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
|
da Silva Amorim AF, Sobalvarro JVM, Torres LH, Dos Reis TM. Sotrovimab in the treatment of coronavirus disease-2019 (COVID-19): a systematic review and meta-analysis of randomized clinical trials. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024:10.1007/s00210-024-03298-y. [PMID: 39031183 DOI: 10.1007/s00210-024-03298-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 07/12/2024] [Indexed: 07/22/2024]
Abstract
This study was carried out to verify the evidence regarding the effectiveness and safety of sotrovimab in patients with COVID-19. This is a systematic review of randomized clinical trials retrieved from the PubMed, Embase, Scopus, Lilacs, and Cochrane Library databases. The risk of bias was measured using the Cochrane Risk and Bias Checklist (RoB 2). For the meta-analysis, RStudio Version 2024.04.2 software was used. The certainty of evidence was assessed using GRADE. The study protocol was registered in PROSPERO (CRD42022355786). A total of 1893 studies were identified and four were included in the study. The total population consisted of 5470 patients with COVID-19, 1921 (35%) in the sotrovimab group and 3549 (65%) in the control group (placebo or BRII-196 + BRII-198 or casirivimab + imdevimab or bamlanivimab + etesevimab, administered in a similar way to sotrovimab, in a single dose with a 60-min intravenous infusion). For the effectiveness outcome, three studies presented low risk and one high risk of bias, while for safety all presented high risk of bias. The meta-analysis showed no significant difference between the sotrovimab and control groups in terms of hospitalization rates (95% confidence interval (CI) - 2.10-0.51; p = 0 > 0.05), use of invasive mechanical ventilation (95% CI - 2.78-0.65; p = 0.35) and mortality (95% CI - 0.92-0.59; p = 0.39). However, sensitivity analysis showed that sotrovimab may be effective in reducing hospitalization rates compared to the control (IV = - 1.57; 95% CI - 2.41-0.73; p = 0.99). The use of sotrovimab in the treatment of patients with COVID-19 had no significant impact on mortality and need for mechanical ventilation and did not appear to be safer compared to controls. However, there was evidence of effectiveness in reducing the rate of hospitalization, although the certainty of the evidence is moderate and the risk of bias is high.
Collapse
Affiliation(s)
- Ana Flávia da Silva Amorim
- Department of Food and Drugs, Faculty of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Brazil
| | | | - Larissa Helena Torres
- Department of Food and Drugs, Faculty of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Brazil.
| | - Tiago Marques Dos Reis
- Department of Clinical and Toxicological Analysis, Faculty of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Brazil.
| |
Collapse
|
3
|
Zheng Z, Sun H, Hu X, Xuan Z, Fu M, Bai Y, Du Y, Liu B, Sui X, Zheng J, Shao C. Prevention and treatment strategies for kidney transplant recipients in the context of long-term existence of COVID-19. Front Med (Lausanne) 2024; 11:1287836. [PMID: 38633308 PMCID: PMC11021598 DOI: 10.3389/fmed.2024.1287836] [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: 09/04/2023] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
The sudden outbreak of coronavirus disease 2019 (COVID-19) in early 2020 posed a massive threat to human life and caused an economic upheaval worldwide. Kidney transplant recipients (KTRs) became susceptible to infection during the COVID-19 pandemic owing to their use of immunosuppressants, resulting in increased hospitalization and mortality rates. Although the current epidemic situation is alleviated, the long-term existence of COVID-19 still seriously threatens the life and health of KTRs with low immunity. The Omicron variant, a highly infectious but less-pathogenic strain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has raised concerns among transplant physicians regarding managing KTRs diagnosed with this variant. However, currently, there are no clear and unified guidelines for caring for KTRs infected with this variant. Therefore, we aimed to summarize the ongoing research on drugs that can treat Omicron variant infections in KTRs and explore the potential of adjusting immunotherapy strategies to enhance their responsiveness to vaccines. Herein, we discuss the situation of KTRs since the emergence of COVID-19 and focus on various prevention and treatment strategies for KTRs since the Omicron variant outbreak. We hope to assist physicians in managing KTRs in the presence of long-term COVID-19 variants.
Collapse
Affiliation(s)
- Zeyuan Zheng
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Huimin Sun
- Central Laboratory, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Xiaoyan Hu
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Zuodong Xuan
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Meiling Fu
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Yang Bai
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Yifan Du
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Bin Liu
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Xiuyuan Sui
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jianzhong Zheng
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Chen Shao
- Department of Urology, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| |
Collapse
|
4
|
Kapur R, Okumura K, Ohira S, Isath A, Gandhi A, Keller M, Nog R, Gass A, Spielvogel D, Lansman S, Dhand A. Coronavirus Disease 2019 (COVID-19) in Heart Transplant Recipients and Anti-SARS-CoV-2 Monoclonal Antibodies: Experience, Lessons Learnt, and Future Challenges. Cardiol Rev 2024:00045415-990000000-00208. [PMID: 38334977 DOI: 10.1097/crd.0000000000000640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Solid organ transplant recipients (SOTRs), including heart transplant (HT) recipients, infected with Coronavirus disease 2019 (COVID-19) are at higher risk of hospitalization, mechanical ventilation, or death when compared with general population. Advances in diagnosis and treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have reduced COVID-19-related mortality rates from ~30% in the early pandemic to <3% in 2022 among HT recipients. We performed a retrospective chart review including adult HT recipients at Westchester Medical Center from January 1, 2020 to December 10, 2022, who received anti-SARS-CoV-2 monoclonal antibodies (mAbs) for treatment of mild-to-moderate COVID-19, and those who received tixagevimab/cilgavimab for preexposure prophylaxis. Additionally, a comprehensive review of the literature involving SOTRs who received mAbs for COVID-19 was conducted. In this largest single-center study in this population, 42 adult HT recipients received casirivimab/imdevimab (36%), sotrovimab (31%), or bebtelovimab (29%) for treatment of mild-to-moderate COVID-19. Among these recipients, no infusion-associated adverse effects, progression of disease, COVID-19-associated hospitalizations, or death were noted. Preexposure prophylaxis with tixagevimab/cilgavimab was given to 63 HT recipients in a dedicated infusion center (40%), inpatient setting (33%), or at time of annual heart biopsy (27%). No immediate adverse events were noted. There were 11 breakthrough infections, all mild. Overall, the data suggests that HT recipients receiving mAbs have reduced rates of hospitalization, need for intensive care unit care, or death. Use of anti-SARS-CoV-2 mAbs in SOTRs is resource intensive and requires a programmatic team approach for optimal administration and to minimize any risk of disparities in their use.
