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Patel V, Yarwood MJ, Levick B, Gibbons DC, Drysdale M, Kerr W, Watkins JD, Young S, Pierce BF, Lloyd EJ, Birch HJ, Kamalati T, Brett SJ. Characteristics and outcomes of patients with COVID-19 at high risk of disease progression receiving sotrovimab, oral antivirals or no treatment in England: a retrospective cohort study. Curr Med Res Opin 2024; 40:1323-1334. [PMID: 38975862 DOI: 10.1080/03007995.2024.2376144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/08/2024] [Accepted: 03/29/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVE To describe characteristics and acute clinical outcomes for patients with COVID-19 treated with sotrovimab, nirmatrelvir/ritonavir or molnupiravir, or untreated patients at highest risk per National Health Service (NHS) criteria. METHODS Retrospective study of non-hospitalized patients between 1 December 2021 and 31 May 2022, using data from the Discover-NOW dataset (North-West London). Included patients were aged ≥12 years and treated with sotrovimab, nirmatrelvir/ritonavir or molnupiravir, or untreated but expected to be eligible for early treatment per NHS highest-risk criteria. COVID-19-related and all-cause hospitalizations were reported for 28 days from COVID-19 diagnosis (index). Subgroup analyses were conducted in patients with advanced renal disease, those aged 18-64 and ≥65 years, and by period of Omicron BA.1, BA.2 and BA.5 (post-hoc exploratory) predominance. RESULTS Overall, 1503 treated and 4044 eligible high-risk untreated patients were included. A high proportion of patients on sotrovimab had advanced renal disease (29.3%), ≥3 high-risk comorbidities (47.6%) and were aged ≥65 years (36.9%). Five of 696 (0.7%) patients on sotrovimab, <5/337 (0.3-1.2%) on nirmatrelvir/ritonavir, 10/470 (2.1%) on molnupiravir and 114/4044 (2.8%) untreated patients were hospitalized with COVID-19. Similar results were observed across all subgroups. The proportion of patients dying within 28 days of the index period was similarly low across all cohorts (<2%). CONCLUSION Patients receiving sotrovimab appeared to show evidence of multiple high-risk comorbidities. Low hospitalization rates were observed for all treated cohorts across subgroups and periods of predominant variants of concern. These results require confirmation with comparative effectiveness analyses adjusting for differences in underlying patient characteristics.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Stephen J Brett
- Department of Surgery and Cancer, Imperial College, London, UK
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2
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Karunathilake RP, Kumara RA, Karunathilaka A, Wazil AWM, Nanayakkara N, Bandara CK, Abeysekera RA, Noordeen F, Gawarammana IB, Ratnatunga CN. 18-month longitudinal SARS COV-2 neutralizing antibody dynamics in haemodialysis patients receiving heterologous 3-dose vaccination (AZD-1222- AZD-1222- BNT162b2) in a lower middle income setting. BMC Nephrol 2024; 25:176. [PMID: 38778281 PMCID: PMC11112903 DOI: 10.1186/s12882-024-03599-7] [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: 12/06/2023] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Patients with chronic kidney disease on haemodialysis (HD) were given priority COVID-19 vaccination due to increased disease risk. The immune response to COVID-19 vaccination in patients on HD was diminished compared to healthy individuals in 2-dose studies. This study aimed to evaluate seroconversion rate, neutralizing antibody (nAB) levels and longitudinal antibody dynamics to 3-dose heterologous vaccination against COVID-19 in a cohort of HD patients compared to healthy controls and assess patient factors associated with antibody levels. METHODS This study was a case-control longitudinal evaluation of nAB dynamics in 74 HD patients compared to 37 healthy controls in a low/middle income setting. Corresponding samples were obtained from the two cohorts at time-points (TP) 1-1-month post 2nd dose of AZD1222 vaccine, TP2- 4 months post 2nd dose, TP4- 2 weeks post 3rd dose with BNT162b2 vaccine, TP5-5 months post 3rd dose and TP6-12 months post 3rd dose. Additional data is available at TP0- pre 2nd dose and TP3- 6 months post 2nd dose in HC and HD cohorts respectively. Anti-SARS-CoV-2 nAB were detected using Genscript cPassTM pseudoviral neutralization kit. Demographic and clinical details were obtained using an interviewer administered questionnaire. RESULTS Cohorts were gender matched while mean age of the HD cohort was 54.1yrs (vs HCs mean age, 42.6yrs, p < 0.05). Percentage seroconverted and mean/median antibody level (MAB) in the HD cohort vs HCs at each sampling point were, TP1-83.7% vs 100% (p < 0.05), MAB-450 IU/ml vs 1940 IU/ml (p < 0.0001); TP2-71.4% vs 100%, (p < 0.001), MAB- 235 IU/ml vs 453 IU/ml, (p < 0.05); TP4-95.2% vs 100% (p > 0.05), MAB-1029 IU/ml vs 1538 IU/ml (p < 0.0001); TP5-100% vs 100%, MAB-1542 IU/ml vs 1741IU/ml (p > 0.05); TP6-100% vs 100%, MAB-1961 IU/ml vs 2911 IU/ml (p > 0.05). At TP2, patients aged < 60 years (p < 0.001) were associated with maintaining seropositivity compared to patients > 60 years. CONCLUSION Two dose vaccination of haemodialysis patients provided poor nAB levels which improved markedly following 3rd dose vaccination, the effect of which was long- lasting with high nAB levels in both patients and controls detectable at 1 year follow-up.
