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Chesdachai S, Rivera CG, Cole KC, Teaford HR, Gonzalez Suarez ML, Larsen JJ, Ganesh R, Tulledge-Scheitel S, Razonable RR. Comparable outcomes of outpatient remdesivir and sotrovimab among high-risk patients with mild to moderate COVID-19 during the omicron BA.1 surge. Sci Rep 2024; 14:5430. [PMID: 38443438 PMCID: PMC10914739 DOI: 10.1038/s41598-024-56195-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/04/2024] [Indexed: 03/07/2024] Open
Abstract
Studies conducted prior to SARS-CoV-2 Omicron demonstrated that sotrovimab and remdesivir reduced hospitalization among high-risk outpatients with mild to moderate COVID-19. However, their effectiveness has not been directly compared. This study examined all high-risk outpatients with mild to moderate COVID-19 who received either remdesivir or sotrovimab at Mayo Clinic during the Omicron BA.1 surge from January to March 2022. COVID-19-related hospitalization or death within 28 days were compared between the two treatment groups. Among 3257 patients, 2158 received sotrovimab and 1099 received remdesivir. Patients treated with sotrovimab were younger and had lower comorbidity but were more likely to be immunocompromised than remdesivir-treated patients. The majority (89%) had received at least one dose of COVID-19 vaccine. COVID-19-related hospitalization (1.5% and 1.0% in remdesivir and sotrovimab, respectively, p = .15) and mortality within 28 days (0.4% in both groups, p = .82) were similarly low. A propensity score weighted analysis demonstrated no significant difference in the outcomes between the two groups. We demonstrated favorable outcomes that were not significantly different between patients treated with remdesivir or sotrovimab.
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Affiliation(s)
- Supavit Chesdachai
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| | | | - Kristin C Cole
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Ravindra Ganesh
- Department of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Raymund R Razonable
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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2
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Behzad A, Mohamed A, Ali A, Niinuma S, Butler AE, Alqahtani M. Real world effectiveness of sotrovimab in preventing COVID-19-related hospitalisation or death in patients infected with Omicron BA.2. J Infect Public Health 2024; 17:315-320. [PMID: 38160562 DOI: 10.1016/j.jiph.2023.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/11/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Laboratory-based evidence indicates that neutralization of the BA.2 (Omicron) variant by sotrovimab is reduced versus previous SARS-CoV-2 variants. Since there is a lack of real-world data, we investigated whether sotrovimab has reduced clinical efficacy against the BA.2 variant. METHODS We performed a prospective cohort study using real-world data from 1180 randomly-selected BA.2 variant-infected patients. Follow-up to study endpoints averaged 29 days. For mild cases (not requiring oxygen-supplementation), primary outcomes were requiring O2-supplementation, intensive care unit (ICU) admission or death. For moderate-to-severe COVID-19 cases (requiring oxygen-supplementation other than mechanical ventilation), the primary outcome was ICU admission or death. RESULTS Patients in the sotrovimab group (n = 569) and control patients (n = 611) were included. Sotrovimab-treated patients versus controls had reduced risk of death (0.4% vs 6.4%, p < 0.001), need for oxygen supplementation (3.5% vs 12.8%, p < 0.001) and ICU admission (0.2% vs 4.9%, p < 0.001). The adjusted-odds ratio for developing any of these outcomes was 0.090 (95% CI 0.049-0.165, p < 0.001). Subgroup analysis of moderate-to-severe sotrovimab-treated patients versus controls revealed reduced mortality (17.7% vs 37.2%, p = 0.006) and ICU admission (0.0% vs 37.2%, p < 0.001). Adjusted-hazards ratio for death or ICU admission was 0.256 (95% CI 0.111-0.593, p < 0.001). CONCLUSION Sotrovimab was effective in reducing COVID-19 progression risk in high-risk BA.2 variant-infected patients. This finding may alleviate concerns about its clinical efficacy.
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Affiliation(s)
- Alwaleed Behzad
- Salmaniya Medical Complex - Government Hospitals, Manama, Bahrain
| | | | - Ahmed Ali
- Royal College of Surgeons Ireland Bahrain, Adliya, Bahrain
| | - Sara Niinuma
- Royal College of Surgeons Ireland Bahrain, Adliya, Bahrain
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Drysdale M, Gibbons DC, Singh M, Rolland C, Lavoie L, Skingsley A, Lloyd EJ. Real-world effectiveness of sotrovimab for the treatment of SARS-CoV-2 infection during Omicron BA.2 subvariant predominance: a systematic literature review. Infection 2024; 52:1-17. [PMID: 37776474 PMCID: PMC10811031 DOI: 10.1007/s15010-023-02098-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/08/2023] [Indexed: 10/02/2023]
Abstract
PURPOSE Emerging SARS-CoV-2 variants have impacted the in vitro activity of sotrovimab, with variable fold changes in neutralization potency for the Omicron BA.2 sublineage and onward. The correlation between reduced in vitro activity and clinical efficacy outcomes is unknown. A systematic literature review (SLR) evaluated the effectiveness of sotrovimab on severe clinical outcomes during Omicron BA.2 predominance. METHODS Electronic databases were searched for peer-reviewed journals, preprint articles, and conference abstracts published from January 1-November 3, 2022. RESULTS Five studies were included, which displayed heterogeneity in study design and population. Two UK studies had large samples of patients during BA.2 predominance: one demonstrated clinical effectiveness vs molnupiravir during BA.1 (adjusted hazard ratio [aHR] 0.54, 95% CI 0.33-0.88; p = 0.014) and BA.2 (aHR 0.44, 95% CI 0.27-0.71; p = 0.001); the other reported no difference in the clinical outcomes of sotrovimab-treated patients when directly comparing sequencing-confirmed BA.1 and BA.2 cases (HR 1.17, 95% CI 0.74-1.86). One US study showed a lower risk of 30-day all-cause hospitalization/mortality for sotrovimab compared with no treatment during the BA.2 surge in March (adjusted relative risk [aRR] 0.41, 95% CI 0.27-0.62) and April 2022 (aRR 0.54, 95% CI 0.08-3.54). Two studies from Italy and Qatar reported low progression rates but were either single-arm descriptive or not sufficiently powered to draw conclusions on the effectiveness of sotrovimab. CONCLUSION This SLR showed that the effectiveness of sotrovimab was maintained against Omicron BA.2 in both ecological and sequencing-confirmed studies, by demonstrating low/comparable clinical outcomes between BA.1 and BA.2 periods or comparing against an active/untreated comparator.
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Affiliation(s)
- Myriam Drysdale
- Value Evidence and Outcomes, GSK, 980 Great West Road, Brentford, TW8 9GS, UK.
| | - Daniel C Gibbons
- Value Evidence and Outcomes, GSK, 980 Great West Road, Brentford, TW8 9GS, UK
| | - Moushmi Singh
- Value Evidence and Outcomes, GSK, 980 Great West Road, Brentford, TW8 9GS, UK
| | - Catherine Rolland
- Evidence Synthesis, Modelling and Communications, PPD Evidera, London, UK
| | - Louis Lavoie
- Evidence Synthesis, Modelling and Communications, PPD Evidera, Montreal, Canada
| | | | - Emily J Lloyd
- Value Evidence and Outcomes, GSK, 980 Great West Road, Brentford, TW8 9GS, UK
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Venturini E, Fusani L, Lo Vecchio A, Scarano SM, Garazzino S, Pruccoli G, Donà D, Lancella L, Castelli Gattinara G, Galli L. Safety of Sotrovimab use in children with COVID-19: an Italian experience. J Chemother 2024; 36:45-48. [PMID: 37605372 DOI: 10.1080/1120009x.2023.2250138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023]
Abstract
Sotrovimab is a monoclonal antibody approved in adult and adolescents at high risk for COVID-19. Thirty-three children evaluated in five Italian paediatric centres received Sotrovimab infusion and were retrospectively enrolled from December 2021 to April 2022. In more than half of cases (19/33, 57.6%) Sotrovimab was prescribed off-label. Overall, the infusion was well tolerated with no significative differences in those receiving an off-label prescription. All children had a complete recovery. Data on the safety of Sotrovimab should be investigated in a larger paediatric cohort, considering the continuous selection of new SARS CoV-2 variants which may be more or less susceptible to the effects of the Sotrovimab.
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Affiliation(s)
- Elisabetta Venturini
- Infectious Disease Unit, IRCSS-Meyer Children's University Hospital, Florence, Italy
| | - Lara Fusani
- Infectious Disease Unit, IRCSS-Meyer Children's University Hospital, Florence, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Pediatric Infectious Disease Unit, University of Naples Federico II, Naples, Italy
| | - Sara Maria Scarano
- Department of Translational Medical Sciences, Pediatric Infectious Disease Unit, University of Naples Federico II, Naples, Italy
| | - Silvia Garazzino
- Department of Pediatric and Public Health Sciences, Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Giulia Pruccoli
- Department of Pediatric and Public Health Sciences, Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
| | | | | | - Luisa Galli
- Infectious Disease Unit, IRCSS-Meyer Children's University Hospital, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
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Nichols RM, Macpherson L, Patel DR, Yeh WW, Peppercorn A. Effect of Bamlanivimab as Monotherapy or in Combination with Etesevimab or Sotrovimab on Persistently High Viral Load in Patients with Mild-to-Moderate COVID-19: A Randomized, Phase 2 BLAZE-4 Trial. Infect Dis Ther 2024; 13:401-411. [PMID: 38291279 PMCID: PMC10904692 DOI: 10.1007/s40121-024-00918-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/09/2024] [Indexed: 02/01/2024] Open
Abstract
INTRODUCTION Treatment with monoclonal antibodies provides rapid, passive immunity and may stop COVID-19 disease progression. The study evaluated the effect of bamlanivimab (BAM) or BAM + etesevimab (ETE)/sotrovimab compared to placebo on SARS-CoV-2 viral load in patients with COVID-19. METHODS The phase 2, randomized, single-dose study included patients aged between ≥ 18 and < 65 years, not hospitalized at the time of randomization, and had ≥ 1 mild or moderate COVID-19 symptoms. Study included arms 1-6 (placebo, BAM 175 mg + ETE 350 mg, BAM 700 mg + ETE 1400 mg, BAM 2800 mg + ETE 2800 mg, BAM 700 mg alone, and BAM 350 mg + ETE 700 mg, respectively), BAM 700 mg + ETE 700 mg unintentional dosing; and arms 7 and 8 (BAM 700 mg + sotrovimab 500 mg and placebo, respectively). The primary endpoint was proportion of patients with SARS-CoV-2 log viral load > 5.27 on day 7 (persistently high viral load [PHVL]) who received BAM or BAM + (ETE or sotrovimab). RESULTS A total of 725 patients, mean age 39.6 years (range 18-75 years), 50.2% male were randomized and infused with study drug in arms 1-6; and a total 202 patients, mean age 38 years (range 18-63 years), 53.5% female were randomized and infused with study drug in arms 7 and 8. A significantly lower proportion of patients in arms 2-6 and arm 7 experienced PHVL on day 7 compared to placebo. On day 7, patients in arms 2, 3, and 6 consistently experienced significantly greater reduction in viral load than placebo. Significant improvement was observed in time to viral load clearance and time to symptom improvement by day 29 in some arms compared to placebo. No new safety concerns were observed with drug combinations. CONCLUSION The study demonstrated that a significantly lower proportion of patients with mild-to-moderate COVID-19 treated with BAM or BAM + (ETE or sotrovimab) experienced a PHVL at day 7. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT04634409.