Collapse
Affiliation(s)
| | - Kenji Okumura
- Department of Surgery, New York Medical College/Westchester Medical Center, Valhalla, NY
| | - Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery
| | - Ameesh Isath
- Division of Cardiology, Department of Medicine, Westchester Medical Center, Valhalla, NY
| | | | | | - Rajat Nog
- From the Department of Medicine
- Department of Surgery, New York Medical College/Westchester Medical Center, Valhalla, NY
| | - Alan Gass
- Division of Cardiology, Department of Medicine, Westchester Medical Center, Valhalla, NY
| | | | - Steven Lansman
- Department of Surgery, New York Medical College/Westchester Medical Center, Valhalla, NY
| | - Abhay Dhand
- From the Department of Medicine
- Department of Surgery, New York Medical College/Westchester Medical Center, Valhalla, NY
| |
Collapse
|
5
|
Sanchez E, Krantz EM, Yoke L, Gallaher M, Bhattacharyya P, So L, Escobar ZK, Tverdek F, Rosen EA, Quinn ZZ, Swetky M, Walji S, Wilson MH, McCreery B, McCulloch D, Weixler A, Roychoudhury P, Pergam SA, Liu C. Clinical outcomes and frequency of persistent infection among immunosuppressed patients treated with bebtelovimab for COVID-19 infection at an ambulatory cancer center. Transpl Infect Dis 2024; 26:e14223. [PMID: 38191852 PMCID: PMC10922880 DOI: 10.1111/tid.14223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND There are limited data on clinical outcomes associated with the use of bebtelovimab for the treatment of coronavirus disease 2019 (COVID-19) among cancer patients. We aimed to define the clinical characteristics and outcomes among patients receiving bebtelovimab as part of the COVID-19 therapeutics program at our cancer center. METHODS This is a retrospective cohort study of immunosuppressed adult patients who received bebtelovimab at Fred Hutchinson Cancer Center between March 2022, and November 2022. We reviewed medical records to capture the date of the first positive COVID-19 test, clinical characteristics, outcomes, and follow-up COVID-19 testing for 60 days after the first positive. Persistent infection was defined as a positive test beyond day 30; these patients were reviewed beyond day 60. RESULTS Among 93 patients who received bebtelovimab, 64 (69%) had hematologic malignancy. Sixty-nine (74%) patients received bebtelovimab within 2 days after diagnosis. Two (2%) patients were hospitalized, none required ICU care, and one patient died on day 52; although it is unknown if death was directly related to COVID-19. Ten (11%) patients had persistent COVID-19 infection; of these, four received additional COVID-19 therapy with either nirmatrelvir/ritonavir or remdesivir, and five out of six patients with sequencing data available had spike protein mutations associated with bebtelovimab resistance. CONCLUSION A coordinated systems-based approach led to prompt initiation of bebtelovimab within two days of testing positive in most patients. We observed few hospitalizations or deaths. Persistent infection was noted in 11% of patients with four requiring additional therapies, highlighting a need for novel strategies to manage immunosuppressed patients.
Collapse
Affiliation(s)
- Eduardo Sanchez
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Leah Yoke
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Pooja Bhattacharyya
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Lisa So
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Zahra Kassamali Escobar
- Fred Hutchinson Cancer Center, Seattle, WA, USA
- School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Frank Tverdek
- Fred Hutchinson Cancer Center, Seattle, WA, USA
- School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Emily A Rosen
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - ZZ Quinn
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | - Salma Walji
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | | | | | - Denise McCulloch
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Amelia Weixler
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | - Pavitra Roychoudhury
- Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | | | - Catherine Liu
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| |
Collapse
|
6
|
Amani B, Shabestan R, Rajabkhah K, Amani B. Sotrovimab in solid organ transplant recipients with COVID-19: a systematic review and meta-analysis. KOREAN JOURNAL OF TRANSPLANTATION 2023; 37:277-285. [PMID: 37916433 PMCID: PMC10772269 DOI: 10.4285/kjt.23.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/13/2023] [Accepted: 09/26/2023] [Indexed: 11/03/2023] Open
Abstract
Background Despite widespread implementation of vaccination against coronavirus disease 2019 (COVID-19), solid organ transplant recipients (SOTRs) can remain particularly vulnerable to this disease. The present study was conducted to investigate the efficacy and safety of sotrovimab in the treatment of SOTRs with COVID-19. Methods A search was performed of PubMed, Cochrane Library, Web of Science, medRxiv, and Google Scholar to gather relevant evidence through July 25, 2023. The quality of the included studies was assessed using the risk of bias tool. Comprehensive Meta-Analysis software (ver. 3.0, Biostat) was employed for data analysis. Results Ten studies, involving a total of 1,569 patients, were included. The meta-analysis revealed significant differences between the patients administered sotrovimab and those treated with the standard of care. These differences were observed in mortality rate (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.03-0.67), hospitalization rate (OR, 0.35; 95% CI, 0.21-0.57), intensive care unit (ICU) admission rate (OR, 0.16; 95% CI, 0.04-0.62), the need for supplemental oxygen therapy (OR, 0.22; 95% CI, 0.09-0.51), and the need for mechanical ventilation (OR, 0.09; 95% CI, 0.01-0.70). However, no significant difference was observed between sotrovimab and other treatments regarding the rates of hospitalization or ICU admission (P>0.05). Regarding safety, sotrovimab was associated with a lower rate of adverse events compared to the absence of sotrovimab (OR, 0.15; 95% CI, 0.02-0.86). Conclusions These results suggest that sotrovimab may improve efficacy outcomes among SOTRs with COVID-19. Nevertheless, additional high-quality trials are necessary to confirm these findings.
Collapse
Affiliation(s)
- Behnam Amani
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Rouhollah Shabestan
- Department of Biostatistics and Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Kourosh Rajabkhah
- Department of Curative Affairs, Ministry of Health and Medical Education, Tehran, Iran
| | - Bahman Amani
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
7
|
Leider JP, Lim S, DeBruin D, Waterman AT, Smith B, Ghimire U, Huhtala H, Zirnhelt Z, Lynfield R, Hick JL. Using a web platform for equitable distribution of COVID-19 monoclonal antibodies: a case study in resource allocation. Front Public Health 2023; 11:1226935. [PMID: 38106886 PMCID: PMC10722896 DOI: 10.3389/fpubh.2023.1226935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023] Open
Abstract
While medical countermeasures in COVID-19 have largely focused on vaccinations, monoclonal antibodies (mAbs) were early outpatient treatment options for COVID-positive patients. In Minnesota, a centralized access platform was developed to offer access to mAbs that linked over 31,000 patients to care during its operation. The website allowed patients, their representative, or providers to screen the patient for mAbs against Emergency Use Authorization (EUA) criteria and connect them with a treatment site if provisionally eligible. A validated clinical risk scoring system was used to prioritize patients during times of scarcity. Both an ethics and a clinical subject matter expert group advised the Minnesota Department of Health on equitable approaches to distribution across a range of situations as the pandemic evolved. This case study outlines the implementation of this online platform and clinical outcomes of its users. We assess the impact of referral for mAbs on hospitalizations and death during a period of scarcity, finding in particular that vaccination conferred a substantially larger protection against hospitalization than a referral for mAbs, but among unvaccinated users that did not get a referral, chances of hospitalization increased by 4.1 percentage points.
Collapse
Affiliation(s)
- Jonathon P. Leider
- Center for Public Health Systems, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Sarah Lim
- Minnesota Department of Health, Saint Paul, MN, United States
| | - Debra DeBruin
- Center for Bioethics, University of Minnesota, Minneapolis, MN, United States
| | | | - Barbara Smith
- Health Sciences Technology, University of Minnesota, Minneapolis, MN, United States
| | - Umesh Ghimire
- Center for Public Health Systems, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Haley Huhtala
- Health Sciences Technology, University of Minnesota, Minneapolis, MN, United States
| | | | - Ruth Lynfield
- Minnesota Department of Health, Saint Paul, MN, United States
| | - John L. Hick
- Hennepin Healthcare, Minneapolis, MN, United States
| |
Collapse
|
8
|
Múñez-Rubio E, Calderón-Parra J, Gutiérrez-Villanueva A, Fernández-Cruz A, Ramos-Martínez A. Clinical experience in the treatment of COVID-19 with monoclonal antibodies in solid organ transplant recipients. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2023; 36 Suppl 1:25-28. [PMID: 37997867 PMCID: PMC10793550 DOI: 10.37201/req/s01.07.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Solid organ transplant (SOT) recipients are at high risk for complications from coronavirus disease 2019 (COVID-19). SOT recipients mount lower immunological responses to vaccines than general population and are at high risk for breakthrough COVID-19 infections. Passive immunotherapy in the form of anti-Spike monoclonal antibodies (MoAbs) may be an alternative for the prophylaxis and treatment of COVID-19 in these patients. SARS-CoV-2 has evolved by accumulating resistance mutations that have escaped the neutralizing action of most MoAbs. However, MoAbs directed at more conserved epitopes and that maintain effector functions could maintain efficacy in the treatment of these patients. According to published data, SOT recipients with low anti-spike antibody responses to vaccination could benefit from the use of MoAbs in pre-exposure prophylaxis, in the treatment of COVID-19 mild to moderate and severe COVID-19 with less than 15 days of symptom duration and low oxygen requirements. Combination therapy could be more effective than monotherapy for the treatment of mild-to-moderate SARS-CoV-2 infection.