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Affiliation(s)
| | - Roshan Athula Kumara
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Amali Karunathilaka
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | | | | | | | - Rajitha Asanga Abeysekera
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka
- Center for Education, Research and Training in Kidney Disease (CERTKiD), University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Faseeha Noordeen
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka
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Courville KJ, Bustamante NE, Nuñez-Samudio V, Pecchio M, Landires I, Viggiano C, Durán H, Novoa N, Alvarado E, Vargas F, Salado D, Manzanares J, Haughton K, Cuero C, Niedda M, Valdés R. Vaccination and mortality from COVID-19: a comparative study between hemodialysis, peritoneal dialysis, and non-dialysis adult population in Panama. Int Urol Nephrol 2023:10.1007/s11255-023-03529-w. [PMID: 36828920 PMCID: PMC9955520 DOI: 10.1007/s11255-023-03529-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 02/19/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE Dialysis patients have a different response than the non-dialysis population to infection with COVID-19. This study evaluates the prevalence of infection and lethality in patients receiving hemodialysis or peritoneal dialysis in Panama, compared to non-dialysis adult population, and reports of adverse events of vaccination. METHODS This is a prospective, multi-center cohort study of spatients aged 18 years or older and receiving in-center hemodialysis or ambulatory peritoneal dialysis in 13 centers in Panama from March 2021 to 2022. For comparison with general population, the study used an extended period of two years. RESULTS A total of 1531 patients receiving dialysis treatment accepted to participate. PD patients represented an 18% of study patients. Lethality was higher in peritoneal dialysis patients with COVID-19 infection than in hemodialysis in the study group (p 0.02). Total deaths in dialysis patients for 2020 were 156 patients, before vaccination; 79 in 2021; and 25 for the first trimester of 2022. Lethality for the period of 2020-2022 was 9.3% for dialysis patients and 0.2% for non-dialysis population. There was no difference in symptoms in first dose, but with second dose, hemodialysis patients reported fewer symptoms than peritoneal dialysis patients (p < 0.0001). CONCLUSION Ninety one percent of people in the country received BNT162b2 Pfizer BionTech vaccine. Lethality decreased from 30 to 5% once vaccination was available. There were no severe adverse effects and symptoms reported were less frequent than in general population, probably due to low reactogenicity in dialysis patients, or better tolerance to pain.
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Affiliation(s)
- Karen J. Courville
- Sociedad Panameña de Nefrología e Hipertensión, Calle Gervasio García, Edificio Cetrersa, Piso 3, Hato Pintado, 0819 Panamá, Panamá ,Nefrología/Hospital Dr. Gustavo N. Collado, Caja de Seguro Social, Chitré, Panamá ,Departamento de Investigación/Instituto de Ciencias Médicas, Las Tablas, Panamá
| | - Norman E. Bustamante
- Sociedad Panameña de Nefrología e Hipertensión, Calle Gervasio García, Edificio Cetrersa, Piso 3, Hato Pintado, 0819 Panamá, Panamá ,Nefrología/Hospital Dr. Gustavo N. Collado, Caja de Seguro Social, Chitré, Panamá ,Departamento de Investigación/Instituto de Ciencias Médicas, Las Tablas, Panamá
| | | | - Maydelin Pecchio
- Departamento de Investigación/Instituto de Ciencias Médicas, Las Tablas, Panamá
| | - Iván Landires
- Departamento de Investigación/Instituto de Ciencias Médicas, Las Tablas, Panamá
| | - Carlos Viggiano
- Sociedad Panameña de Nefrología e Hipertensión, Calle Gervasio García, Edificio Cetrersa, Piso 3, Hato Pintado, 0819 Panamá, Panamá ,Nefrología/Complejo Hospitalario Metropolitano, Caja de Seguro Social, Panama City, Panamá
| | - Herna Durán
- Coordinación Nacional de Hemodiálisis, Panama City, Panamá
| | - Nadji Novoa
- Sociedad Panameña de Nefrología e Hipertensión, Calle Gervasio García, Edificio Cetrersa, Piso 3, Hato Pintado, 0819 Panamá, Panamá ,Nefrología/Hospital Dr. Rafael Hernández, Caja de Seguro Social, David, Panamá
| | - Ernesto Alvarado
- Sociedad Panameña de Nefrología e Hipertensión, Calle Gervasio García, Edificio Cetrersa, Piso 3, Hato Pintado, 0819 Panamá, Panamá ,Nefrología/Policlínica Dr. Horacio Díaz Gómez, Santiago de Veraguas, Panamá