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Affiliation(s)
| | | | | | - Wendy W Yeh
- Vir Biotechnology, Inc., San Francisco, CA, USA
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Lo CKL, Lo CKF, Komorowski AS, Leung V, Matic N, McKenna S, Perez-Patrigeon S, Sheth PM, Lowe CF, Chagla Z, Bai AD. Evaluating in vivo effectiveness of sotrovimab for the treatment of Omicron subvariant BA.2 versus BA.1: a multicentre, retrospective cohort study. BMC Res Notes 2024; 17:37. [PMID: 38267971 PMCID: PMC10809552 DOI: 10.1186/s13104-024-06695-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND In vitro data suggested reduced neutralizing capacity of sotrovimab, a monoclonal antibody, against Omicron BA.2 subvariant. However, limited in vivo data exist regarding clinical effectiveness of sotrovimab for coronavirus disease 2019 (COVID-19) due to Omicron BA.2. METHODS A multicentre, retrospective cohort study was conducted at three Canadian academic tertiary centres. Electronic medical records were reviewed for patients ≥ 18 years with mild COVID-19 (sequencing-confirmed Omicron BA.1 or BA.2) treated with sotrovimab between February 1 to April 1, 2022. Thirty-day co-primary outcomes included hospitalization due to moderate or severe COVID-19; all-cause intensive care unit (ICU) admission, and all-cause mortality. Risk differences (BA.2 minus BA.1 group) for co-primary outcomes were adjusted with propensity score matching (e.g., age, sex, vaccination, immunocompromised status). RESULTS Eighty-five patients were included (15 BA.2, 70 BA.1) with similar baseline characteristics between groups. Adjusted risk differences were non-statistically significant between groups for 30-day hospitalization (- 14.3%; 95% confidence interval (CI): - 32.6 to 4.0%), ICU admission (- 7.1%; 95%CI: - 20.6 to 6.3%), and mortality (- 7.1%; 95%CI: - 20.6 to 6.3%). CONCLUSIONS No differences were demonstrated in hospitalization, ICU admission, or mortality rates within 30 days between sotrovimab-treated patients with BA.1 versus BA.2 infection. More real-world data may be helpful to properly assess sotrovimab's effectiveness against infections due to specific emerging COVID-19 variants.
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Affiliation(s)
- Carson K L Lo
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, ON, Canada.
- Transplant Infectious Diseases and Ajmera Transplant Centre, University Health Network, 585 University Avenue, MaRS Building, 9th Floor, Toronto, ON, M5G 2N2, Canada.
| | - Calvin K F Lo
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Adam S Komorowski
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Medical Microbiology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Victor Leung
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Medical Microbiology and Virology, St. Paul's Hospital, Providence Health Care, Vancouver, BC, Canada
| | - Nancy Matic
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Medical Microbiology and Virology, St. Paul's Hospital, Providence Health Care, Vancouver, BC, Canada
| | - Susan McKenna
- Department of Pharmacy Services, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Santiago Perez-Patrigeon
- Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Prameet M Sheth
- Division of Microbiology, Kingston Health Sciences Centre, Kingston, ON, Canada
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
- Department of Biomedical & Molecular Sciences, Queen's University, Kingston, ON, Canada
- Gastrointestinal Disease Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Christopher F Lowe
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Medical Microbiology and Virology, St. Paul's Hospital, Providence Health Care, Vancouver, BC, Canada
| | - Zain Chagla
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Anthony D Bai
- Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, ON, Canada
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Gentile I, Foggia M, Silvitelli M, Sardanelli A, Cattaneo L, Viceconte G. Optimizing COVID-19 treatment in immunocompromised patients: early combination therapy with remdesivir, nirmatrelvir/ritonavir and sotrovimab. Virol J 2023; 20:301. [PMID: 38102675 PMCID: PMC10724917 DOI: 10.1186/s12985-023-02269-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/12/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Morbidity and mortality are higher in immunocompromised patients affected by COVID-19 than in the general population. Some authors have successfully used antiviral combination, but never in the early phase of the infection. METHODS We conducted a retrospective cohort study to determine the efficacy and safety of the combination of two antivirals, with and without a monoclonal antibody (mAb), in both the early (within 10 days of symptoms) and in a later phase (after 10 days) of SARS-CoV-2 infection in immunocompromised patients admitted to our Facility. RESULTS We treated 11 patients (seven in an early phase and four in a late phase of COVID-19) with 10 days of intravenous remdesivir plus five days of oral nirmatelvir/ritonavir, also combined with sotrovimab in 10/11 cases. Notably, all the "early" patients reached virological clearance at day 30 from the end of the therapy and were alive and well at follow-up, whereas the corresponding numbers in the "late" patients were 50% and 75%. Patients in the "late" group more frequently needed oxygen supplementation (p = 0.015) and steroid therapy (p = 0.045) during admission and reached higher COVID-19 severity (p = 0.017). DISCUSSION The combination of antiviral and sotrovimab in the early phase of COVID-19 is well tolerated by immunocompromised patients and is associated with 100% of virological clearance. Patients treated later have lower response rates and higher disease severity, but whether therapy plays a causative role in such findings has yet to be determined.
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Affiliation(s)
- Ivan Gentile
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "AOU Federico II", Via Sergio Pansini,5, Naples, 80131, Italy
| | - Maria Foggia
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "AOU Federico II", Via Sergio Pansini,5, Naples, 80131, Italy
| | - Maria Silvitelli
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "AOU Federico II", Via Sergio Pansini,5, Naples, 80131, Italy
| | - Alessia Sardanelli
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "AOU Federico II", Via Sergio Pansini,5, Naples, 80131, Italy
| | - Letizia Cattaneo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "AOU Federico II", Via Sergio Pansini,5, Naples, 80131, Italy
| | - Giulio Viceconte
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "AOU Federico II", Via Sergio Pansini,5, Naples, 80131, Italy.
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Zheng B, Tazare J, Nab L, Green AC, Curtis HJ, Mahalingasivam V, Herrett EL, Costello RE, Eggo RM, Speed V, Bacon SC, Bates C, Parry J, Cockburn J, Hester F, Harper S, Schaffer AL, Hulme WJ, Mehrkar A, Evans SJ, MacKenna B, Goldacre B, Douglas IJ, Tomlinson LA. Comparative effectiveness of nirmatrelvir/ritonavir versus sotrovimab and molnupiravir for preventing severe COVID-19 outcomes in non-hospitalised high-risk patients during Omicron waves: observational cohort study using the OpenSAFELY platform. Lancet Reg Health Eur 2023; 34:100741. [PMID: 37927438 PMCID: PMC10624988 DOI: 10.1016/j.lanepe.2023.100741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/06/2023] [Accepted: 09/14/2023] [Indexed: 11/07/2023]
Abstract
Background Timely evidence of the comparative effectiveness between COVID-19 therapies in real-world settings is needed to inform clinical care. This study aimed to compare the effectiveness of nirmatrelvir/ritonavir versus sotrovimab and molnupiravir in preventing severe COVID-19 outcomes in non-hospitalised high-risk COVID-19 adult patients during Omicron waves. Methods With the approval of NHS England, we conducted a real-world cohort study using the OpenSAFELY-TPP platform. Patient-level primary care data were obtained from 24 million people in England and were securely linked with data on COVID-19 infection and therapeutics, hospital admission, and death, covering a period where both nirmatrelvir/ritonavir and sotrovimab were first-line treatment options in community settings (February 10, 2022-November 27, 2022). Molnupiravir (third-line option) was used as an exploratory comparator to nirmatrelvir/ritonavir, both of which were antivirals. Cox proportional hazards model stratified by area was used to compare the risk of 28-day COVID-19 related hospitalisation/death across treatment groups. Findings A total of 9026 eligible patients treated with nirmatrelvir/ritonavir (n = 5704) and sotrovimab (n = 3322) were included in the main analysis. The mean age was 52.7 (SD = 14.9) years and 93% (8436/9026) had three or more COVID-19 vaccinations. Within 28 days after treatment initiation, 55/9026 (0.61%) COVID-19 related hospitalisations/deaths were observed (34/5704 [0.60%] treated with nirmatrelvir/ritonavir and 21/3322 [0.63%] with sotrovimab). After adjusting for demographics, high-risk cohort categories, vaccination status, calendar time, body mass index and other comorbidities, we observed no significant difference in outcome risk between nirmatrelvir/ritonavir and sotrovimab users (HR = 0.89, 95% CI: 0.48-1.63; P = 0.698). Results from propensity score weighted model also showed non-significant difference between treatment groups (HR = 0.82, 95% CI: 0.45-1.52; P = 0.535). The exploratory analysis comparing nirmatrelvir/ritonavir users with 1041 molnupiravir users (13/1041 [1.25%] COVID-19 related hospitalisations/deaths) showed an association in favour of nirmatrelvir/ritonavir (HR = 0.45, 95% CI: 0.22-0.94; P = 0.033). Interpretation In routine care of non-hospitalised high-risk adult patients with COVID-19 in England, no substantial difference in the risk of severe COVID-19 outcomes was observed between those who received nirmatrelvir/ritonavir and sotrovimab between February and November 2022, when Omicron subvariants BA.2, BA.5, or BQ.1 were dominant. Funding UK Research and Innovation, Wellcome Trust, UK Medical Research Council, National Institute for Health and Care Research, and Health Data Research UK.
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Affiliation(s)
- Bang Zheng
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - John Tazare
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Linda Nab
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, University of Oxford, Oxford OX2 6GG, UK
| | - Amelia Ca Green
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, University of Oxford, Oxford OX2 6GG, UK
| | - Helen J Curtis
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, University of Oxford, Oxford OX2 6GG, UK
| | | | - Emily L Herrett
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Ruth E Costello
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Rosalind M Eggo
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Victoria Speed
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, University of Oxford, Oxford OX2 6GG, UK
| | - Sebastian Cj Bacon
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, University of Oxford, Oxford OX2 6GG, UK
| | | | - John Parry
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds LS18 5PX, UK
| | | | - Frank Hester
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds LS18 5PX, UK
| | - Sam Harper
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds LS18 5PX, UK
| | - Andrea L Schaffer
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, University of Oxford, Oxford OX2 6GG, UK
| | - William J Hulme
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, University of Oxford, Oxford OX2 6GG, UK
| | - Amir Mehrkar
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, University of Oxford, Oxford OX2 6GG, UK
| | - Stephen Jw Evans
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Brian MacKenna
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, University of Oxford, Oxford OX2 6GG, UK
| | - Ben Goldacre
- Nuffield Department of Primary Care Health Sciences, Bennett Institute for Applied Data Science, University of Oxford, Oxford OX2 6GG, UK
| | - Ian J Douglas
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Laurie A Tomlinson
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Focosi D, McConnell S, Sullivan DJ, Casadevall A. Analysis of SARS-CoV-2 mutations associated with resistance to therapeutic monoclonal antibodies that emerge after treatment. Drug Resist Updat 2023; 71:100991. [PMID: 37572569 DOI: 10.1016/j.drup.2023.100991] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/18/2023] [Accepted: 07/30/2023] [Indexed: 08/14/2023]
Abstract
The mutation rate of the Omicron sublineage has led to baseline resistance against all previously authorized anti-Spike monoclonal antibodies (mAbs). Nevertheless, in case more antiviral mAbs will be authorized in the future, it is relevant to understand how frequently treatment-emergent resistance has emerged so far, under different combinations and in different patient subgroups. We report the results of a systematic review of the medical literature for case reports and case series for treatment-emergent immune escape, which is defined as emergence of a resistance-driving mutation in at least 20% of sequences in a given host at a given timepoint. We identified 32 publications detailing 216 cases that included different variants of concern (VOC) and found that the incidence of treatment emergent-resistance ranged from 10% to 50%. Most of the treatment-emergent resistance events occurred in immunocompromised patients. Interestingly, resistance also emerged against cocktails of two mAbs, albeit at lower frequencies. The heterogenous therapeutic management of those cases doesn't allow inferences about the clinical outcome in patients with treatment-emergent resistance. Furthermore, we noted a temporal correlation between the introduction of mAb therapies and a subsequent increase in SARS-CoV-2 sequences across the globe carrying mutations conferring resistance to that mAb, raising concern as to whether these had originated in mAb-treated individuals. Our findings confirm that treatment-emergent immune escape to anti-Spike mAbs represents a frequent and concerning phenomenon and suggests that these are associated with mAb use in immunosuppressed hosts.