Collapse
Affiliation(s)
- E Múñez-Rubio
- Elena Múñez-Rubio, Infectious Diseases Unit, Department of Internal Medicine, University Hospital Puerta de Hierro, Majadahonda, Spain.
| | | | | | | | | |
Collapse
|
9
|
Yazdani AN, Abdi A, Velpuri P, Patel P, DeMarco N, Agrawal DK, Rai V. A Review of Hematological Complications and Treatment in COVID-19. Hematol Rep 2023; 15:562-577. [PMID: 37873794 PMCID: PMC10594461 DOI: 10.3390/hematolrep15040059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/30/2023] [Accepted: 10/11/2023] [Indexed: 10/25/2023] Open
Abstract
COVID-19, caused by SARS-CoV-2, and its variants have spread rapidly across the globe in the past few years, resulting in millions of deaths worldwide. Hematological diseases and complications associated with COVID-19 severely impact the mortality and morbidity rates of patients; therefore, there is a need for oversight on what pharmaceutical therapies are prescribed to hematologically at-risk patients. Thrombocytopenia, hemoglobinemia, leukopenia, and leukocytosis are all seen at increased rates in patients infected with COVID-19 and become more prominent in patients with severe COVID-19. Further, COVID-19 therapeutics may be associated with hematological complications, and this became more important in immunocompromised patients with hematological conditions as they are at higher risk of hematological complications after treatment. Thus, it is important to understand and treat COVID-19 patients with underlying hematological conditions with caution. Hematological changes during COVID-19 infection and treatment are important because they may serve as biomarkers as well as to evaluate the treatment response, which will help in changing treatment strategies. In this literature review, we discuss the hematological complications associated with COVID-19, the mechanisms, treatment groups, and adverse effects of commonly used COVID-19 therapies, followed by the hematological adverse events that could arise due to therapeutic agents used in COVID-19.
Collapse
Affiliation(s)
- Armand N. Yazdani
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Arian Abdi
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Prathosh Velpuri
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Parth Patel
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Nathaniel DeMarco
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Devendra K. Agrawal
- Department of Translational Research, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Vikrant Rai
- Department of Translational Research, Western University of Health Sciences, Pomona, CA 91766, USA
| |
Collapse
|
10
|
Lahouati M, Cazanave C, Labadie A, Gohier P, Guirlé L, Desclaux A, Gigan M, Malvy D, Pedeboscq S, Xuereb F, Duvignaud A. Outcomes of targeted treatment in immunocompromised patients with asymptomatic or mild COVID-19: a retrospective study. Sci Rep 2023; 13:15357. [PMID: 37717101 PMCID: PMC10505186 DOI: 10.1038/s41598-023-42727-5] [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] [Received: 06/15/2023] [Accepted: 09/14/2023] [Indexed: 09/18/2023] Open
Abstract
The aim of this study was to describe the outcomes of targeted COVID-19 treatments in immunocompromised patients with asymptomatic or mild COVID-19 during the period of expansion of the different Omicron subvariants in France. A retrospective monocentric observational study was performed. All immunocompromised patients aged 18 or more, with asymptomatic SARS-CoV-2 infection or mild COVID-19, and who had received a targeted treatment with sotrovimab, tixagevimab/cilgavimab, nirmatrelvir/ritonavir or remdesivir at the Bordeaux University Hospital from 1st January 2022 to 31st December 2022 were eligible. The primary outcomes of interest was defined as a composite of either (i) progression to moderate (WHO-Clinical Progression Scale at 4 or 5) or severe COVID-19 (WHO-CPS ≥ 6), or (ii) the occurrence of COVID-19-related death. The secondary outcomes of interest were the components of the primary outcome. Outcomes were collected until day 30 after targeted treatment administration or at discharge for patients still hospitalised in relation with COVID-19 at day 30. 223 immunocompromised patients received targeted treatment for asymptomatic SARS-CoV-2 infection or mild COVID-19: 114 received sotrovimab, 50 tixagevimab/cilgavimab, 49 nirmatrelvir/ritonavir, and 10 remdesivir. Among 223 treated patients, 10 (4.5%) progressed to moderate or severe disease: three patients (1.3%) progressed to moderate COVID-19 and 7 (3.1%) patients progressed to severe disease. Among them, 4 (1.8%) died of COVID-19. More than 95% of immunocompromised patients with asymptomatic SARS-CoV-2 infection or mild COVID-19 treated by targeted therapies during the Omicron subvariants era did not progress to moderate or severe disease.
Collapse
Affiliation(s)
- M Lahouati
- Service de Pharmacie Clinique, Hôpital Pellegrin, Centre Hospitalo-Universitaire de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France.
- Inserm, UMR 1034, Biology of Cardiovascular Diseases, Université de Bordeaux, Pessac, France.
| | - C Cazanave
- Service des maladies infectieuses et tropicales, CHU de Bordeaux, 33076, Bordeaux, France
| | - A Labadie
- Service de Pharmacie Clinique, Hôpital Pellegrin, Centre Hospitalo-Universitaire de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - P Gohier
- Service de Pharmacie Clinique, Hôpital Pellegrin, Centre Hospitalo-Universitaire de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - L Guirlé
- Service de Pharmacie Clinique, Hôpital Pellegrin, Centre Hospitalo-Universitaire de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - A Desclaux
- Service des maladies infectieuses et tropicales, CHU de Bordeaux, 33076, Bordeaux, France
| | - M Gigan
- Service de Pharmacie Clinique, Hôpital Pellegrin, Centre Hospitalo-Universitaire de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - D Malvy
- Service des maladies infectieuses et tropicales, CHU de Bordeaux, 33076, Bordeaux, France
- Inserm UMR 1219, IRD EMR 271, Bordeaux Population Health, Université de Bordeaux, 33076, Bordeaux, France
| | - S Pedeboscq
- Service de Pharmacie Clinique, Hôpital Pellegrin, Centre Hospitalo-Universitaire de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - F Xuereb
- Service de Pharmacie Clinique, Hôpital Pellegrin, Centre Hospitalo-Universitaire de Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France
- Inserm, UMR 1034, Biology of Cardiovascular Diseases, Université de Bordeaux, Pessac, France
| | - A Duvignaud
- Service des maladies infectieuses et tropicales, CHU de Bordeaux, 33076, Bordeaux, France
- Inserm UMR 1219, IRD EMR 271, Bordeaux Population Health, Université de Bordeaux, 33076, Bordeaux, France
| |
Collapse
|
11
|
López V, Mazuecos A, Villanego F, López-Oliva M, Alonso A, Beneyto I, Crespo M, Díaz-Corte C, Franco A, González-Roncero F, Guirado L, Jiménez C, Juega J, Llorente S, Paul J, Rodríguez-Benot A, Ruiz JC, Sánchez-Fructuoso A, Torregrosa V, Zárraga S, Rodrigo E, Hernández D. Update of the recommendations on the management of the SARS-CoV-2 coronavirus pandemic (COVID-19) in kidney transplant patients. Nefrologia 2023; 43:531-545. [PMID: 37957107 DOI: 10.1016/j.nefroe.2023.10.007] [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] [Received: 10/10/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/15/2023] Open
Abstract
SARS-CoV-2 infection (COVID-19) has had a significant impact on transplant activity in our country. Mortality and the risk of complications associated with COVID-19 in kidney transplant recipients (KT) were expected to be higher due to their immunosuppressed condition and the frequent associated comorbidities. Since the beginning of the pandemic in March 2020 we have rapidly improved our knowledge about the epidemiology, clinical features and management of COVID-19 post-transplant, resulting in a better prognosis for our patients. KT units have been able to adapt their programs to this new reality, normalizing both donation and transplantation activity in our country. This manuscript presents a proposal to update the general recommendations for the prevention and treatment of infection in this highly vulnerable population such as KT.