| | - Francisco Vargas
- Sociedad Panameña de Nefrología e Hipertensión, Calle Gervasio García, Edificio Cetrersa, Piso 3, Hato Pintado, 0819 Panamá, Panamá ,Nefrología/Hospital Ezequiel Abadía, Soná, Panamá
| | - Dayan Salado
- Sociedad Panameña de Nefrología e Hipertensión, Calle Gervasio García, Edificio Cetrersa, Piso 3, Hato Pintado, 0819 Panamá, Panamá ,Nefrología/Hospital Dr. Rafael Estevez, Caja de Seguro Social, Aguadulce, Panamá
| | - José Manzanares
- Sociedad Panameña de Nefrología e Hipertensión, Calle Gervasio García, Edificio Cetrersa, Piso 3, Hato Pintado, 0819 Panamá, Panamá ,Nefrología/Policlínica Dr. Santiago Barraza, La Chorrera, Panamá
| | - Kelly Haughton
- Sociedad Panameña de Nefrología e Hipertensión, Calle Gervasio García, Edificio Cetrersa, Piso 3, Hato Pintado, 0819 Panamá, Panamá ,Nefrología/Unidad de Hemodiálisis Metro 1, Panama City, Panamá
| | - César Cuero
- Sociedad Panameña de Nefrología e Hipertensión, Calle Gervasio García, Edificio Cetrersa, Piso 3, Hato Pintado, 0819 Panamá, Panamá ,Nefrología/Unidad de Hemodiálisis Metro 2, Panama City, Panamá
| | - María Niedda
- Sociedad Panameña de Nefrología e Hipertensión, Calle Gervasio García, Edificio Cetrersa, Piso 3, Hato Pintado, 0819 Panamá, Panamá ,Nefrología/Hospital Dra. Susana Jones Cano, San Miguelito, Panamá
| | - Régulo Valdés
- Sociedad Panameña de Nefrología e Hipertensión, Calle Gervasio García, Edificio Cetrersa, Piso 3, Hato Pintado, 0819 Panamá, Panamá ,Coordinación Nacional de Hemodiálisis, Panama City, Panamá
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Füessl L, Lau T, Rau S, Regenauer R, Paal M, Hasmann S, Arend FM, Bruegel M, Teupser D, Fischereder M, Schönermarck U. Humoral response after SARS-CoV-2 booster vaccination in hemodialysis patients with and without prior infection. Clin Kidney J 2022; 15:1633-1635. [PMID: 35892016 PMCID: PMC9308091 DOI: 10.1093/ckj/sfac148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Louise Füessl
- Department of Medicine IV, University Hospital, LMU Munich, Germany
| | - Tobias Lau
- Dialysezentrum Bad Tölz und Wolfratshausen, Germany
| | - Simon Rau
- Dialysezentrum Bad Tölz und Wolfratshausen, Germany
| | - Ron Regenauer
- Department of Medicine IV, University Hospital, LMU Munich, Germany
| | - Michael Paal
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Germany
| | - Sandra Hasmann
- Department of Medicine IV, University Hospital, LMU Munich, Germany
| | - Florian M Arend
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Germany
| | - Mathias Bruegel
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Germany
| | - Daniel Teupser
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Germany
| | | | - Ulf Schönermarck
- Department of Medicine IV, University Hospital, LMU Munich, Germany
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Lo Sasso B, Agnello L, Giglio RV, Gambino CM, Ciaccio AM, Vidali M, Ciaccio M. Longitudinal analysis of anti-SARS-CoV-2 S-RBD IgG antibodies before and after the third dose of the BNT162b2 vaccine. Sci Rep 2022; 12:8679. [PMID: 35606426 PMCID: PMC9126106 DOI: 10.1038/s41598-022-12750-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/12/2022] [Indexed: 12/20/2022] Open
Abstract
Immunosurveillance by evaluating anti-spike protein receptor-binding domain (S-RBD) antibodies represents a useful tool to estimate the long immunity against Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) infection. The aim of this study was to evaluate the kinetics of antibody response in vaccine recipients. We measured anti-S-RBD IgG levels by indirect chemiluminescence immunoassay on Maglumi 800 (SNIBE, California) in 1013 healthy individuals naïve to SARS-CoV2 infection after two and three COVID-19 vaccine doses. We found that anti-S-RBD IgG levels are higher in females than males. Antibody levels gradually decrease to a steady state after four months since the peak, and the decay is independent of age, sex, vaccine doses, and baseline antibodies titer. The third dose induces a high anti-S-RBD IgG reactivity in individuals with previous high responses and triggers a moderate-high anti-S-RBD IgG reactivity. The assessment of anti-S-RBD IgG levels is essential for monitoring long-term antibody response. A third SARS-CoV-2 vaccine dose is associated with a significant immunological response. Thus, our results support the efficacy of the vaccine programs and the usefulness of the third dose.