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Affiliation(s)
- Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, Italy.
| | - Scott McConnell
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - David J Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Arturo Casadevall
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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10
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Jassoy C, Biemann R, Hönemann M. Low BAU/ml values with 4 of 5 SARS CoV-2 spike-specific monoclonal antibodies in the Roche Elecsys antibody assay. J Virol Methods 2023; 321:114786. [PMID: 37516369 DOI: 10.1016/j.jviromet.2023.114786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND The Abbott SARS-CoV-2 IgG Quant II assay and the Roche Elecsys double antigen sandwich (DAgS) immunoassay measure SARS-CoV-2 receptor binding domain (RBD)-specific antibodies in serum samples in different ways. The IgG Quant II assay uses an antigen in combination with a secondary antibody and the DAgS assay uses two antigens. The aim of the study was to investigate whether the assays give comparable results with monoclonal antibodies. MATERIAL AND METHODS The immunoassays were tested with the RBD-specific human monoclonal antibodies (mAbs) casirivimab. imdevimab, CR3022, etesevimab and sotrovimab. The mAbs were tested at various concentrations in µg/ml, alone or in combination and the relative light units (RLU) and binding antibody units (BAU)/ml were determined. RESULTS With 1 µg/ml of casirivimab, imdevimab, CR3022 and etesevimab the Abbott IgG II Quant assay yielded between 65 and 158 BAU/ml and the Elecsys assay < 0.4 - 7.1 BAU/ml. In the DAgS assay, the addition of a second and a third mAb increased the BAU/ml values synergistically. With increasing concentrations of the mAb combinations in µg/ml the Abbott IgG Quant II assay showed proportionate and the Elecsys DAgS assay disproportionate increases in BAU/ml. With 1 µg/ml sotrovimab the Abbott assay gave 39 and the Elecsys assay 136 BAU/ml. The DAgS assay showed a high dose hook effect in the µg/ml range. CONCLUSIONS The secondary antibody-based and the DAgS-based SARS CoV-2 antibody assays gave very different results with 4 of 5 mAbs. This suggests that the two assays measure different binding characteristics. The ability of antibodies to cross-link multiple antigen-antibody complexes may contribute to the measurement signal in the DAgS assay.
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Affiliation(s)
- Christian Jassoy
- Institute for Medical Microbiology and Virology, University Hospital and Medical Faculty, University of Leipzig, Leipzig, Germany.
| | - Ronald Biemann
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital and Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Mario Hönemann
- Institute for Medical Microbiology and Virology, University Hospital and Medical Faculty, University of Leipzig, Leipzig, Germany
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11
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Satram S, Ghafoori P, Reyes CM, Keeley TJH, Birch HJ, Brintziki D, Aldinger M, Alexander E, Lopuski A, Sarkis EH, Gupta A, Shapiro AE, Powers JH. Assessment of symptoms in COMET-ICE, a phase 2/3 study of sotrovimab for early treatment of non-hospitalized patients with COVID-19. J Patient Rep Outcomes 2023; 7:92. [PMID: 37702920 PMCID: PMC10499766 DOI: 10.1186/s41687-023-00621-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 07/26/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND The COMET-ICE trial demonstrated that sotrovimab clinically and statistically significantly reduces the risk of all-cause > 24-h hospitalization or death due to any cause among patients with COVID-19 at high risk of disease progression. Patient-reported outcomes are important to capture symptom burden of COVID-19 and assess treatment effectiveness. This study investigated symptoms and their impact over the acute phase of COVID-19 infection among patients on sotrovimab versus placebo. METHODS Randomized (1:1), double-blind, multicenter, placebo-controlled, phase 2/3 study in 57 centers across five countries. Participants were non-hospitalized patients with symptomatic, mild-to-moderate COVID-19 and ≥ 1 baseline risk factor for disease progression (aged ≥ 55 years or ≥ 1 of the following: diabetes requiring medication, obesity, chronic kidney disease, congestive heart failure, chronic obstructive pulmonary disease, or moderate-to-severe asthma). An intravenous infusion of sotrovimab 500 mg or placebo was administered on Day 1. The FLU-PRO Plus questionnaire was administered once-daily with 24-h recall from Day 1-21, and at Day 29. Intensity and duration of COVID-19 symptoms were determined from area under the curve (AUC) and mean change in total and individual domain scores through Days 7, 14, and 21. Time to symptom alleviation was assessed. RESULTS In total, 1057 patients were randomized to sotrovimab (n = 528) or placebo (n = 529). At Day 7, mean decrease in FLU-PRO Plus total score (measured by AUC) was statistically significantly greater for patients on sotrovimab (-3.05 [95% confidence interval (CI) -3.27 to -2.83]) than placebo (-1.98 [95% CI -2.20 to -1.76]; difference -1.07 [95% CI -1.38 to -0.76]; p < 0.001). Significant differences were also observed at Days 14 and 21. A more rapid decline in symptom severity was observed with sotrovimab versus placebo through Week 1 and the first 21 days post-treatment. By Day 21, 41% of patients on sotrovimab and 34% on placebo reported symptom resolution. In a post-hoc analysis, median time to symptom alleviation was 4 and 6 days, respectively. CONCLUSIONS Sotrovimab provides significant and rapid improvements in patient-reported COVID-19 symptoms, as measured by the FLU-PRO Plus. These results further show the benefits of sotrovimab in alleviating symptoms among high-risk patients with COVID-19. Trial registration ClinicalTrials.Gov: NCT04545060 ( https://clinicaltrials.gov/ct2/show/NCT04545060 ). Date of registration: September 10, 2020 (retrospectively registered).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Anil Gupta
- Albion Finch Medical, William Osler Health Centre, Toronto, ON, Canada
| | - Adrienne E Shapiro
- Departments of Global Health and Medicine, University of Washington and Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - John H Powers
- George Washington University School of Medicine, Washington, DC, USA
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12
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Driouich JS, Bernadin O, Touret F, de Lamballerie X, Nougairède A. Activity of Sotrovimab against BQ.1.1 and XBB.1 Omicron sublineages in a hamster model. Antiviral Res 2023; 215:105638. [PMID: 37207822 PMCID: PMC10191698 DOI: 10.1016/j.antiviral.2023.105638] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/11/2023] [Accepted: 05/16/2023] [Indexed: 05/21/2023]
Abstract
The successive emergence of SARS-CoV-2 Omicron variants has completely changed the modalities of use of therapeutic monoclonal antibodies. Recent in vitro studies indicated that only Sotrovimab has maintained partial activity against BQ.1.1 and XBB.1. In the present study, we used the hamster model to determine whether Sotrovimab retains antiviral activity against these Omicron variants in vivo. Our results show that at exposures consistent with those observed in humans, Sotrovimab remains active against BQ.1.1 and XBB.1, although for BQ.1.1 the efficacy is lower than that observed against the first globally dominant Omicron sublineages BA.1 and BA.2.
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Affiliation(s)
- Jean-Sélim Driouich
- Unité des Virus Émergents, UVE: Aix Marseille Univ, IRD 190, INSERM, 1207, Marseille, France
| | - Ornéllie Bernadin
- Unité des Virus Émergents, UVE: Aix Marseille Univ, IRD 190, INSERM, 1207, Marseille, France
| | - Franck Touret
- Unité des Virus Émergents, UVE: Aix Marseille Univ, IRD 190, INSERM, 1207, Marseille, France
| | - Xavier de Lamballerie
- Unité des Virus Émergents, UVE: Aix Marseille Univ, IRD 190, INSERM, 1207, Marseille, France
| | - Antoine Nougairède
- Unité des Virus Émergents, UVE: Aix Marseille Univ, IRD 190, INSERM, 1207, Marseille, France.
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13
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Frallonardo L, Vimercati A, Novara R, Lepera C, Ferrante I, Chiarello G, Cicinelli R, Mongelli M, Brindicci G, Segala FV, Santoro CR, Bavaro DF, Laforgia N, Cicinelli E, Saracino A, Di Gennaro F. Use of Sotrovimab in a cohort of pregnant women with a high risk of COVID 19 progression: a single-center experience. Pathog Glob Health 2023; 117:513-519. [PMID: 36896940 PMCID: PMC10262799 DOI: 10.1080/20477724.2023.2188839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Neutralizing monoclonal antibodies (mAbs) have been shown to reduce disease progression in patients with underlying predisposing conditions. Unfortunately, there is no evidence on the use of Sotrovimab in pregnant women. Herein we present a case series of pregnant women who received mAbs with Sotrovimab following the Italian Drug Agency (AIFA) indications. Since February 1, 2022 all pregnant women - regardless of gestational age - admitted to Obstetrics & Gynaecology of Policlinico University of Bari, with positive nasopharyngeal NAAT for SARS-CoV-2 were screened according to the AIFA indications for Sotrovimab and, if eligible, were proposed for treatment. Data on COVID-19, pregnancy, delivery, newborn outcomes, and adverse events were collected. From February 1 to May 15, 2022, 58 pregnant women were screened. Fifty (86%) patients were eligible, 19 of them (32.7%) denied their consent, in 18 cases (31%), the drug was temporarily unavailable, and the remaining 13 (22%) were treated with Sotrovimab. Out of these 13 patients, 6 (46%) were in the 3rd and 7 (54%) in the 2nd trimester of pregnancy. None of the 13 patients experienced adverse reactions due to Sotrovimab and all had a good clinical outcome. Furthermore, evaluating pre- and post-infusion clinical status and hematochemical profile, a reduction in D-dimers and an increase in SARS-CoV-2 antibodies (p < 0.01) during the 72 h following the infusion were observed. Our data, the first on the use of Sotrovimab in pregnant women, showed the safety and efficacy drug profile and its potential crucial role in preventing COVID-19 disease progression.