Collapse
Affiliation(s)
- Verónica López
- Unidad de Gestión Clínica de Nefrología, Hospital Regional Universitario de Málaga, Universidad de Málaga, Instituto Biomédico de Investigación de Málaga (IBIMA), RICORS2040 (RD21/0005/0012), Málaga, Spain.
| | | | | | | | - Angel Alonso
- Servicio de Nefrología, Complejo Hospitalario A Coruña, A Coruña, Spain
| | - Isabel Beneyto
- Servicio de Nefrología, Hospital Universitario Politécnico La Fe, Valencia, Spain
| | - Marta Crespo
- Servicio de Nefrología, Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), RD16/0009/0013 (ISCIII FEDER REDinREN), Barcelona, Spain
| | - Carmen Díaz-Corte
- Servicio de Nefrología, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
| | - Antonio Franco
- Servicio de Nefrología, Hospital de Alicante, Alicante, Spain
| | | | - Luis Guirado
- Servicio de Nefrología, Fundación Puigvert, REDinREN RD16/0009/0019, Barcelona, Spain
| | | | - Javier Juega
- Servicio de Nefrología, Hospital Trias i Pujol, REDinREN RD16/0009/0032, Barcelona, Spain
| | - Santiago Llorente
- Servicio de Nefrología, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Javier Paul
- Servicio de Nefrología, Hospital Miguel Servet, Zaragoza, Spain
| | - Alberto Rodríguez-Benot
- Servicio de Nefrología, Hospital Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | - Juan Carlos Ruiz
- Servicio de Nefrología, Hospital Marqués de Valdecilla, IDIVAL, REDinREN RD16/0009/0027, Santander, Cantabria, Spain
| | - Ana Sánchez-Fructuoso
- Servicio de Nefrología, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Sofía Zárraga
- Servicio de Nefrología, Hospital de Cruces, Bilbao, Vizcaya, Spain
| | - Emilio Rodrigo
- Servicio de Nefrología, Hospital Marqués de Valdecilla, IDIVAL, REDinREN RD16/0009/0027, Santander, Cantabria, Spain
| | - Domingo Hernández
- Unidad de Gestión Clínica de Nefrología, Hospital Regional Universitario de Málaga, Universidad de Málaga, Instituto Biomédico de Investigación de Málaga (IBIMA), RICORS2040 (RD21/0005/0012), Málaga, Spain
| |
Collapse
|
12
|
Vafea MT, Haidar G. COVID-19 Prevention in Solid Organ Transplant Recipients: Current State of the Evidence. Infect Dis Clin North Am 2023; 37:459-473. [PMID: 37217369 PMCID: PMC10030334 DOI: 10.1016/j.idc.2023.03.002] [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: 03/24/2023]
Abstract
Although COVID-19 vaccines are safe, most organ transplant recipients fail to mount an antibody response after two mRNA vaccines. Thus, three mRNA vaccines constitute a primary vaccine series after solid organ transplant. However, neutralizing antibodies after three or greater mRNA vaccines are lower against Omicron versus older variants. Predictors of attenuated responses include age, vaccination within 1 year from transplant, mycophenolate, and BNT162b2. Some seronegative transplant recipients exhibit durable T-cell responses. Vaccine effectiveness in transplants is lower than in the general population. Immunosuppression reduction around revaccination warrants further study. Monoclonal antibody pre-exposure prophylaxis may be protective against susceptible variants.
Collapse
Affiliation(s)
- Maria Tsikala Vafea
- Divison of Internal Medicine, University of Pittsburgh School of Medicine, UPMC, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Ghady Haidar
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, 3601 Fifth Avenue, Falk Medical Building, Suite 5B, Pittsburgh, PA 15213, USA.
| |
Collapse
|
13
|
Liew MNY, Kua KP, Lee SWH, Wong KK. SARS-CoV-2 neutralizing antibody bebtelovimab - a systematic scoping review and meta-analysis. Front Immunol 2023; 14:1100263. [PMID: 37701439 PMCID: PMC10494534 DOI: 10.3389/fimmu.2023.1100263] [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] [Received: 11/16/2022] [Accepted: 07/28/2023] [Indexed: 09/14/2023] Open
Abstract
Introduction The COVID-19 pandemic is a major global public health crisis. More than 2 years into the pandemic, effective therapeutic options remain limited due to rapid viral evolution. Stemming from the emergence of multiple variants, several monoclonal antibodies are no longer suitable for clinical use. This scoping review aimed to summarize the preclinical and clinical evidence for bebtelovimab in treating newly emerging SARS-CoV-2 variants. Methods We systematically searched five electronic databases (PubMed, CENTRAL, Embase, Global Health, and PsycINFO) from date of inception to September 30, 2022, for studies reporting on the effect of bebtelovimab in SARS-CoV-2 infection, using a combination of search terms around -bebtelovimab‖, -LY-CoV1404‖, -LY3853113‖, and -coronavirus infection‖. All citations were screened independently by two researchers. Data were extracted and thematically analyzed based on study design by adhering to the stipulated scoping review approaches. Results Thirty-nine studies were included, thirty-four non-clinical studies were narratively synthesized, and five clinical studies were meta-analyzed. The non-clinical studies revealed bebtelovimab not only potently neutralized wide-type SARS-CoV-2 and existing variants of concern such as B.1.1.7 (Alpha), B.1.351 (Beta), P.1 (Gamma), and B.1.617.2 (Delta), but also retained appreciable activity against Omicron lineages, including BA.2.75, BA.4, BA.4.6, and BA.5. Unlike other monoclonal antibodies, bebtelovimab was able to bind to epitope of the SARS-CoV-2 S protein by exploiting loop mobility or by minimizing side-chain interactions. Pooled analysis from clinical studies depicted that the rates of hospitalization, ICU admission, and death were similar between bebtelovimab and other COVID-19 therapies. Bebtelovimab was associated with a low incidence of treatment-emergent adverse events. Conclusion Preclinical evidence suggests bebtelovimab be a potential treatment for COVID-19 amidst viral evolution. Bebtelovimab has comparable efficacy to other COVID-19 therapies without evident safety concerns.
