repurposed as a potential component of a cocktail regimen in treating future COVID variants.
Collapse
Affiliation(s)
- Yu-Lin Tai
- Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Pediatrics, Hsinchu Municipal MacKay Children’s Hospital, Hsinchu, Taiwan
| | - Ming-Dar Lee
- Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Pediatrics, Hsinchu Municipal MacKay Children’s Hospital, Hsinchu, Taiwan
| | - Hsin Chi
- Medicine, MacKay Medical College, New Taipei, Taiwan
- Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
| | - Nan-Chang Chiu
- Medicine, MacKay Medical College, New Taipei, Taiwan
- Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
| | - Wei-Te Lei
- Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Pediatrics, Hsinchu Municipal MacKay Children’s Hospital, Hsinchu, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shun-Long Weng
- Medicine, MacKay Medical College, New Taipei, Taiwan
- Department of Obstetrics and Gynecology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Lawrence Yu-Min Liu
- Medicine, MacKay Medical College, New Taipei, Taiwan
- Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Chung-Chu Chen
- Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Teaching Center of Natural Science, Minghsin University of Science and Technology, Hsinchu, Taiwan
| | - Shih-Yu Huang
- Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Ya-Ning Huang
- Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Pediatrics, Hsinchu Municipal MacKay Children’s Hospital, Hsinchu, Taiwan
| | - Chien-Yu Lin
- Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Pediatrics, Hsinchu Municipal MacKay Children’s Hospital, Hsinchu, Taiwan
- Medicine, MacKay Medical College, New Taipei, Taiwan
| |
Collapse
|
6
|
Lokhandwala T, Acharya M, Farrelly E, Coutinho AD, Bell CF, Svedsater H. Within-trial economic analysis of resource use from COMET-ICE: A phase 3 clinical trial evaluating sotrovimab for the treatment of patients with COVID-19 at high risk of progression. J Manag Care Spec Pharm 2022; 28:1261-1271. [PMID: 36282931 PMCID: PMC10372996 DOI: 10.18553/jmcp.2022.28.11.1261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND: Final results for the primary endpoint of the COVID-19 Monoclonal antibody Efficacy Trial-Intent to Care Early (COMET-ICE) randomized controlled trial (NCT04545060) showed a 79% (P < 0.001) adjusted relative risk reduction in longer-than-24-hour hospitalization or death due to any cause in high-risk patients with COVID-19 receiving sotrovimab compared with placebo at Day 29. Given the substantial costs associated with COVID-19 hospitalizations, there is a need to quantify the economic impact of clinical trial outcomes to inform decisionmaking. OBJECTIVE: To compare longer-than-24-hour hospitalization costs (primary objective) and total health care costs (secondary objective) associated with COVID-19 care in the sotrovimab vs placebo group in the COMET-ICE trial. METHODS: This was a 2-step, retrospective, post hoc, within-trial economic analysis. Step 1 was a health care claims (MarketScan) database analysis to source unit cost data (2020 USD) from a US payer perspective for COVID-19 care-related resource use from April 1 through June 30, 2020, among adults diagnosed with COVID-19 at high risk of progression (similar to those enrolled in the COMET-ICE trial). Cost per day for an inpatient event stratified by the following maximum respiratory support levels was obtained: no respiratory support or oxygen therapy only, noninvasive ventilation, and invasive mechanical ventilation. Cost per event was obtained for outpatient resource use. Step 2 was the within-trial economic analysis, in which unit costs from Step 1 were applied to the resource use (based on maximum respiratory support and length of stay for inpatient events and number of visits for outpatient events) observed during the first 29 days post-randomization in COMET-ICE. RESULTS: A total of 1,057 patients from the intent-to-treat COMET-ICE population were included (sotrovimab, n = 528; placebo, n = 529). Baseline demographic and clinical characteristics were well balanced between groups. During 29 days of follow-up, mean (SD) costs for the primary endpoint, longer-than-24-hour hospitalization, were $2,827 ($15,545) in the placebo group and $485 ($5,049) in the sotrovimab group (difference, -$2,342; P < 0.0001). Total health care costs were $2,850 ($15,546) in the placebo group and $525 ($5,070) in the sotrovimab group (difference, -$2,325; P = 0.0021). CONCLUSIONS: This post hoc within-trial economic analysis of COMET-ICE data shows that early treatment with sotrovimab vs placebo may be associated with lower longer-than-24-hour hospitalization costs and total health care costs for COVID-19 care in high-risk patients with COVID-19. These findings may be important in informing decision-making regarding use of sotrovimab in clinical practice. DISCLOSURES: Dr Lokhandwala and Ms Farrelly are employees of Xcenda LLC; Xcenda received funding from GSK to support the conduct of this study and did not receive funding for manuscript development. Mr Acharya and Dr Coutinho were employees of Xcenda LLC during the conduct of the study. Mr Bell and Dr Svedsater are employees of, and hold stocks/shares in, GSK. This study was funded by GSK (study 216974) and Vir Biotechnology, Inc. The study sponsors were involved in the study design; collection, analysis, and interpretation of data; writing of the report; and the decision to submit the report for publication.