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Affiliation(s)
- Luisa Frallonardo
- Clinic of Infectious Diseases, University of "Aldo Moro" Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of Bari "Aldo Moro", Piazza Giulio Cesare n. 11 Cap, Bari, Italy
| | | | - Roberta Novara
- Clinic of Infectious Diseases, University of "Aldo Moro" Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of Bari "Aldo Moro", Piazza Giulio Cesare n. 11 Cap, Bari, Italy
| | - Cherola Lepera
- Clinic of Obstetrics & Gynaecology, University of "Aldo Moro", Bari, Italy
| | - Ilaria Ferrante
- Clinic of Obstetrics & Gynaecology, University of "Aldo Moro", Bari, Italy
| | - Giulia Chiarello
- Clinic of Obstetrics & Gynaecology, University of "Aldo Moro", Bari, Italy
| | - Rossana Cicinelli
- Clinic of Obstetrics & Gynaecology, University of "Aldo Moro", Bari, Italy
| | - Michele Mongelli
- Clinic of Obstetrics & Gynaecology, University of "Aldo Moro", Bari, Italy
| | - Gaetano Brindicci
- Clinic of Infectious Diseases, University of "Aldo Moro" Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of Bari "Aldo Moro", Piazza Giulio Cesare n. 11 Cap, Bari, Italy
| | - Francesco Vladimiro Segala
- Clinic of Infectious Diseases, University of "Aldo Moro" Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of Bari "Aldo Moro", Piazza Giulio Cesare n. 11 Cap, Bari, Italy
| | - Carmen Rita Santoro
- Clinic of Infectious Diseases, University of "Aldo Moro" Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of Bari "Aldo Moro", Piazza Giulio Cesare n. 11 Cap, Bari, Italy
| | - Davide Fiore Bavaro
- Clinic of Infectious Diseases, University of "Aldo Moro" Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of Bari "Aldo Moro", Piazza Giulio Cesare n. 11 Cap, Bari, Italy
| | - Nicola Laforgia
- U.O.C. Neonatology and NICU Policlinico Bari, University of Bari "Aldo Moro", Bari, Italy
| | - Ettore Cicinelli
- Clinic of Obstetrics & Gynaecology, University of "Aldo Moro", Bari, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, University of "Aldo Moro" Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of Bari "Aldo Moro", Piazza Giulio Cesare n. 11 Cap, Bari, Italy
| | - Francesco Di Gennaro
- Clinic of Infectious Diseases, University of "Aldo Moro" Department of Precision and Regenerative Medicine and Ionian Area - (DiMePRe-J), University of Bari "Aldo Moro", Piazza Giulio Cesare n. 11 Cap, Bari, Italy
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14
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Razonable RR. Neutralizing anti-spike monoclonal antibodies for COVID-19 in vulnerable populations: lessons learned and future directions. Expert Opin Biol Ther 2023. [PMID: 37318043 DOI: 10.1080/14712598.2023.2226326] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Anti-spike monoclonal antibodies were highly effective for prophylaxis and early treatment of mild to moderate COVID-19 in high-risk populations. AREAS COVERED This article reviews the clinical trials that led to the emergency use authorization of bamlanivimab with or without etesevimab, casirivimab and imdevimab, sotrovimab, bebtelovimab, and tixagevimab and cilgavimab in the United States. Clinical trials provided evidence that anti-spike monoclonal antibodies were highly effective, if administered early, for the treatment of mild to moderate COVID-19 among high-risk patients. Clinical trials also provided evidence that certain anti-spike monoclonal antibodies were highly effective when given as pre-exposure or post-exposure prophylaxis among high-risk individuals, including immunosuppressed populations. The evolution of SARS-CoV-2 resulted in spike mutations that conferred reduced susceptibility to anti-spike monoclonal antibodies. EXPERT OPINION Anti-spike monoclonal antibodies for treatment and prevention of COVID-19 resulted in therapeutic successes that resulted in reduced morbidity and improved survival among the high-risk populations. Lessons learned from their clinical use should guide the future development of durable antibody-based therapies. A strategy that will preserve their therapeutic lifespan is needed.
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Affiliation(s)
- Raymund R Razonable
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
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15
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Hérate C, Marlin R, Touret F, Dereuddre-Bosquet N, Donati F, Relouzat F, Junges L, Galhaut M, Dehan O, Sconosciuti Q, Nougairède A, de Lamballerie X, van der Werf S, Le Grand R. Sotrovimab retains activity against SARS-CoV-2 omicron variant BQ.1.1 in a non-human primate model. Heliyon 2023; 9:e16664. [PMID: 37287613 PMCID: PMC10228175 DOI: 10.1016/j.heliyon.2023.e16664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/09/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023] Open
Abstract
The SARS-CoV2 Omicron variants have acquired new Spike mutations leading to escape from the most of the currently available monoclonal antibody treatments reducing the options for patients suffering from severe Covid-19. Recently, both in vitro and in vivo data have suggested that Sotrovimab could retain partial activity against recent omicron sub-lineage such as BA.5 variants, including BQ.1.1. Here we report full efficacy of Sotrovimab against BQ.1.1 viral replication as measure by RT-qPCR in a non-human primate challengemodel.
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Affiliation(s)
- Cécile Hérate
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IMVA-HB/IDMIT), 18 route du Panorama, 92265, Fontenay-aux-Roses, France
| | - Romain Marlin
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IMVA-HB/IDMIT), 18 route du Panorama, 92265, Fontenay-aux-Roses, France
| | - Franck Touret
- Unité des Virus Émergents (UVE), Aix Marseille Université, IRD 190, INSERM 1207, 27 Bd Jean Moulin, 13005, Marseille, France
| | - Nathalie Dereuddre-Bosquet
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IMVA-HB/IDMIT), 18 route du Panorama, 92265, Fontenay-aux-Roses, France
| | - Flora Donati
- Institut Pasteur, Université Paris Cité, CNRS UMR 3569, Molecular Genetics of RNA Viruses Unit, 25-28 Rue du Dr Roux, 75015, Paris, France
- Institut Pasteur, Université Paris Cité, National Reference Center for Respiratory Viruses, 25-28 Rue du Dr Roux, 75015, Paris, France
| | - Francis Relouzat
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IMVA-HB/IDMIT), 18 route du Panorama, 92265, Fontenay-aux-Roses, France
| | - Laura Junges
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IMVA-HB/IDMIT), 18 route du Panorama, 92265, Fontenay-aux-Roses, France
| | - Mathilde Galhaut
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IMVA-HB/IDMIT), 18 route du Panorama, 92265, Fontenay-aux-Roses, France
| | - Océane Dehan
- Institut Pasteur, Université Paris Cité, CNRS UMR 3569, Molecular Genetics of RNA Viruses Unit, 25-28 Rue du Dr Roux, 75015, Paris, France
- Institut Pasteur, Université Paris Cité, National Reference Center for Respiratory Viruses, 25-28 Rue du Dr Roux, 75015, Paris, France
| | - Quentin Sconosciuti
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IMVA-HB/IDMIT), 18 route du Panorama, 92265, Fontenay-aux-Roses, France
| | - Antoine Nougairède
- Unité des Virus Émergents (UVE), Aix Marseille Université, IRD 190, INSERM 1207, 27 Bd Jean Moulin, 13005, Marseille, France
| | - Xavier de Lamballerie
- Unité des Virus Émergents (UVE), Aix Marseille Université, IRD 190, INSERM 1207, 27 Bd Jean Moulin, 13005, Marseille, France
| | - Sylvie van der Werf
- Institut Pasteur, Université Paris Cité, CNRS UMR 3569, Molecular Genetics of RNA Viruses Unit, 25-28 Rue du Dr Roux, 75015, Paris, France
- Institut Pasteur, Université Paris Cité, National Reference Center for Respiratory Viruses, 25-28 Rue du Dr Roux, 75015, Paris, France
| | - Roger Le Grand
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IMVA-HB/IDMIT), 18 route du Panorama, 92265, Fontenay-aux-Roses, France
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Cegolon L, Pol R, Simonetti O, Larese Filon F, Luzzati R. Molnupiravir, Nirmatrelvir/Ritonavir, or Sotrovimab for High-Risk COVID-19 Patients Infected by the Omicron Variant: Hospitalization, Mortality, and Time until Negative Swab Test in Real Life. Pharmaceuticals (Basel) 2023; 16:721. [PMID: 37242504 PMCID: PMC10221734 DOI: 10.3390/ph16050721] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023] Open
Abstract
Background. Several drugs which are easy to administer in outpatient settings have been authorized and endorsed for high-risk COVID-19 patients with mild-moderate disease to prevent hospital admission and death, complementing COVID-19 vaccines. However, the evidence on the efficacy of COVID-19 antivirals during the Omicron wave is scanty or conflicting. Methods. This retrospective controlled study investigated the efficacy of Molnupiravir or Nirmatrelvir/Ritonavir (Paxlovid®) or Sotrovimab against standard of care (controls) on three different endpoints among 386 high-risk COVID-19 outpatients: hospital admission at 30 days; death at 30 days; and time between COVID-19 diagnosis and first negative swab test result. Multivariable logistic regression was employed to investigate the determinants of hospitalization due to COVID-19-associated pneumonia, whereas time to first negative swab test result was investigated by means of multinomial logistic analysis as well as Cox regression analysis. Results. Only 11 patients (overall rate of 2.8%) developed severe COVID-19-associated pneumonia requiring admission to hospital: 8 controls (7.2%); 2 patients on Nirmatrelvir/Ritonavir (2.0%); and 1 on Sotrovimab (1.8%). No patient on Molnupiravir was institutionalized. Compared to controls, hospitalization was less likely for patients on Nirmatrelvir/Ritonavir (aOR = 0.16; 95% CI: 0.03; 0.89) or Molnupiravir (omitted estimate); drug efficacy was 84% for Nirmatrelvir/Ritonavir against 100% for Molnupiravir. Only two patients died of COVID-19 (rate of 0.5%), both were controls, one (a woman aged 96 years) was unvaccinated and the other (a woman aged 72 years) had adequate vaccination status. At Cox regression analysis, the negativization rate was significantly higher in patients treated with both antivirals-Nirmatrelvir/Ritonavir (aHR = 1.68; 95% CI: 1.25; 2.26) or Molnupiravir (aHR = 1.45; 95% CI: 1.08; 1.94). However, COVID-19 vaccination with three (aHR = 2.03; 95% CI: 1.51; 2.73) or four (aHR = 2.48; 95% CI: 1.32; 4.68) doses had a slightly stronger effect size on viral clearance. In contrast, the negativization rate reduced significantly in patients who were immune-depressed (aHR = 0.70; 95% CI: 0.52; 0.93) or those with a Charlson index ≥5 (aHR = 0.63; 0.41; 0.95) or those who had started the respective treatment course 3+ days after COVID-19 diagnosis (aOR = 0.56; 95% CI: 0.38; 0.82). Likewise, at internal analysis (excluding patients on standard of care), patients on Molnupiravir (aHR = 1.74; 95% CI: 1.21; 2.50) or Nirmatrelvir/Ritonavir (aHR = 1.96; 95% CI: 1.32; 2.93) were more likely to turn negative earlier than those on Sotrovimab (reference category). Nonetheless, three (aHR = 1.91; 95% CI: 1.33; 2.74) or four (aHR = 2.20; 95% CI: 1.06; 4.59) doses of COVID-19 vaccine were again associated with a faster negativization rate. Again, the negativization rate was significantly lower if treatment started 3+ days after COVID-19 diagnosis (aHR = 0.54; 95% CI: 0.32; 0.92). Conclusions. Molnupiravir, Nirmatrelvir/Ritonavir, and Sotrovimab were all effective in preventing hospital admission and/or mortality attributable to COVID-19. However, hospitalizations also decreased with higher number of doses of COVID-19 vaccines. Although they are effective against severe disease and mortality, the prescription of COVID-19 antivirals should be carefully scrutinized by double opinion, not only to contain health care costs but also to reduce the risk of generating resistant SARS-CoV-2 strains. Only 64.7% of patients were in fact immunized with 3+ doses of COVID-19 vaccines in the present study. High-risk patients should prioritize COVID-19 vaccination, which is a more cost-effective approach than antivirals against severe SARS-CoV-2 pneumonia. Likewise, although both antivirals, especially Nirmatrelvir/Ritonavir, were more likely than standard of care and Sotrovimab to reduce viral shedding time (VST) in high-risk SARS-CoV-2 patients, vaccination had an independent and stronger effect on viral clearance. However, the effect of antivirals or COVID-19 vaccination on VST should be considered a secondary benefit. Indeed, recommending Nirmatrelvir/Ritonavir in order to control VST in high-risk COVID-19 patients is rather questionable since other cheap, large spectrum and harmless nasal disinfectants such as hypertonic saline solutions are available on the market with proven efficacy in containing VST.