Collapse
Affiliation(s)
- Mabel Nyit Yi Liew
- Pharmacy Unit, Puchong Health Clinic, Petaling District Health Office, Ministry of Health Malaysia, Petaling, Selangor, Malaysia
| | - Kok Pim Kua
- Pharmacy Unit, Puchong Health Clinic, Petaling District Health Office, Ministry of Health Malaysia, Petaling, Selangor, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University, Subang Jaya, Selangor, Malaysia
- Health and Well-being Cluster, Monash University, Subang Jaya, Selangor, Malaysia
- Gerontechnology Laboratory, Monash University, Bandar Sunway, Selangor, Malaysia
- Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Selangor, Malaysia
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Kon Ken Wong
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| |
Collapse
|
14
|
Luo J, Li T, Liu C, Wang Y, Tran C, Ao G. The effect of bebtelovimab on clinical outcomes in patients with COVID-19: A meta-analysis. J Infect 2023; 87:68-71. [PMID: 37085048 PMCID: PMC10114314 DOI: 10.1016/j.jinf.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/17/2023] [Indexed: 04/23/2023]
Affiliation(s)
- Jie Luo
- Department of Nephrology, Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Toni Li
- School of Medicine, Queen's University, Kingston, Canada
| | - Changying Liu
- Department of Geriatrics, People's Liberation Army, The General Hospital of Western Theater Command, Chengdu, China
| | - Yushu Wang
- Chengdu West China Clinical Research Center, Chengdu, Sichuan, China
| | - Carolyn Tran
- Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Guangyu Ao
- Department of Nephrology, Chengdu First People's Hospital, Chengdu, Sichuan, China.
| |
Collapse
|
15
|
Chih S, Clarke BA, Albert M, Buchan CA, Kafil TS, Kim DH, Kumar D, Smith SJ, Solera Rallo JT, Stubbs MJ, McDonald MA. The COVID-19 Pandemic and Adult Cardiac Transplantation: Impact, Interventions, and Implications. Can J Cardiol 2023; 39:853-864. [PMID: 36965667 PMCID: PMC10035809 DOI: 10.1016/j.cjca.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 03/27/2023] Open
Abstract
In this review, we provide a comprehensive overview of the impact of the COVID-19 pandemic on adult heart transplantation. We highlight the decline in the number of adult transplantations performed throughout the pandemic as a consequence of restrictions imposed on individual programs and hospitals. There were challenges to maintaining cardiac transplant activity at multiple levels, including organ donation in intensive care units, logistical difficulties with organ procurement, and rapidly changing resource considerations at health system and jurisdictional levels. We also review the impact of COVID-19 on cardiac transplant recipients. Despite the high rates of morbidity and mortality observed during the initial phases of the pandemic among heart transplant patients infected with COVID-19, the availability of effective vaccines, pre-exposure prophylaxis, and specific antiviral therapies have drastically improved outcomes over time. Vaccines have proven to be safe and effective in reducing infections and illness severity, but specific considerations in the immunocompromised solid organ transplant population apply, including the need for additional booster doses to achieve sufficient immunisation. We further outline the strong rationale for vaccination before transplantation wherever possible. Finally, the COVID-19 response created a number of barriers to safe and efficient post-transplantation care. Given the need for frequent evaluation and monitoring, especially in the first several months after cardiac transplantation, the pandemic provided the impetus to improve virtual care delivery and explore noninvasive rejection surveillance through gene expression profiling. We hope that lessons learned will allow us to prepare and pivot effectively during future pandemics and health care emergencies.
Collapse
Affiliation(s)
- Sharon Chih
- Division of Cardiology, Heart Failure, and Transplantation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Brian A Clarke
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Albert
- Department of Medicine and Critical Care, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada; CIUSSS-NIM Research Centre, Department of Surgery, Montréal Heart Institute, Montréal, Québec, Canada; Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - C Arianne Buchan
- Division of Infectious Diseases, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Canada, Ottawa, Ontario, Canada
| | - Tahir S Kafil
- Division of Cardiology, Heart Failure, and Transplantation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Daniel H Kim
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Canada
| | - Deepali Kumar
- Division of Infectious Disease, Transplant Infectious Disease, Ajmera Transplant Centre, University of Toronto, Toronto, Ontario, Canada
| | - Stuart J Smith
- Division of Cardiology, London Health Sciences Centre, Western University, London, Canada
| | - Javier Tomas Solera Rallo
- Division of Infectious Disease, Transplant Infectious Disease, Ajmera Transplant Centre, University of Toronto, Toronto, Ontario, Canada
| | - Michael J Stubbs
- Division of Cardiology, University Health Network, Ajmera Transplant Centre, University of Toronto, Toronto, Ontario, Canada
| | - Michael A McDonald
- Division of Cardiology, University Health Network, Ajmera Transplant Centre, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
16
|
Kapur R, Okumura K, Feola N, Keller M, Dhand A. Outcomes of Bebtelovimab Therapy in Patients With Solid Organ Transplantation With Mild and Moderate COVID-19. Cureus 2023; 15:e38867. [PMID: 37313067 PMCID: PMC10259679 DOI: 10.7759/cureus.38867] [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] [Accepted: 05/10/2023] [Indexed: 06/15/2023] Open
Abstract
Solid organ transplant recipients (SOTRs) are at greater risk of poorer outcomes from coronavirus disease 2019 (COVID-19) as compared to the general population. Because of significant drug-drug interactions between nirmatrelvir-ritonavir and immunosuppressive agents as well as logistical challenges of outpatient administration of remdesivir, anti-severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) monoclonal antibodies (mAbs) had been the mainstay of outpatient treatment of COVID-19 among SOTRs, with bamlanivimab, casirivimab-imdevimab, and sotrovimab having been previously granted emergency use authorization by the Food and Drug Administration (FDA). The challenge with the ongoing use of these monoclonal antibodies is the loss of efficacy against emerging variants of SARS-CoV-2. Bebtelovimab, which retained efficacy against early subvariants of Omicron, was granted emergency use authorization by the Food and Drug Administration when Omicron BA.4 and BA.5 became the predominant variants in the United States. However, the study based on which bebtelovimab was authorized by the FDA did not include SOTRs. The only available safety and efficacy data on these patients are from retrospective studies. In our retrospective analysis of 62 SOTRs who received bebtelovimab infusion between May 11, 2022, and October 11, 2022, 28 had a kidney transplant, 18 had a liver transplant, 10 had a heart transplant, and six had multi-organ transplants (liver/kidney: 4, heart/kidney: 2). None of the patients reported infusion-associated adverse reaction. Only one (1.6%) patient developed progression of COVID-19, requiring subsequent treatment with remdesivir, steroids, and oxygen supplementation. The rate of need for intensive care and death from COVID-19 during the 30-day follow-up period was 0%.
Collapse
Affiliation(s)
- Rohan Kapur
- Internal Medicine, Westchester Medical Center, Valhalla, USA
| | - Kenji Okumura
- Surgery, Westchester Medical Center/New York Medical College, Valhalla, USA
| | | | - Marina Keller
- Infectious Diseases, Westchester Medical Center, Valhalla, USA
| | - Abhay Dhand
- Transplant Infectious Disease, Medicine, and Surgery, Westchester Medical Center/New York Medical College, Valhalla, USA
| |
Collapse
|
17
|
Yan J, Steiger SN, Kodama R, Fender J, Tan C, Laracy J, Cohen N, McMillen T, Jani K, Robilotti EV, Babady NE, Seo SK, Kamboj M. Predictors of Coronavirus Disease 2019 Hospitalization After Sotrovimab in Patients With Hematologic Malignancy During the BA.1 Omicron Surge. Clin Infect Dis 2023; 76:1476-1482. [PMID: 36445792 DOI: 10.1093/cid/ciac916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/09/2022] [Accepted: 11/23/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Sotrovimab is an anti-spike neutralization monoclonal antibody developed to reduce the risk of coronavirus disease 2019 (COVID-19) progression and advancement to hospitalization in high-risk patients. Currently, there is limited research describing the association of sotrovimab treatment in patients with hematologic malignancy and the predictive factors of hospitalization. METHODS We performed an observational study of 156 consecutive cancer patients who received sotrovimab at Memorial Sloan Kettering Cancer Center in New York City during the BA.1 Omicron surge. We evaluated the demographic, clinical, and laboratory characteristics of the patients who had subsequent COVID-19-related hospitalization(s) compared to those who did not. RESULTS Among the 156 study patients, 17 (11%) were hospitalized, of whom 4 were readmitted for COVID-19-related complications; 3 deaths were attributed to COVID-19. Results from multivariable logistic regression show that significant factors associated with hospitalization include patients on anti-CD20 therapy (adjusted odds ratio [aOR], 5.59 [95% confidence interval {CI}, 1.73-18.12]; P = .004) and with relapse/refractory disease (aOR, 5.69 [95% CI, 1.69-19.16]; P = .005). Additionally, whole genome sequencing of severe acute respiratory syndrome coronavirus 2 detected high occurrences of mutations in the spike gene associated with treatment-related resistance longitudinal samples from 11 patients treated with sotrovimab. CONCLUSIONS While sotrovimab is effective at reducing COVID-19 hospitalization and disease severity in patients with hematologic malignancy when administered early, patients who received anti-CD20 antibodies showed substantial morbidity. Due to the high potential for resistance mutation to sotrovimab and increased morbidity in patients on anti-CD20 therapy, combination treatment should be explored to determine whether it provides added benefits compared to monotherapy.