Collapse
Affiliation(s)
| | - Mahip Acharya
- University of Arkansas for Medical Sciences, Little Rock
| | | | | | | | - Henrik Svedsater
- GSK, Global Value Evidence and Outcomes, Brentford, Middlesex, UK
| |
Collapse
|
7
|
Kwan BM, Sobczak C, Beaty L, Wynia MK, DeCamp M, Owen V, Ginde AA. Clinician Perspectives on Monoclonal Antibody Treatment for High-Risk Outpatients with COVID-19: Implications for Implementation and Equitable Access. J Gen Intern Med 2022; 37:3426-3434. [PMID: 35790666 PMCID: PMC9255528 DOI: 10.1007/s11606-022-07702-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 06/15/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is an urgent need to identify and address factors influencing uptake and equitable access to monoclonal antibody (mAb) treatment for high-risk outpatients with COVID-19. OBJECTIVE To assess clinician knowledge, beliefs, and experiences regarding obtaining mAb treatment for eligible patients. DESIGN AND PARTICIPANTS Survey of clinicians (N = 374) practicing in the state of Colorado who care for patients with COVID-19 in primary care, emergency medicine, and other clinical settings. MAIN MEASURE(S) Diffusion of innovation theory concepts including knowledge, perceived strength of evidence, barriers, and experience with, ease of use, preparedness, and feasibility, appropriateness, and acceptability of mAb referral systems and processes. KEY RESULTS Most respondents indicated little to no knowledge about mAb therapies for COVID-19 (67%, 74%, 77%, for bamlanivimab, bamlanivimab+etesivimab, and casirivimab+imdevimab, respectively). About half reported little to no familiarity with eligibility criteria (50.9%) and did not know the strength of evidence (31%, 43%, 52%, for bamlanivimab, bamlanivimab+etesivimab, and casirivimab+imdevimab, respectively). Lack of knowledge or confidence in treatment was a top barrier to mAbs use; other barriers included complicated referral processes, patients not eligible when seen, and out-of-pocket costs concerns. Respondents rated four mAb referral steps as generally acceptable, appropriate, and feasible to complete in their primary outpatient clinical setting. Only 24% indicated their clinical setting was very prepared to facilitate referrals, 40% had ever referred a patient for mAbs, and 43% intended to refer a patient in the next month. CONCLUSIONS Clinician education on strength of evidence and eligibility criteria for mAbs is needed. However, education alone is not sufficient. Given the urgent need to rapidly scale up access to treatment and reduce hospitalizations and death from COVID-19, more efficient, equitable systems and processes for referral and delivery of care, such as those coordinated by health systems, public health departments, or disaster management services, are warranted.
Collapse
Affiliation(s)
- Bethany M Kwan
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
- Colorado Clinical & Translational Sciences Institute, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Chelsea Sobczak
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Laurel Beaty
- Center for Innovative Design & Analysis, Colorado School of Public Health, Aurora, CO, USA
| | - Matthew K Wynia
- Colorado Clinical & Translational Sciences Institute, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew DeCamp
- Colorado Clinical & Translational Sciences Institute, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Vanessa Owen
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Colorado Clinical & Translational Sciences Institute, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
8
|
Antispike monoclonal antibodies for prevention and treatment of coronavirus disease-2019 in solid organ transplant recipients. Curr Opin Organ Transplant 2022; 27:269-276. [PMID: 36354253 DOI: 10.1097/mot.0000000000000981] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE OF REVIEW Coronavirus disease-2019 (COVID-19) disproportionately causes severe outcomes in solid organ transplant recipients (SOTR). Antispike monoclonal antibodies have been authorized for therapy and prophylaxis for COVID-19. Here, we review the current state of antispike monoclonal antibodies and their role for SOTRs. RECENT FINDINGS Bamlanivimab with or without etesevimab, casirivimab-imdevimab and sotrovimab have reduced the rates of hospitalization and severe disease in high-risk patients with mild-to-moderate COVID-19. Multiple retrospective studies have also demonstrated monoclonal antibodies are effective in SOTR populations. However, the evolution of resistant severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concerns has resulted in revocation of the authorization of bamlanivimab with or without etesevimab, and casirivimab-imdevimab as treatment and postexposure prophylaxis (PEP). Sotrovimab and bebtelovimab are currently authorized for treatment of the predominant circulating SARS-CoV-2 B.1.1.529 (Omicron), but not as pre or PEP. Tixagevimab-cilgavimab, a long-acting antibody combination preparation, is authorized for preexposure prophylaxis in high-risk immunocompromised populations, including SOTRs, who are less likely to mount an effective immune response following vaccination series and booster. SUMMARY Antispike monoclonal antibodies are useful for the prevention and treatment of mild-to-moderate COVID-19 in SOTRs. However, their clinical use should be determined by the evolving epidemiology of SARS-CoV-2 variants in the community.