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Affiliation(s)
- Luca Cegolon
- Department of Medical, Surgical & Health Sciences, University of Trieste, 34147 Trieste, Italy; (F.L.F.); (R.L.)
- Occupational Medicine Unit, University Health Agency Giuliano-Isontina (ASUGI), 34129 Trieste, Italy
| | - Riccardo Pol
- Infectious Disease Unit, University Health Agency Giuliano-Isontina (ASUGI), 34129 Trieste, Italy; (R.P.)
| | - Omar Simonetti
- Infectious Disease Unit, University Health Agency Giuliano-Isontina (ASUGI), 34129 Trieste, Italy; (R.P.)
| | - Francesca Larese Filon
- Department of Medical, Surgical & Health Sciences, University of Trieste, 34147 Trieste, Italy; (F.L.F.); (R.L.)
- Occupational Medicine Unit, University Health Agency Giuliano-Isontina (ASUGI), 34129 Trieste, Italy
| | - Roberto Luzzati
- Department of Medical, Surgical & Health Sciences, University of Trieste, 34147 Trieste, Italy; (F.L.F.); (R.L.)
- Infectious Disease Unit, University Health Agency Giuliano-Isontina (ASUGI), 34129 Trieste, Italy; (R.P.)
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Tuan JJ, Sharma M, Kayani J, Davis MW, McManus D, Topal JE, Ogbuagu O. Outcomes of pregnant women exposed to Sotrovimab for the treatment of COVID-19 in the BA.1 Omicron predominant era (PRESTO). BMC Infect Dis 2023; 23:258. [PMID: 37101135 PMCID: PMC10130811 DOI: 10.1186/s12879-023-08198-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/25/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Sotrovimab, a monoclonal antibody with efficacy against SARS-CoV-2 including certain Omicron variants, has been used in treatment of mild-moderate COVID-19. Limited data exists regarding its use in pregnant women. METHODS Electronic medical record review of pregnant COVID-19 patients treated with sotrovimab from 12/30/21 - 1/31/22 (Yale New Haven Health Hospital System [YNHHS]) was performed. Included were pregnant individuals ≥ 12 years, weighing ≥ 40 kg, with positive SARS-CoV-2 test (within 10 days). Those receiving care outside YNHHS or receiving other SARS-CoV-2 treatment were excluded. We assessed demographics, medical history, and Monoclonal Antibody Screening Score (MASS). The primary composite clinical outcome assessed included emergency department (ED) visit < 24 h, hospitalization, intensive care unit (ICU) admission, and/or death within 29 days of sotrovimab. Secondarily, adverse feto-maternal outcomes and events for neonates were assessed at birth or through the end of the study period, which was 8/15/22. RESULTS Among 22 subjects, median age was 32 years and body mass index was 27 kg/m2. 63% were Caucasian, 9% Hispanic, 14% African-American, and 9% Asian. 9% had diabetes and sickle cell disease. 5% had well-controlled HIV. 18%, 46%, and 36% received sotrovimab in trimester 1, 2, and 3, respectively. No infusion/allergic reactions occurred. MASS values were < 4. Only 12/22 (55%) received complete primary vaccination (46% mRNA-1273; 46% BNT162b2; 8% JNJ-78,436,735); none received a booster. CONCLUSIONS Pregnant COVID-19 patients receiving sotrovimab at our center tolerated it well with good clinical outcomes. Pregnancy and neonatal complications did not appear sotrovimab-related. Though a limited sample, our data helps elucidate the safety and tolerability of sotrovimab in pregnant women.
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Affiliation(s)
- Jessica J Tuan
- Yale University School of Medicine, 333 Cedar Street, PO Box 208022, New Haven, CT, 06510, USA.
- Yale Department of Medicine, Section of Infectious Diseases, Yale University School of Medicine, 333 Cedar Street, PO Box 208022, New Haven, CT, 06510, USA.
- Yale AIDS Program, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06510, USA.
| | - Manas Sharma
- Yale University School of Medicine, 333 Cedar Street, PO Box 208022, New Haven, CT, 06510, USA
| | - Jehanzeb Kayani
- Yale University School of Medicine, 333 Cedar Street, PO Box 208022, New Haven, CT, 06510, USA
| | - Matthew W Davis
- Yale University School of Medicine, 333 Cedar Street, PO Box 208022, New Haven, CT, 06510, USA
- Department of Pharmacy Services, Yale New Haven Hospital, 20 York Street, New Haven, CT, 06510, USA
| | - Dayna McManus
- Yale University School of Medicine, 333 Cedar Street, PO Box 208022, New Haven, CT, 06510, USA
- Department of Pharmacy Services, Yale New Haven Hospital, 20 York Street, New Haven, CT, 06510, USA
| | - Jeffrey E Topal
- Yale University School of Medicine, 333 Cedar Street, PO Box 208022, New Haven, CT, 06510, USA
- Department of Pharmacy Services, Yale New Haven Hospital, 20 York Street, New Haven, CT, 06510, USA
| | - Onyema Ogbuagu
- Yale University School of Medicine, 333 Cedar Street, PO Box 208022, New Haven, CT, 06510, USA
- Yale Department of Medicine, Section of Infectious Diseases, Yale University School of Medicine, 333 Cedar Street, PO Box 208022, New Haven, CT, 06510, USA
- Yale AIDS Program, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06510, USA
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18
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Mambelli E, Gasperoni L, Maldini L, Biagetti C, Rigotti A. Sotrovimab in SARS-COV-2 chronic hemodialysis patients in the Omicron era. Is intradialytic administration feasible? Report of 4 cases. J Nephrol 2023; 36:669-672. [PMID: 36098880 PMCID: PMC9469048 DOI: 10.1007/s40620-022-01449-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/21/2022] [Indexed: 11/04/2022]
Abstract
Chronic hemodialysis patients are at high risk of morbidity and mortality in case of SARS-CoV-2 infection and they may need to be treated with monoclonal antibodies, either because they have not been vaccinated, or because they have a low anti spike antibody titer. Administration of Sotrovimab has recently been proposed for hemodialysis patients, but data are on the results lacking. We report on four cases of chronic dialysis patients who received Sotrovimab during intermittent dialysis sessions. In our series, no adverse reactions were recorded; intradialytic administration resulted safe and allowed an adequate observation time without prolonging hospital stay in chronic hemodialysis outpatients.
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Affiliation(s)
- Emanuele Mambelli
- U.O. Nefrologia e Dialisi, Ospedale Infermi, AUSL Romagna, Rimini, Italy.
| | - Lorenzo Gasperoni
- U.O. Nefrologia e Dialisi, Ospedale Infermi, AUSL Romagna, Rimini, Italy
| | - Laura Maldini
- U.O. Nefrologia e Dialisi, Ospedale Infermi, AUSL Romagna, Rimini, Italy
| | - Carlo Biagetti
- U.O. Malattie Infettive, Ospedale Infermi, AUSL Romagna, Rimini, Italy
| | - Angelo Rigotti
- U.O. Nefrologia e Dialisi, Ospedale Infermi, AUSL Romagna, Rimini, Italy
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Pinargote-Celorio H, Otero-Rodríguez S, González-de-la-Aleja P, Rodríguez-Díaz JC, Climent E, Chico-Sánchez P, Riera G, Llorens P, Aparicio M, Montiel I, Boix V, Moreno-Pérez Ó, Ramos-Rincón JM, Merino E. Mild SARS-CoV-2 infection in vulnerable patients: implementation of a clinical pathway for early treatment. Enferm Infecc Microbiol Clin (Engl Ed) 2023:S2529-993X(23)00090-4. [PMID: 37003904 PMCID: PMC10063154 DOI: 10.1016/j.eimce.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/16/2022] [Accepted: 11/20/2022] [Indexed: 04/03/2023]
Abstract
INTRODUCTION The objective of this report is to describe the clinical pathway for early treatment of patients with acute SARS-CoV-2 infection and to evaluate the first results of its implementation. METHODS This is a descriptive and retrospective study of the implementation of a clinical pathway of treatment in outpatients (January 1 to June 30 2022). Clinical pathway: detection and referral systems from Primary Care, Emergency services, hospital specialities and an automated detection system; clinical evaluation and treatment administration in the COVID-19 day-hospital and subsequent clinical follow-up. Explanatory variables: demographics, comorbidity, vaccination status, referral pathways and treatment administration. OUTCOME VARIABLES hospitalization and death with 30 days, grade 2-3 toxicity related to treatment. RESULTS Treatment was administered to 262 patients (53,4% women, median age 60 years). The treatment indication criteria were immunosupression (68,3%), and the combination of age, vaccination status and comorbidity in the rest 47,3% of the patients s received remdesivir, 35,9% nirmatrelvir/ritonavir, 13,4% sotrovimab and 2,4% combined treatment with a median of 4 days after symptom onset. Hospital admission was required for 6,1% of the patients, 3,8% related to progression COVID-19. No patient died. Toxicity grade 2-3 toxicity was reported in 18,7%, 89,8% dysgeusia and metallic tasted related nirmatrelvir/ritonavir. Seven patients discontinued treatment due to toxicity. CONCLUSION The creation and implementation of a clinical pathway for non-hospitalized patients with SARS-CoV-2 infection is effective and it allows early accessibility and equity of currently available treatments.