Collapse
Affiliation(s)
- Judy Yan
- Infection Control, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Samantha N Steiger
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Rich Kodama
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jerome Fender
- Infection Control, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Digital Informatics and Technology Solutions, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Carrie Tan
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Justin Laracy
- Infection Control, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Joan and Sanford Weill Medical College of Cornell University, New York, New York, USA
| | - Nina Cohen
- Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Tracy McMillen
- Clinical Microbiology Service, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Krupa Jani
- Clinical Microbiology Service, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elizabeth V Robilotti
- Infection Control, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Joan and Sanford Weill Medical College of Cornell University, New York, New York, USA
| | - N Esther Babady
- Clinical Microbiology Service, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Susan K Seo
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Joan and Sanford Weill Medical College of Cornell University, New York, New York, USA
| | - Mini Kamboj
- Infection Control, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Joan and Sanford Weill Medical College of Cornell University, New York, New York, USA
| |
Collapse
|
18
|
COVID-19 Management Strategies in Solid Organ Transplant Recipients. Infect Dis Clin North Am 2023:S0891-5520(23)00024-7. [PMID: 37142512 PMCID: PMC10028355 DOI: 10.1016/j.idc.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Solid organ transplant recipients are at high risk of severe coronavirus disease-2019 (COVID-19). If left untreated, it results in high rates of hospitalization, intensive care unit admission and death. Early diagnosis of COVID-19 is essential to ensure the early administration of therapeutics. Treatment of mild-to-moderate COVID-19 with remdesivir, ritonavir-boosted nirmatrelvir, or an anti-spike neutralizing monoclonal antibody may prevent progression to severe and critical COVID-19. Among patients with severe and critical COVID-19, treatment with intravenous remdesivir and immunomodulation is recommended. This review article discusses strategies in the management of solid organ transplant recipients with COVID-19.
Collapse
|
19
|
COVID-19 Outcomes in Solid Organ Transplant Recipients Who Received Tixagevimab-cilgavimab Prophylaxis and/or Bebtelovimab Treatment in a Nurse-driven Monoclonal Antibody Program During the Omicron Surge. Transplantation 2023; 107:e60-e61. [PMID: 36228295 PMCID: PMC9875834 DOI: 10.1097/tp.0000000000004418] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
20
|
Cox M, Peacock TP, Harvey WT, Hughes J, Wright DW, Willett BJ, Thomson E, Gupta RK, Peacock SJ, Robertson DL, Carabelli AM. SARS-CoV-2 variant evasion of monoclonal antibodies based on in vitro studies. Nat Rev Microbiol 2023; 21:112-124. [PMID: 36307535 PMCID: PMC9616429 DOI: 10.1038/s41579-022-00809-7] [Citation(s) in RCA: 124] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 01/20/2023]
Abstract
Monoclonal antibodies (mAbs) offer a treatment option for individuals with severe COVID-19 and are especially important in high-risk individuals where vaccination is not an option. Given the importance of understanding the evolution of resistance to mAbs by SARS-CoV-2, we reviewed the available in vitro neutralization data for mAbs against live variants and viral constructs containing spike mutations of interest. Unfortunately, evasion of mAb-induced protection is being reported with new SARS-CoV-2 variants. The magnitude of neutralization reduction varied greatly among mAb-variant pairs. For example, sotrovimab retained its neutralization capacity against Omicron BA.1 but showed reduced efficacy against BA.2, BA.4 and BA.5, and BA.2.12.1. At present, only bebtelovimab has been reported to retain its efficacy against all SARS-CoV-2 variants considered here. Resistance to mAb neutralization was dominated by the action of epitope single amino acid substitutions in the spike protein. Although not all observed epitope mutations result in increased mAb evasion, amino acid substitutions at non-epitope positions and combinations of mutations also contribute to evasion of neutralization. This Review highlights the implications for the rational design of viral genomic surveillance and factors to consider for the development of novel mAb therapies.
Collapse
Affiliation(s)
- MacGregor Cox
- Department of Medicine, University of Cambridge, Addenbrookes Hospital, Cambridge, UK
| | - Thomas P Peacock
- Department of Infectious Disease, St Mary's Medical School, Imperial College London, London, UK
| | - William T Harvey
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Joseph Hughes
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Derek W Wright
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Brian J Willett
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Emma Thomson
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Ravindra K Gupta
- Department of Medicine, University of Cambridge, Addenbrookes Hospital, Cambridge, UK
- Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Jeffrey Cheah Biomedical Centre, University of Cambridge, Cambridge, UK
| | - Sharon J Peacock
- Department of Medicine, University of Cambridge, Addenbrookes Hospital, Cambridge, UK
| | - David L Robertson
- MRC-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK.
| | | |
Collapse
|
21
|
Rasmussen LD, Lebech A, Øvrehus A, Poulsen BK, Christensen HR, Nielsen H, Johansen IS, Omland LH, Wiese L, Helleberg M, Storgaard M, Dalager‐Pedersen M, Rasmussen TA, Benfield T, Petersen TS, Andersen ÅB, Gram MA, Stegger M, Edslev SM, Obel N. Experience with sotrovimab treatment of SARS-CoV-2-infected patients in Denmark. Br J Clin Pharmacol 2023; 89:1820-1833. [PMID: 36519217 PMCID: PMC9878138 DOI: 10.1111/bcp.15644] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/20/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
AIMS To evaluate the experience with use of sotrovimab following severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in high-risk groups. METHODS In a nationwide, population-based cohort study, we identified all individuals treated with sotrovimab (N = 2933) and stratified them by 4 high-risk groups: (A) malignant haematological disease, (B) solid organ transplantation, (C) anti-CD20 therapy ≤1 year and (D) other risks. Cox regression analysis was used to calculate hazard ratios for hospitalization, death and associated prognostic factors. RESULTS Of 2933 sotrovimab-treated individuals, 83% belonged to high-risk groups (37.6% haematological malignancy, 27.4% solid organ transplantation and 17.5% treatment with anti-CD20 ≤1 year). Only 17.8% had other risks (11.8% were pregnant, 10.7% primary immunodeficiency, 21.2% other malignancy, 4.3% received anti-CD20 >1 year and 52.0% other/unknown causes). Within 90 days of infusion, 30.2% were hospitalized and 5.3% died. The main prognostic factors were the predefined high-risk groups, mainly malignant haematological disease and age ≥65 years. Number of COVID-19 vaccines (≥3) was associated with a decreased risk of hospitalization. The Delta but not the Omicron BA.2 variant was associated with a higher risk of death compared to the BA.1 variant. CONCLUSION More than 90% of the patients treated with sotrovimab belonged to the very high-risk groups as described in the Danish guidelines. Sotrovimab-treated individuals remained at a high risk of hospitalization and death which was strongly associated with the underlying immunocompromised state and age. Having received >3 COVID-19 vaccines was association with decreased risk of death and hospitalization.