Collapse
|
9
|
Early administration of Anti-SARS-CoV-2 Monoclonal Antibodies prevents severe Covid-19 in Kidney Transplant Patients. Kidney Int Rep 2022; 7:1241-1247. [PMID: 35372734 PMCID: PMC8957354 DOI: 10.1016/j.ekir.2022.03.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction Kidney transplant recipients (KTRs) are prone to develop severe COVID-19 and are less well protected by vaccine than immunocompetent subjects. Thus, the use of neutralizing anti–SARS-CoV-2 monoclonal antibody (MoAb) to confer a passive immunity appears attractive in KTRs. Methods We performed a French nationwide study to compare COVID-19–related hospitalization, 30-day admission to intensive care unit (ICU), and 30-day death between KTRs who received an early infusion of MoAb (MoAb group) and KTRs who did not (control group). Controls were identified from the COVID-SFT registry (NCT04360707) using a propensity score matching with the following covariates: age, sex, delay between transplantation and infection, induction and maintenance immunosuppressive therapy, initial symptoms, and comorbidities. Results A total of 80 KTRs received MoAb between February 2021 and June 2021. They were matched to 155 controls. COVID-19–related hospitalization, 30-day admission to ICU, and 30-day death were less frequently observed in the MoAb group (35.0% vs. 49.7%, P = 0.032; 2.5% vs. 15.5%, P = 0.002; 1.25% vs. 11.6%, P = 0.005, respectively). No patient required mechanical ventilation in the MoAb group. The number of patients to treat to prevent 1 death was 9.7. Conclusion The early use of MoAb in KTRs with a mild form of COVID-19 largely improved outcomes in KTRs.
Collapse
|
10
|
Xiang HR, He B, Li Y, Cheng X, Zhang QZ, Peng WX. Bamlanivimab plus etesevimab treatment have a better outcome against COVID-19: A meta-analysis. J Med Virol 2021; 94:1893-1905. [PMID: 34936121 DOI: 10.1002/jmv.27542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 01/10/2023]
Abstract
Bamlanivimab is routinely used in the treatment of coronavirus disease 2019 (COVID-19) worldwide. We performed a meta-analysis to investigate the efficacy and safety of bamlanivimab treatment in patients with COVID-19. We searched articles from Web of Science, PubMed, Embase, the Cochrane Library, and medRxiv between January 30, 2020 and August 5, 2021. We selected randomized clinical trials (RCTs) and observational studies with a control group to assess the efficiency of bamlanivimab in treating patients with COVID-19. Our meta-analysis retrieved three RCTs and seven cohort studies including 14 461 patients. Bmlanivimab may help outpatients to prevent hospitalization or emergency department visits (RR 0.41, 95%CI 0.29-0.58), reduce ICU admission (RR 0.47, 95%CI 0.23-0.92), and mortality (RR 0.32, 95%CI 0.13-0.77) from the disease. The combination of bamlanivimab and etesevimab may have a greater potential for positive treatment outcomes. Bamlanivimab has demonstrated clinical efficacy on mild or moderate ill patients with COVID-19 to prevent hospitalization, reduce severity, and mortality from the disease. Combinations of bamlanivimab and etesevimab have a significant relative risk reduction for COVID-related hospitalization or death for patients than the monotherapy 700 mg group. Well-designed clinical trials to identify the clinical and biochemical characteristics in the COVID-19 patients' population that could benefit from bamlanivimab or plus etesevimab are warranted in the future.
Collapse
Affiliation(s)
- Huai-Rong Xiang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bei He
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yun Li
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xuan Cheng
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qi-Zhi Zhang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wen-Xing Peng
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Institute of Clinical Pharmacy, Central South University, Changsha, Hunan, China
| |
Collapse
|
11
|
Zuo L, Ao G, Wang Y, Gao M, Qi X. Bamlanivimab improves hospitalization and mortality rates in patients with COVID-19: A systematic review and meta-analysis. J Infect 2021; 84:248-288. [PMID: 34534563 PMCID: PMC8438996 DOI: 10.1016/j.jinf.2021.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/05/2021] [Accepted: 09/12/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Ling Zuo
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guangyu Ao
- Department of Nephrology, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Yushu Wang
- Department of Cardiology, Chengdu First People's Hospital, Chengdu, Sichuan, China; Chengdu West China Clinical Research Center Co., Ltd., Chengdu, China
| | - Ming Gao
- Department of Cardiology, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Xin Qi
- Department of Neurology, The Affiliated Hospital of Southwest Jiaotong University & The Third People's Hospital of Chengdu, No.82 North Qinglong Street, Qingyang District, Sichuan 610016, China.
| |
Collapse
|