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Affiliation(s)
- Héctor Pinargote-Celorio
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Silvia Otero-Rodríguez
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Pilar González-de-la-Aleja
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Juan-Carlos Rodríguez-Díaz
- Servicio de Microbiología, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain; Departamento de Producción Vegetal y Microbiología, Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Eduardo Climent
- Servicio de Farmacia, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain; Área de Farmacia y Tecnología Farmacéutica, Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Pablo Chico-Sánchez
- Servicio de Medicina Preventiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Gerónima Riera
- Servicio de Farmacia, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Pere Llorens
- Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General Universitario Dr. Balmis, Instituto Investigación Biomédica y Sanitaria de Alicante (ISABIAL), Alicante, Spain; Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Marta Aparicio
- Farmacia de Atención Primaria, Hospital General Universitario Dr. Balmis, Alicante. Spain
| | - Inés Montiel
- Dirección de Atención Primaria, Hospital General Universitario Dr. Balmis, Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL), Alicante, Spain
| | - Vicente Boix
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain; Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, Spain
| | - Óscar Moreno-Pérez
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, Spain; Sección de Endocrinología, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - José-Manuel Ramos-Rincón
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Alicante, Spain; Servicio de Medicina Interna, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Esperanza Merino
- Unidad de Enfermedades Infecciosas, Hospital General Universitario Dr. Balmis, Instituto Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
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20
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Akerman A, Milogiannakis V, Jean T, Esneau C, Silva MR, Ison T, Fichter C, Lopez JA, Chandra D, Naing Z, Caguicla J, Li D, Walker G, Amatayakul-Chantler S, Roth N, Manni S, Hauser T, Barnes T, Condylios A, Yeang M, Wong M, Foster CSP, Sato K, Lee S, Song Y, Mao L, Sigmund A, Phu A, Vande More AM, Hunt S, Douglas M, Caterson I, Britton W, Sandgren K, Bull R, Lloyd A, Triccas J, Tangye S, Bartlett NW, Darley D, Matthews G, Stark DJ, Petoumenos K, Rawlinson WD, Murrell B, Brilot F, Cunningham AL, Kelleher AD, Aggarwal A, Turville SG. Emergence and antibody evasion of BQ, BA.2.75 and SARS-CoV-2 recombinant sub-lineages in the face of maturing antibody breadth at the population level. EBioMedicine 2023; 90:104545. [PMID: 37002990 PMCID: PMC10060887 DOI: 10.1016/j.ebiom.2023.104545] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND The Omicron era of the COVID-19 pandemic commenced at the beginning of 2022 and whilst it started with primarily BA.1, it was latter dominated by BA.2 and the related sub-lineage BA.5. Following resolution of the global BA.5 wave, a diverse grouping of Omicron sub-lineages emerged derived from BA.2, BA.5 and recombinants thereof. Whilst emerging from distinct lineages, all shared similar changes in the Spike glycoprotein affording them an outgrowth advantage through evasion of neutralising antibodies. METHODS Over the course of 2022, we monitored the potency and breadth of antibody neutralization responses to many emerging variants in the Australian community at three levels: (i) we tracked over 420,000 U.S. plasma donors over time through various vaccine booster roll outs and Omicron waves using sequentially collected IgG pools; (ii) we mapped the antibody response in individuals using blood from stringently curated vaccine and convalescent cohorts. (iii) finally we determine the in vitro efficacy of clinically approved therapies Evusheld and Sotrovimab. FINDINGS In pooled IgG samples, we observed the maturation of neutralization breadth to Omicron variants over time through continuing vaccine and infection waves. Importantly, in many cases, we observed increased antibody breadth to variants that were yet to be in circulation. Determination of viral neutralization at the cohort level supported equivalent coverage across prior and emerging variants with isolates BQ.1.1, XBB.1, BR.2.1 and XBF the most evasive. Further, these emerging variants were resistant to Evusheld, whilst increasing neutralization resistance to Sotrovimab was restricted to BQ.1.1 and XBF. We conclude at this current point in time that dominant variants can evade antibodies at levels equivalent to their most evasive lineage counterparts but sustain an entry phenotype that continues to promote an additional outgrowth advantage. In Australia, BR.2.1 and XBF share this phenotype and, in contrast to global variants, are uniquely dominant in this region in the later months of 2022. INTERPRETATION Whilst the appearance of a diverse range of omicron lineages has led to primary or partial resistance to clinically approved monoclonal antibodies, the maturation of the antibody response across both cohorts and a large donor pools importantly observes increasing breadth in the antibody neutralisation responses over time with a trajectory that covers both current and known emerging variants. FUNDING This work was primarily supported by Australian Medical Foundation research grants MRF2005760 (SGT, GM & WDR), Medical Research Future Fund Antiviral Development Call grant (WDR), the New South Wales Health COVID-19 Research Grants Round 2 (SGT & FB) and the NSW Vaccine Infection and Immunology Collaborative (VIIM) (ALC). Variant modeling was supported by funding from SciLifeLab's Pandemic Laboratory Preparedness program to B.M. (VC-2022-0028) and by the European Union's Horizon 2020 research and innovation programme under grant agreement no. 101003653 (CoroNAb) to B.M.
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Affiliation(s)
- Anouschka Akerman
- The Kirby Institute, University of New South Wales, New South Wales, Australia
| | | | - Tyra Jean
- Serology and Virology Division (SAViD), NSW Health Pathology, Randwick, Australia
| | - Camille Esneau
- Hunter Medical Research Institute, University of Newcastle, Callaghan, Australia
| | - Mariana Ruiz Silva
- The Kirby Institute, University of New South Wales, New South Wales, Australia
| | - Timothy Ison
- The Kirby Institute, University of New South Wales, New South Wales, Australia
| | - Christina Fichter
- The Kirby Institute, University of New South Wales, New South Wales, Australia
| | - Joseph A Lopez
- Brain Autoimmunity Group, Kids Neuroscience Centre, The Children's Hospital at Westmead, Faculty of Medicine and Health, School of Medical Sciences, New South Wales, Australia
| | - Deborah Chandra
- The Kirby Institute, University of New South Wales, New South Wales, Australia
| | - Zin Naing
- Serology and Virology Division (SAViD), NSW Health Pathology, Randwick, Australia
| | - Joanna Caguicla
- Serology and Virology Division (SAViD), NSW Health Pathology, Randwick, Australia
| | - Daiyang Li
- Serology and Virology Division (SAViD), NSW Health Pathology, Randwick, Australia
| | - Gregory Walker
- Serology and Virology Division (SAViD), NSW Health Pathology, Randwick, Australia
| | | | - Nathan Roth
- Department of Bioanalytical Sciences, Plasma Product Development, Research & Development, CSL Behring AG, Bern, Switzerland
| | - Sandro Manni
- Plasma Product Development, Research & Development, CSL Behring AG, Bern, Switzerland
| | - Thomas Hauser
- Plasma Product Development, Research & Development, CSL Behring AG, Bern, Switzerland
| | - Thomas Barnes
- Plasma Product Development, Research & Development, CSL Behring AG, Bern, Switzerland
| | - Anna Condylios
- Serology and Virology Division (SAViD), NSW Health Pathology, Randwick, Australia
| | - Malinna Yeang
- Serology and Virology Division (SAViD), NSW Health Pathology, Randwick, Australia
| | - Maureen Wong
- Serology and Virology Division (SAViD), NSW Health Pathology, Randwick, Australia
| | - Charles S P Foster
- Serology and Virology Division (SAViD), NSW Health Pathology, Randwick, Australia
| | - Kenta Sato
- Molecular Diagnostic Medicine Laboratory, Sydpath, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Sharon Lee
- Research & Education Network, Westmead Hospital, WSLHD, New South Wales, Australia
| | - Yang Song
- Research & Education Network, Westmead Hospital, WSLHD, New South Wales, Australia
| | - Lijun Mao
- Research & Education Network, Westmead Hospital, WSLHD, New South Wales, Australia
| | - Allison Sigmund
- Research & Education Network, Westmead Hospital, WSLHD, New South Wales, Australia
| | - Amy Phu
- Research & Education Network, Westmead Hospital, WSLHD, New South Wales, Australia
| | | | - Stephanie Hunt
- Royal Prince Alfred Hospital, SLHD, New South Wales, Australia
| | - Mark Douglas
- The Westmead Institute for Medical Research, Westmead, New South Wales, Australia; Centre for Infectious Diseases and Microbiology, Sydney Institute for Infectious Diseases, The University of Sydney at Westmead Hospital, Westmead, NSW, Australia
| | - Ian Caterson
- Royal Prince Alfred Hospital, SLHD, New South Wales, Australia
| | - Warwick Britton
- The Centenary Institute, University of Sydney, Camperdown, New South Wales 2050, Australia
| | - Kerrie Sandgren
- The Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Rowena Bull
- The Kirby Institute, University of New South Wales, New South Wales, Australia
| | - Andrew Lloyd
- The Kirby Institute, University of New South Wales, New South Wales, Australia
| | - Jamie Triccas
- Sydney Institute for Infectious Diseases and the Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Stuart Tangye
- Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Nathan W Bartlett
- Hunter Medical Research Institute, University of Newcastle, Callaghan, Australia
| | - David Darley
- St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Gail Matthews
- The Kirby Institute, University of New South Wales, New South Wales, Australia; St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Damien J Stark
- Molecular Diagnostic Medicine Laboratory, Sydpath, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Kathy Petoumenos
- The Kirby Institute, University of New South Wales, New South Wales, Australia
| | - William D Rawlinson
- Serology and Virology Division (SAViD), NSW Health Pathology, Randwick, Australia
| | - Ben Murrell
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Fabienne Brilot
- Brain Autoimmunity Group, Kids Neuroscience Centre, The Children's Hospital at Westmead, Faculty of Medicine and Health, School of Medical Sciences, New South Wales, Australia
| | - Anthony L Cunningham
- The Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Anthony D Kelleher
- The Kirby Institute, University of New South Wales, New South Wales, Australia; St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Anupriya Aggarwal
- The Kirby Institute, University of New South Wales, New South Wales, Australia
| | - Stuart G Turville
- The Kirby Institute, University of New South Wales, New South Wales, Australia.
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21
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Humphrey TJL, Dosanjh D, Hiemstra TF, Richter A, Chen-Xu M, Qian W, Jha V, Gatley K, Adhikari R, Dowling F, Smith RM. PROphylaxis for paTiEnts at risk of COVID-19 infecTion (PROTECT-V). Trials 2023; 24:185. [PMID: 36915199 PMCID: PMC10009350 DOI: 10.1186/s13063-023-07128-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/30/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Despite the introduction of vaccination, there remains a need for pre-exposure prophylactic agents against SARS-CoV-2. Several patient groups are more vulnerable to SARS-CoV-2 infection by virtue of underlying health conditions, treatments received or suboptimal responses to vaccination. METHODS PROTECT-V is a platform trial testing pre-exposure prophylactic interventions against SARS-CoV-2 infection in vulnerable patient populations (organ transplant recipients; individuals with oncological/haematological diagnoses, immune deficiency or autoimmune diseases requiring immunosuppression or on dialysis). Multiple agents can be evaluated across multiple vulnerable populations sharing placebo groups, with the option of adding additional treatments at later time points as these become available. The primary endpoint is symptomatic SARS-CoV-2 infection, and each agent will be independently evaluated in real time when the required number of events occurs. Presently, three agents are approved in the platform: intranasal niclosamide, nasal and inhaled ciclesonide and intravenous sotrovimab. DISCUSSION Despite the introduction of vaccination, there remains a need for pre-exposure prophylactic agents against SARS-CoV-2. Several patient groups are more vulnerable to COVID-19 disease by virtue of underlying health conditions, treatments received or suboptimal responses to vaccination. TRIAL REGISTRATION ClinicalTrials.gov NCT04870333. EudraCT 2020-004144-28.
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Affiliation(s)
- Toby J L Humphrey
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- University of Cambridge, Cambridge, UK
| | - Davinder Dosanjh
- Birmingham and West Midlands Lung Research Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Alex Richter
- Birmingham and West Midlands Lung Research Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Michael Chen-Xu
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- University of Cambridge, Cambridge, UK
| | - Wendi Qian
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Vivekanand Jha
- George Institute for Global Health, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Katrina Gatley
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Rakshya Adhikari
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Francis Dowling
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Rona M Smith
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
- University of Cambridge, Cambridge, UK.