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Affiliation(s)
- Bruna Lo Sasso
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, University of Palermo, 90127, Palermo, Italy
- Department of Laboratory Medicine, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", 90127, Palermo, Italy
| | - Luisa Agnello
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, University of Palermo, 90127, Palermo, Italy
| | - Rosaria Vincenza Giglio
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, University of Palermo, 90127, Palermo, Italy
- Department of Laboratory Medicine, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", 90127, Palermo, Italy
| | - Caterina Maria Gambino
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, University of Palermo, 90127, Palermo, Italy
- Department of Laboratory Medicine, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", 90127, Palermo, Italy
| | - Anna Maria Ciaccio
- Unit of Clinical Biochemistry, University of Palermo, 90127, Palermo, Italy
| | - Matteo Vidali
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Marcello Ciaccio
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, University of Palermo, 90127, Palermo, Italy.
- Department of Laboratory Medicine, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone", 90127, Palermo, Italy.
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Wang X, Han M, Fuentes LR, Thwin O, Grobe N, Wang K, Wang Y, Kotanko P. SARS-CoV-2 neutralizing antibody response after three doses of mRNA1273 vaccine and COVID-19 in hemodialysis patients. FRONTIERS IN NEPHROLOGY 2022; 2:926635. [PMID: 36106337 PMCID: PMC9470295 DOI: 10.3389/fneph.2022.926635] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND In hemodialysis patients, a third vaccination is frequently administered to augment protection against coronavirus disease 2019 (COVID-19). However, the newly emerged B.1.1.159 (Omicron) variant may evade vaccinal protection more easily than previous strains. It is of clinical interest to better understand the neutralizing activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants after booster vaccine or COVID-19 infection in these mostly immunocompromised patients. METHODS Hemodialysis patients from four dialysis centers were recruited between June 2021 and February 2022. Each patient provided a median of six serum samples. SARS-CoV-2 neutralizing antibodies (nAbs) against wild type (WT) or Omicron were measured using the GenScript SARS-CoV-2 Surrogate Virus Neutralization Test Kit. RESULTS Forty-two patients had three doses of mRNA1273. Compared to levels prior to the third dose, nAb-WT increased 18-fold (peak at day 23) and nAb-Omicron increased 23-fold (peak at day 24) after the third dose. Peak nAb-WT exceeded peak nAb-Omicron 27-fold. Twenty-one patients had COVID-19 between December 24, 2021, and February 2, 2022. Following COVID-19, nAb-WT and nAb-Omicron increased 12- and 40-fold, respectively. While levels of vaccinal and post-COVID nAb-WT were comparable, post-COVID nAb-Omicron levels were 3.2 higher than the respective peak vaccinal nAb-Omicron. Four immunocompromised patients having reasons other than end-stage kidney disease have very low to no nAb after the third dose or COVID-19. CONCLUSIONS Our results suggest that most hemodialysis patients have a strong humoral response to the third dose of vaccination and an even stronger post-COVID-19 humoral response. Nevertheless, nAb levels clearly decay over time. These findings may inform ongoing discussions regarding a fourth vaccination in hemodialysis patients.
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Affiliation(s)
- Xiaoling Wang
- Renal Research Institute, New York, NY, United States
- CORRESPONDENCE: Xiaoling Wang,
| | - Maggie Han
- Renal Research Institute, New York, NY, United States
| | | | - Ohnmar Thwin
- Renal Research Institute, New York, NY, United States
| | - Nadja Grobe
- Renal Research Institute, New York, NY, United States
| | - Kevin Wang
- College of Creative Studies, University of California at Santa Barbara, Santa Barbara, CA, United States
| | - Yuedong Wang
- Department of Statistics and Applied Probability, University of California at Santa Barbara, Santa Barbara, CA, United States
| | - Peter Kotanko
- Renal Research Institute, New York, NY, United States
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
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