Collapse
Affiliation(s)
- Line Dahlerup Rasmussen
- Department of Infectious Disease, Odense University Hospital, Odense C, Denmark & Research Unit for Infectious DiseasesUniversity of Southern DenmarkOdenseDenmark
| | - Anne‐Mette Lebech
- Department of Infectious DiseasesCopenhagen University Hospital, RigshospitaletCopenhagenDenmark,Faculty of Health SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Anne Øvrehus
- Department of Infectious Disease, Odense University Hospital, Odense C, Denmark & Research Unit for Infectious DiseasesUniversity of Southern DenmarkOdenseDenmark
| | | | | | - Henrik Nielsen
- Department of Infectious DiseasesAalborg University HospitalAalborgDenmark,Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Isik Somuncu Johansen
- Department of Infectious Disease, Odense University Hospital, Odense C, Denmark & Research Unit for Infectious DiseasesUniversity of Southern DenmarkOdenseDenmark
| | - Lars Haukali Omland
- Department of Infectious DiseasesCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
| | - Lothar Wiese
- Department of Infectious DiseasesZealand University Hospital RoskildeDenmark
| | - Marie Helleberg
- Department of Infectious DiseasesCopenhagen University Hospital, RigshospitaletCopenhagenDenmark,Center of excellence for Health Immunity & InfectionsCopenhagen University Hospital‐RigshospitaletCopenhagenDenmark
| | - Merete Storgaard
- Department of Infectious DiseasesAarhus University HospitalAarhusDenmark
| | - Michael Dalager‐Pedersen
- Department of Infectious DiseasesAalborg University HospitalAalborgDenmark,Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Thomas A. Rasmussen
- Department of Infectious DiseasesAarhus University HospitalAarhusDenmark,Doherty Institute for Infection and ImmunityUniversity of MelbourneAustralia
| | - Thomas Benfield
- Department of Infectious DiseasesCopenhagen University Hospital – Amager and HvidovreHvidovreDenmark
| | | | - Åse Bengård Andersen
- Department of Infectious DiseasesCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
| | - Mie Agermose Gram
- Department of Bacteria, Parasites and Fungi, Statens Serum InstitutCopenhagenDenmark
| | - Marc Stegger
- Department of Bacteria, Parasites and Fungi, Statens Serum InstitutCopenhagenDenmark
| | - Sofie Marie Edslev
- Department of Bacteria, Parasites and Fungi, Statens Serum InstitutCopenhagenDenmark
| | - Niels Obel
- Department of Infectious DiseasesCopenhagen University Hospital, RigshospitaletCopenhagenDenmark,Faculty of Health SciencesUniversity of CopenhagenCopenhagenDenmark,Department of Infectious Disease Epidemiology and PreventionStatens Serum InstitutCopenhagenDenmark
| |
Collapse
|
22
|
Sridhara S, Gungor AB, Erol HK, Al-Obaidi M, Zangeneh TT, Bedrick EJ, Ariyamuthu VK, Shetty A, Qannus AA, Mendoza K, Murugapandian S, Gupta G, Tanriover B. Lack of effectiveness of Bebtelovimab monoclonal antibody among high-risk patients with SARS-Cov-2 Omicron during BA.2, BA.2.12.1 and BA.5 subvariants dominated era. PLoS One 2023; 18:e0279326. [PMID: 37115780 PMCID: PMC10146441 DOI: 10.1371/journal.pone.0279326] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron subvariants are expected to be resistant to Bebtelovimab (BEB) monoclonal antibody (MAb) and the real-world experience regarding its effectiveness is scarce. This retrospective cohort study reports a data analysis in Banner Healthcare System (a large not-for-profit organization) between 4/5/2022 and 8/1/2022 and included 19,778 Coronavirus disease-19 (COVID-19) positive (by PCR or direct antigen testing) patients who were selected from Cerner-Electronic Health Record after the exclusions criteria were met. The study index date for cohort was determined as the date of BEB MAb administration or the date of the first positive COVID-19 testing. The cohort consist of COVID-19 infected patients who received BEB MAb (N = 1,091) compared to propensity score (PS) matched control (N = 1,091). The primary composite outcome was the incidence of 30-day all-cause hospitalization and/or mortality. All statistical analyses were conducted on the paired (matched) dataset. For the primary composite outcome, the event counts and percentages were reported. Ninety-five percent Clopper-Pearson confidence intervals for percentages were computed. The study cohorts were 1:1 propensity matched without replacement across 26 covariates using an optimal matching algorithm that minimizes the sum of absolute pairwise distance across the matched sample after fitting and using logistic regression as the distance function. The pairs were matched exactly on patient vaccination status, BMI group, age group and diabetes status. Compared to the PS matched control group (2.6%; 95% confidence interval [CI]: 1.7%, 3.7%), BEB MAb use (2.2%; 95% CI: 1.4%, 3.3%) did not significantly reduce the incidence of the primary outcome (p = 0.67). In the subgroup analysis, we observed similar no-difference trends regarding the primary outcomes for the propensity rematched BEB MAb treated and untreated groups, stratified by patient vaccination status, age (<65 years or ≥65), and immunocompromised status (patients with HIV/AIDS or solid organ transplants or malignancy including lymphoproliferative disorder). The number needed to treat (1/0.026-0.022) with BEB MAb was 250 to avoid one hospitalization and/or death over 30 days. The BEB MAb use lacked efficacy in patients with SARS-CoV-2 Omicron subvariants (mainly BA.2, BA.2.12.1, and BA.5) in the Banner Healthcare System in the Southwestern United States.
Collapse
Affiliation(s)
- Srilekha Sridhara
- Division of Nephrology, College of Medicine, The University of Arizona, Tucson, Arizona, United States of America
| | - Ahmet B Gungor
- Division of Nephrology, The Banner University Medical Center, Tucson, Arizona, United States of America
| | - Halil K Erol
- Division of Nephrology, College of Medicine, The University of Arizona, Tucson, Arizona, United States of America
| | - Mohanad Al-Obaidi
- Division of Infectious Diseases, College of Medicine, The University of Arizona, Tucson, Arizona, United States of America
| | - Tirdad T Zangeneh
- Division of Infectious Diseases, College of Medicine, The University of Arizona, Tucson, Arizona, United States of America
| | - Edward J Bedrick
- Department of Epidemiology and Biostatistics, College of Public Health, The University of Arizona, Tucson, Arizona, United States of America
| | - Venkatesh K Ariyamuthu
- Division of Nephrology, College of Medicine, The University of Arizona, Tucson, Arizona, United States of America
| | - Aneesha Shetty
- Division of Nephrology, College of Medicine, The University of Arizona, Tucson, Arizona, United States of America
| | - Abd A Qannus
- Division of Nephrology, College of Medicine, The University of Arizona, Tucson, Arizona, United States of America
| | - Katherine Mendoza
- Division of Nephrology, College of Medicine, The University of Arizona, Tucson, Arizona, United States of America
| | - Sangeetha Murugapandian
- Division of Nephrology, College of Medicine, The University of Arizona, Tucson, Arizona, United States of America
| | - Gaurav Gupta
- Division of Nephrology, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Bekir Tanriover
- Division of Nephrology, College of Medicine, The University of Arizona, Tucson, Arizona, United States of America
| |
Collapse
|
23
|
Farhadian N, Farhadian M, Zamanian MH, Taghadosi M, Vaziri S. Sotrovimab therapy in solid organ transplant recipients with mild to moderate COVID-19: a systematic review and meta-analysis. Immunopharmacol Immunotoxicol 2022:1-22. [DOI: 10.1080/08923973.2022.2160733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Negin Farhadian
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Farhadian
- Department of Biostatistics, School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Hossein Zamanian
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Infectious Disease Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahdi Taghadosi
- Department of Immunology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Siavash Vaziri
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Infectious Disease Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|
24
|
López V, Mazuecos A, Villanego F, López-Oliva M, Alonso A, Beneyto I, Crespo M, Díaz-Corte C, Franco A, González-Roncero F, Guirado L, Jiménez C, Juega J, Llorente S, Paul J, Rodríguez-Benot A, Ruiz JC, Sánchez-Fructuoso A, Torregrosa V, Zárraga S, Rodrigo E, Hernández D. [Update of the recommendations on the management of the SARS-CoV-2 coronavirus pandemic (COVID-19) in kidney transplant patients.]. Nefrologia 2022; 43:S0211-6995(22)00174-6. [PMID: 36405492 PMCID: PMC9664833 DOI: 10.1016/j.nefro.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022] Open
Abstract
SARS-CoV-2 infection (COVID-19) has had a significant impact on transplant activity in our country. Mortality and the risk of complications associated with COVID-19 in kidney transplant recipients (KT) were expected to be higher due to their immunosuppressed condition and the frequent associated comorbidities. Since the beginning of the pandemic in March 2020 we have rapidly improved our knowledge about the epidemiology, clinical features and management of COVID-19 post-transplant, resulting in a better prognosis for our patients. KT units have been able to adapt their programs to this new reality, normalizing both donation and transplantation activity in our country.This manuscript presents a proposal to update the general recommendations for the prevention and treatment of infection in this highly vulnerable population such as KT.