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22
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Andrés C, González-Sánchez A, Jiménez M, Márquez-Algaba E, Piñana M, Fernández-Naval C, Esperalba J, Saubi N, Quer J, Rando-Segura A, Miarons M, Codina MG, Ruiz-Camps I, Pumarola T, Abrisqueta P, Antón A. Emergence of Delta and Omicron variants carrying resistance-associated mutations in immunocompromised patients undergoing sotrovimab treatment with long-term viral excretion. Clin Microbiol Infect 2023; 29:240-246. [PMID: 36067943 DOI: 10.1016/j.cmi.2022.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/19/2022] [Accepted: 08/25/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To monitor the early emergence of genetic mutations related to reduced susceptibility to monoclonal anti-body (mAb)-based treatment in immunocompromised patients with long-term viral excretion using whole-genome sequencing at a tertiary university hospital in Barcelona, Spain. METHODS Serial severe acute respiratory syndrome coronavirus 2-positive samples (mid-December 2021-mid-March 2022) from eight immunosuppressed, fully vaccinated patients (for solid-organ transplantation or haematologic malignancies) with long-term viral excretion despite undergoing mAb therapy (sotrovimab) for coronavirus disease 2019 were selected. Whole-genome sequencing was performed following the ARTIC, version 4.1, protocol on the MiSeq platform. Mutations in the coding sequence of the spike protein with a frequency of ≥5% were studied. RESULTS A total of 37 samples from the studied cases were analysed. All the cases, except one, were confirmed to have the Omicron variant BA.1; one had Delta (AY.100). Thirty-four different mutations were detected within the receptor-binding domain of the spike protein in 62.5% of patients, eight of which were not lineage related and located in the sotrovimab target epitope (P337L, E340D, E340R, E340K, E340V, E340Q, R346T and K356T). Except for P337L, all changes showed a significant increase in frequency or fixation after the administration of sotrovimab. Some of them have been associated with either reduced susceptibility to mAb therapy, such as those at position 340, or the acquisition of a new glycosylation site (346 and 356 positions). CONCLUSIONS This study highlights the importance of monitoring for early in vivo selection of mutations associated with reduced susceptibility to mAb therapy, especially in immunocompromised patients receiving anti-viral drugs, whose immune response is not able to control viral replication, resulting in long-term viral shedding, and those receiving selective evolution pressure. Virologic surveillance of genetically resistant viruses to available anti-viral therapies is considered a priority for both patients and the community.
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Affiliation(s)
- Cristina Andrés
- Respiratory Viruses Unit, Virology Section, Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain; Centro de Instigación Biomédica en red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain
| | - Alejandra González-Sánchez
- Respiratory Viruses Unit, Virology Section, Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain; Centro de Instigación Biomédica en red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain
| | - Moraima Jiménez
- Department of Hematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Ester Márquez-Algaba
- Department of Infectious Diseases. Vall d'Hebron University Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Piñana
- Respiratory Viruses Unit, Virology Section, Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain; Centro de Instigación Biomédica en red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain
| | - Candela Fernández-Naval
- Centro de Instigación Biomédica en red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain; Department of Microbiology, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Passeig Vall d'Hebron, Barcelona, Spain
| | - Juliana Esperalba
- Centro de Instigación Biomédica en red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain; Department of Microbiology, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Passeig Vall d'Hebron, Barcelona, Spain
| | - Narcís Saubi
- Respiratory Viruses Unit, Virology Section, Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain; Centro de Instigación Biomédica en red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain
| | - Josep Quer
- Liver Diseases-Viral Hepatitis, Liver Unit, Vall d'Hebron Institut of Research, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Av. Monforte de Lemos, Madrid, Spain; Biochemistry and Molecular Biology Department, Universitat Autònoma de Barcelona (UAB), UAB Campus, Plaça Cívica, Bellaterra, Spain
| | - Ariadna Rando-Segura
- Centro de Instigación Biomédica en red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain; Department of Microbiology, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Passeig Vall d'Hebron, Barcelona, Spain
| | - Marta Miarons
- Pharmacy Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Maria Gema Codina
- Centro de Instigación Biomédica en red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain; Department of Microbiology, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Passeig Vall d'Hebron, Barcelona, Spain
| | - Isabel Ruiz-Camps
- Centro de Instigación Biomédica en red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain; Department of Infectious Diseases. Vall d'Hebron University Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tomàs Pumarola
- Centro de Instigación Biomédica en red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain; Department of Microbiology, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Passeig Vall d'Hebron, Barcelona, Spain.
| | - Pau Abrisqueta
- Department of Hematology, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain
| | - Andrés Antón
- Respiratory Viruses Unit, Virology Section, Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron, Barcelona, Spain; Centro de Instigación Biomédica en red de Enfermedades Infecciosas CIBERINFEC, Instituto Carlos III, Madrid, Spain
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Cheng MM, Reyes C, Satram S, Birch H, Gibbons DC, Drysdale M, Bell CF, Suyundikov A, Ding X, Maher MC, Yeh W, Telenti A, Corey L. Real-World Effectiveness of Sotrovimab for the Early Treatment of COVID-19 During SARS-CoV-2 Delta and Omicron Waves in the USA. Infect Dis Ther 2023; 12:607-621. [PMID: 36629998 PMCID: PMC9832411 DOI: 10.1007/s40121-022-00755-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Sotrovimab, a recombinant human monoclonal antibody (mAb) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had US Food and Drug Administration Emergency Use Authorization for the treatment of high-risk outpatients with mild-to-moderate coronavirus disease 2019 (COVID-19) from 26 May 2021 to 5 April 2022. Real-world clinical effectiveness of sotrovimab in reducing the risk of 30-day all-cause hospitalization and/or mortality was evaluated for the period when the prevalence of circulating SARS-CoV-2 variants changed between Delta and Omicron in the USA. METHODS A retrospective analysis was conducted of de-identified patients diagnosed with COVID-19 between 1 September 2021 to 30 April 2022 in the FAIR Health National Private Insurance Claims database. Patients meeting high-risk criteria were divided into two cohorts: sotrovimab and not treated with a mAb ("no mAb"). All-cause hospitalizations and facility-reported mortality ≤ 30 days of diagnosis ("30-day hospitalization or mortality") were identified. Multivariable and propensity score-matched Poisson and logistic regressions were conducted to estimate the adjusted relative risk (RR) and odds of 30-day hospitalization or mortality in each cohort. RESULTS Compared with the no mAb cohort (n = 1,514,868), the sotrovimab cohort (n = 15,633) was older and had a higher proportion of patients with high-risk conditions. In the no mAb cohort, 84,307 (5.57%) patients were hospitalized and 8167 (0.54%) deaths were identified, while in the sotrovimab cohort, 418 (2.67%) patients were hospitalized and 13 (0.08%) deaths were identified. After adjusting for potential confounders, the sotrovimab cohort had a 55% lower risk of 30-day hospitalization or mortality (RR 0.45, 95% CI 0.41-0.49) and an 85% lower risk of 30-day mortality (RR 0.15, 95% CI 0.08-0.29). Monthly, from September 2021 to April 2022, the RR reduction for 30-day hospitalization or mortality in the sotrovimab cohort was maintained, ranging from 46% to 71% compared with the no mAb cohort; the RR estimate in April 2022 was uncertain, with wide confidence intervals due to the small sample size. CONCLUSION Sotrovimab was associated with reduced risk of 30-day all-cause hospitalization and mortality versus no mAb treatment. Clinical effectiveness persisted during Delta and early Omicron variant waves and among all high-risk subgroups assessed.
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Affiliation(s)
- Mindy M Cheng
- Vir Biotechnology, 499 Illinois St., Suite 500, San Francisco, CA, 94158, USA.
| | | | - Sacha Satram
- Vir Biotechnology, San Francisco, CA, 94158, USA
| | | | | | | | | | | | - Xiao Ding
- Vir Biotechnology, San Francisco, CA, 94158, USA
| | | | - Wendy Yeh
- Vir Biotechnology, San Francisco, CA, 94158, USA
| | | | - Lawrence Corey
- Fred Hutchinson Cancer Research Center Vaccine and Infectious Diseases Division, Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
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Aweda TA, Cheng SH, Lenhard SC, Sepp A, Skedzielewski T, Hsu CY, Marshall S, Haag H, Kehler J, Jagdale P, Peter A, Schmid MA, Gehman A, Doan M, Mayer AP, Gorycki P, Fanget M, Colas C, Smith B, Maier CC, Alsaid H. In vivo biodistribution and pharmacokinetics of sotrovimab, a SARS-CoV-2 monoclonal antibody, in healthy cynomolgus monkeys. Eur J Nucl Med Mol Imaging 2023; 50:667-678. [PMID: 36305907 PMCID: PMC9614201 DOI: 10.1007/s00259-022-06012-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/16/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Sotrovimab (VIR-7831), a human IgG1κ monoclonal antibody (mAb), binds to a conserved epitope on the SARS-CoV-2 spike protein receptor binding domain (RBD). The Fc region of VIR-7831 contains an LS modification to promote neonatal Fc receptor (FcRn)-mediated recycling and extend its serum half-life. Here, we aimed to evaluate the impact of the LS modification on tissue biodistribution, by comparing VIR-7831 to its non-LS-modified equivalent, VIR-7831-WT, in cynomolgus monkeys. METHODS 89Zr-based PET/CT imaging of VIR-7831 and VIR-7831-WT was performed up to 14 days post injection. All major organs were analyzed for absolute concentration as well as tissue:blood ratios, with the focus on the respiratory tract, and a physiologically based pharmacokinetics (PBPK) model was used to evaluate the tissue biodistribution kinetics. Radiomics features were also extracted from the PET images and SUV values. RESULTS SUVmean uptake in the pulmonary bronchi for 89Zr-VIR-7831 was statistically higher than for 89Zr-VIR-7831-WT at days 6 (3.43 ± 0.55 and 2.59 ± 0.38, respectively) and 10 (2.66 ± 0.32 and 2.15 ± 0.18, respectively), while the reverse was observed in the liver at days 6 (5.14 ± 0.80 and 8.63 ± 0.89, respectively), 10 (4.52 ± 0.59 and 7.73 ± 0.66, respectively), and 14 (4.95 ± 0.65 and 7.94 ± 0.54, respectively). Though the calculated terminal half-life was 21.3 ± 3.0 days for VIR-7831 and 16.5 ± 1.1 days for VIR-7831-WT, no consistent differences were observed in the tissue:blood ratios between the antibodies except in the liver. While the lung:blood SUVmean uptake ratio for both mAbs was 0.25 on day 3, the PBPK model predicted the total lung tissue and the interstitial space to serum ratio to be 0.31 and 0.55, respectively. Radiomics analysis showed VIR-7831 had mean-centralized PET SUV distribution in the lung and liver, indicating more uniform uptake than VIR-7831-WT. CONCLUSION The half-life extended VIR-7831 remained in circulation longer than VIR-7831-WT, consistent with enhanced FcRn binding, while the tissue:blood concentration ratios in most tissues for both drugs remained statistically indistinguishable throughout the course of the experiment. In the bronchiolar region, a higher concentration of 89Zr-VIR-7831 was detected. The data also allow unparalleled insight into tissue distribution and elimination kinetics of mAbs that can guide future biologic drug discovery efforts, while the residualizing nature of the 89Zr label sheds light on the sites of antibody catabolism.