Collapse
Affiliation(s)
- Verónica López
- Unidad de Gestión Clínica de Nefrología. Hospital Regional Universitario de Málaga, Universidad de Málaga, Instituto Biomédico de Investigación de Málaga (IBIMA), RICORS2040 (RD21/0005/0012), Málaga, España
| | | | | | | | - Angel Alonso
- Servicio de Nefrología. Complejo Hospitalario A Coruña, España
| | - Isabel Beneyto
- Servicio de Nefrología. Hospital Universitario Politécnico La Fe, Valencia, España
| | - Marta Crespo
- Servicio de Nefrología. Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Barcelona, España. RD16/0009/0013 (ISCIII FEDER REDinREN), España
| | - Carmen Díaz-Corte
- Servicio de Nefrología. Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, España
| | - Antonio Franco
- Servicio de Nefrología. Hospital de Alicante, Alicante, España
| | | | - Luis Guirado
- Servicio de Nefrología. Fundación Puigvert, REDinREN RD16/0009/0019, Barcelona, España
| | | | - Javier Juega
- Servicio de Nefrología. Hospital Trias i Pujol, REDinREN RD16/0009/0032, Barcelona, España
| | - Santiago Llorente
- Servicio de Nefrología. Hospital Virgen de la Arrixaca, Murcia, España
| | - Javier Paul
- Servicio de Nefrología. Hospital Miguel Servet, Zaragoza, España
| | - Alberto Rodríguez-Benot
- Servicio de Nefrología. Hospital Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, España
| | - Juan Carlos Ruiz
- Servicio de Nefrología. Hospital Marqués de Valdecilla, IDIVAL, REDinREN RD16/0009/0027, Santander, España
| | - Ana Sánchez-Fructuoso
- Serivicio de Nefrología. Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, España
| | | | - Sofía Zárraga
- Servicio de Nefrología. Hospital de Cruces, Bilbao, España
| | - Emilio Rodrigo
- Servicio de Nefrología. Hospital Marqués de Valdecilla, IDIVAL, REDinREN RD16/0009/0027, Santander, España
| | - Domingo Hernández
- Unidad de Gestión Clínica de Nefrología. Hospital Regional Universitario de Málaga, Universidad de Málaga, Instituto Biomédico de Investigación de Málaga (IBIMA), RICORS2040 (RD21/0005/0012), Málaga, España
| |
Collapse
|
25
|
Amani B, Amani B. Efficacy and safety of sotrovimab in patients with COVID-19: A rapid review and meta-analysis. Rev Med Virol 2022; 32:e2402. [PMID: 36226323 PMCID: PMC9874927 DOI: 10.1002/rmv.2402] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/01/2022] [Accepted: 10/03/2022] [Indexed: 01/27/2023]
Abstract
The therapeutic potential of sotrovimab in the treatment of coronavirus disease 2019 (COVID-19) is a controversial issue. The aim of this study was to evaluate the efficacy and safety of sotrovimab in COVID-19 patients. To this end, PubMed, Cochrane Library, Embase, Web of Science, medRxiv, and Google Scholar were searched up to 15 August 2022. The reference lists of key studies were also scanned to find additional records. Meta-analysis was performed using Comprehensive Meta-Analysis. Seventeen studies involving 27,429 patients were included. A significant difference was observed in mortality rate (odds ratio [OR] = 0.40; 95% CI: 0.25-0.63, p = 0.00), hospitalisation rate (OR = 0.53; 95% CI: 0.43-0.65. p = 0.00), hospital or death rate (OR = 0.43; 95% CI: 0.25-0.73, p = 0.00), the need for mechanical ventilation (OR = 0.57; 95% CI: 0.33-0.96, p = 0.03), and ICU admission (OR = 0.33; 95% CI: 0.17-0.67, p = 0.00) of the sotrovimab-receiving group compared to those having no sotrovimab. However, no significant difference was observed between the two groups in terms of disease progression (OR = 0.45; 95% CI: 0.16-1.24, p = 0.12) and emergency department visit (OR = 1.01; 95% CI: 0.83-1.24, p = 0.87). The two groups had no significant difference in terms of incidence of adverse events (OR = 0.98; 95% CI: 0.78-1.23, p = 0.88). The findings of the present meta-analysis support that sotrovimab could be an effective and safe treatment option to reduce mortality and hospitalisation rate in both Delta and Omicron Variants of COVID-19.
Collapse
Affiliation(s)
- Bahman Amani
- Department of EpidemiologySchool of HealthIlam University of Medical SciencesIlamIran
| | - Behnam Amani
- Department of EpidemiologySchool of HealthIlam University of Medical SciencesIlamIran
| |
Collapse
|
26
|
Dryden-Peterson S, Kim A, Joyce MR, Johnson JA, Kim AY, Baden LR, Woolley AE. Bebtelovimab for High-Risk Outpatients With Early COVID-19 in a Large US Health System. Open Forum Infect Dis 2022; 9:ofac565. [PMID: 36438619 PMCID: PMC9620388 DOI: 10.1093/ofid/ofac565] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/25/2022] [Indexed: 11/05/2022] Open
Abstract
There are limited data for the clinical efficacy of bebtelovimab in preventing severe coronavirus disease 2019. Among outpatients unable to take nirmatrelvir-ritonavir at a large health system, 10 of 377 (2.7%) patients who received bebtelovimab and 17 of 377 (4.5%) matched untreated patients were hospitalized or died. The 43% observed risk reduction with bebtelovimab was not statistically significant (P = 0.14).
Collapse
Affiliation(s)
- Scott Dryden-Peterson
- Brigham and Women's Hospital, Boston, Massachusetts, USA
- Dana Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Botswana Harvard AIDS Institute, Gaborone, Botswana
- Harvard Medical School, Boston, Massachusetts, USA
| | - Andy Kim
- Brigham and Women's Hospital, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jennifer A Johnson
- Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Arthur Y Kim
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lindsey R Baden
- Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ann E Woolley
- Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|