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Affiliation(s)
- Tolulope A Aweda
- Bioimaging, GSK, 1250 S. Collegeville Rd, Collegeville, PA, 19426, USA
| | - Shih-Hsun Cheng
- Bioimaging, GSK, 1250 S. Collegeville Rd, Collegeville, PA, 19426, USA
| | - Stephen C Lenhard
- Bioimaging, GSK, 1250 S. Collegeville Rd, Collegeville, PA, 19426, USA
| | | | | | - Chih-Yang Hsu
- Bioimaging, GSK, 1250 S. Collegeville Rd, Collegeville, PA, 19426, USA
| | - Shelly Marshall
- Integrated Biological Platform Sciences, GSK, Collegeville, PA, USA
| | - Heather Haag
- Integrated Biological Platform Sciences, GSK, Collegeville, PA, USA
| | - Jonathan Kehler
- Bioanalysis, Immunogenicity & Biomarkers, GSK, Collegeville, PA, USA
| | | | - Alessia Peter
- mAb Engineering & Bioanalytics, Humabs BioMed SA, Vir Biotechnology, Inc, Bellinzona, Switzerland
| | - Michael A Schmid
- mAb Engineering & Bioanalytics, Humabs BioMed SA, Vir Biotechnology, Inc, Bellinzona, Switzerland
| | - Andrew Gehman
- Non-Clinical and Translational Statistics, GSK, Collegeville, PA, USA
| | - Minh Doan
- Bioimaging, GSK, 1250 S. Collegeville Rd, Collegeville, PA, 19426, USA
| | - Andrew P Mayer
- Bioanalysis, Immunogenicity & Biomarkers, GSK, Collegeville, PA, USA
| | | | - Marie Fanget
- Bioanalytical Department, Vir Biotechnology, Inc, San Francisco, CA, USA
| | | | - Brenda Smith
- Toxicology, Vir Biotechnology, Inc, San Francisco, CA, USA
| | | | - Hasan Alsaid
- Bioimaging, GSK, 1250 S. Collegeville Rd, Collegeville, PA, 19426, USA.
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Nagasaka H, Takebe S, Yamamoto S, Kondo T, Terao H, Nakaigawa N, Kishida T. Use of Sotrovimab for COVID-19 in a Patient with International Germ Cell Consensus Classification Poor Prognosis Testicular Germ Cell Tumor. Case Rep Oncol 2023; 16:1028-1032. [PMID: 37900855 PMCID: PMC10601775 DOI: 10.1159/000533888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/11/2023] [Indexed: 10/31/2023] Open
Abstract
A 35-year-old man was diagnosed with stage IIIC non-seminoma with paralysis of the lower half of his body due to 8th thoracic spine metastasis. The patient received bleomycin, etoposide, and cisplatin (BEP) therapy. On day 4 of the second course of BEP, the patient developed a fever and was diagnosed with coronavirus disease (COVID-19). COVID-19 was suspected to worsen because of cancer and chemotherapy-induced immunosuppression. However, the benefits of continuing BEP therapy outweighed these risks. After obtaining fully informed consent, BEP therapy was continued from day 5, while sotrovimab (anti-COVID-19 drug) was administered. The second course of BEP was completed without worsening severe COVID-19 or bleomycin-induced lung injury. The patient completed four courses of BEP, with normalization of tumor markers, partial response on imaging, and improvement in lower body paralysis. In this case, we successfully treated a patient with testicular germ cell tumor with chemotherapy while having COVID-19 without treatment delay. During the COVID-19 pandemic, concomitant chemotherapy and COVID-19 treatment are warranted because delaying treatment will decrease the efficacy of highly curative diseases such as germ cell tumors.
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Affiliation(s)
| | - Shinichi Takebe
- Department of Urology, Kanagawa Cancer Center, Yokohama, Japan
| | | | - Takuya Kondo
- Department of Urology, Kanagawa Cancer Center, Yokohama, Japan
| | - Hideyuki Terao
- Department of Urology, Kanagawa Cancer Center, Yokohama, Japan
| | | | - Takeshi Kishida
- Department of Urology, Kanagawa Cancer Center, Yokohama, Japan
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Martin-Blondel G, Marcelin AG, Soulié C, Kaisaridi S, Lusivika-Nzinga C, Zafilaza K, Dorival C, Nailler L, Boston A, Ronchetti AM, Melenotte C, Cabié A, Choquet C, Trinh-Duc A, Lacombe K, Gaube G, Coustillères F, Pourcher V, Martellosio JP, Peiffer-Smadja N, Chauveau M, Housset P, Piroth L, Devaux M, Pialoux G, Martin A, Dubee V, Frey J, Le Bot A, Cazanave C, Petua P, Liblau R, Carrat F, Yordanov Y. Time to negative PCR conversion amongst high-risk patients with mild-to-moderate Omicron BA.1 and BA.2 COVID-19 treated with sotrovimab or nirmatrelvir. Clin Microbiol Infect 2022; 29:543.e5-543.e9. [PMID: 36586513 PMCID: PMC9794519 DOI: 10.1016/j.cmi.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Our aim was to compare the clinical and virological outcomes in Omicron BA.1- and BA.2-infected patients who received sotrovimab with those in patients who received nirmatrelvir for the prevention of severe COVID-19. METHODS In this multi-centric, prospective ANRS 0003S CoCoPrev cohort study, patients at a high risk of progression of mild-to-moderate BA.1 or BA.2 COVID-19 who received sotrovimab or nirmatrelvir were included. The proportion of patients with progression to severe COVID-19, time between the start of treatment to negative PCR conversion, SARS-CoV-2 viral decay, and characterization of resistance variants were determined. A multi-variable Cox proportional hazard model was used to determine the time to negative PCR conversion and a mixed-effect model for the dynamics of viral decay. RESULTS Amongst 255 included patients, 199 (80%) received ≥3 vaccine doses, 195 (76%) received sotrovimab, and 60 (24%) received nirmatrelvir. On day 28, new COVID-19-related hospitalization occurred in 4 of 193 (2%; 95% CI, 1-5%) sotrovimab-treated patients and 0 of 55 nirmatrelvir-treated patients (p 0.24). One out of the 55 nirmatrelvir-treated patients died (2%; 95% CI, 0-10%). The median time to negative PCR conversion was 11.5 days (95% CI, 10.5-13) in the sotrovimab-treated patients vs. 4 days (95% CI, 4-9) in the nirmatrelvir-treated patients (p < 0.001). Viral decay was faster in the patients who received nirmatrelvir (p < 0.001). In the multi-variable analysis, nirmatrelvir and nasopharyngeal PCR cycle threshold values were independently associated with faster conversion to negative PCR (hazard ratio, 2.35; 95% CI, 1.56-3.56; p < 0.0001 and hazard ratio, 1.05; 95% CI, 1.01-1.08; p 0.01, respectively). CONCLUSIONS Early administration of nirmatrelvir in high-risk patients compared with that of sotrovimab was associated with faster viral clearance. This may participate to decrease transmission and prevent viral resistance.
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Affiliation(s)
- Guillaume Martin-Blondel
- Service des Maladies Infectieuses et Tropicales, CHU de Toulouse, France,Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) INSERM, Université Toulouse III., Toulouse, France,Corresponding author. Pr Guillaume Martin-Blondel, Service des Maladies Infectieuses et Tropicales, CHU de Toulouse, Toulouse 31059, France
| | - Anne-Geneviève Marcelin
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière – Charles Foix, Laboratoire de Virologie, Paris, France
| | - Cathia Soulié
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière – Charles Foix, Laboratoire de Virologie, Paris, France
| | - Sofia Kaisaridi
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Clovis Lusivika-Nzinga
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Karen Zafilaza
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière – Charles Foix, Laboratoire de Virologie, Paris, France
| | - Céline Dorival
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Laura Nailler
- ANRS MIE (France Recherche Nord & Sud Sida-HIV Hépatites, Maladies Infectieuses Emergentes), Paris, France
| | - Anaïs Boston
- ANRS MIE (France Recherche Nord & Sud Sida-HIV Hépatites, Maladies Infectieuses Emergentes), Paris, France
| | - Anne-Marie Ronchetti
- Department of Clinical Hematology, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | - Cléa Melenotte
- Service de Maladies Infectieuses, Hôpital Necker Enfants malades, APHP, Paris, France
| | - André Cabié
- Université des Antilles INSERM PCCEI UMR 1058 Université de Montpellier EFS, CHU de Martinique and INSERM, Fort-de-France, Martinique, France
| | | | | | - Karine Lacombe
- Infectious Diseases Department, St Antoine Hospital, Sorbonne Université, INSERM IPLESP, Paris, France
| | - Géraldine Gaube
- Service des Maladies Infectieuses et Tropicales, CHU de Toulouse, France
| | | | - Valérie Pourcher
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Pitié Salpêtrière, Assistance Publique Hôpitaux de Paris, Université de Paris Sorbonne, Paris, France
| | - Jean-Philippe Martellosio
- Service de Médecine Interne, Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Nathan Peiffer-Smadja
- Infectious Disease Department, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marie Chauveau
- Department of Infectious Diseases, Hotel-Dieu Hospital, Nantes, France,INSERM, Nantes University Hospital, Nantes, France
| | - Pierre Housset
- Department of Nephrology, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | - Lionel Piroth
- INSERM, Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Centre, Dijon University Hospital, Dijon, France,Infectious Diseases Department, Dijon University Hospital, Dijon, France,Faculty of Medicine, University of Bourgogne-Franche-Comté, Dijon, France
| | - Mathilde Devaux
- CHI Poissy-Saint-Germain-en-Laye, Saint-Germain-en-Laye, France
| | - Gilles Pialoux
- Département de Maladies Infectieuses, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Université de Paris Sorbonne, Paris, France
| | - Aurélie Martin
- Department of Infectious and Tropical Diseases, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Vincent Dubee
- Department of Infectious Diseases, University Hospital of Angers, Angers, France
| | - Jérôme Frey
- Service des Urgences, Hôpital de Mercy - CHR Metz Thionville, France
| | - Audrey Le Bot
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Charles Cazanave
- CHU de Bordeaux, Infectious and Tropical Diseases Department, Bordeaux, France,University of Bordeaux, Microbiologie Fondamentale et Pathogénicité, Antimicrobial Resistance in Mycoplasmas and Gram-Negative Bacteria, Bordeaux, France
| | | | - Roland Liblau
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) INSERM, Université Toulouse III., Toulouse, France
| | - Fabrice Carrat
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France,Unité de Santé Publique, Hôpital Saint Antoine, Paris, France
| | - Youri Yordanov
- Sorbonne Université, Hôpital Saint Antoine, Service d'Accueil des Urgences, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
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Yoshida J, Shiraishi K, Tanaka M. Sotrovimab use in Japanese inpatients with COVID-19: post-infusion adverse events. BMC Infect Dis 2022; 22:902. [PMID: 36461006 PMCID: PMC9719203 DOI: 10.1186/s12879-022-07889-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Sotrovimab neutralizing SARS-CoV-2 remained effective at the advent of B.1 lineage of the Omicron variant in outpatients. Primarily for hospitalized patients, however, the Japanese government regulated to administer this antibody agent. As this regulation enabled close monitoring in inpatients to investigate post-infusion adverse events (AEs) and efficacy, we attempted a retrospective study while the Omicron BA.1 lineage was dominant regionally. METHODS Subjects were inpatients with COVID-19 who received infusion of sotrovimab in our institute. In line with previous clinical trials, we included patients at risk of COVID-19 worsening and SARS-CoV-2 vaccinees, who were hospitalized as directed by the government. For statistical analyses, we reviewed background factors of demographics, imaging, and laboratory findings for the outcome infusion-related reactions including post-infusion pyrexia over 38 degrees Celsius and/or pulse oximetry below 94%. RESULTS In a total of 139 patients, the follow-up period had a median of 200 days (range, 154-248 days). Among 119 patients (85.6%) fully vaccinated for SARS-CoV-2, 86 (61.9% of all) underwent 2 doses while 33 (23.7% of all) received 3 doses. For the outcome of pyrexia and/or dyspnea (N = 40, 28.8%), multivariate analysis showed that significant risk factors were pre-infusion lowered oximetry below 96.5% (Odds Ratio [OR] 0.344, 95% Confidence Interval [CI] 0.139-0.851, P = 0.021) and pre-infusion temperature more than 36.7 degrees Celsius (OR 4.056, 95% CI 1.696-9.701, P = 0.002). Infusion-related reactions included vomiting immediately after infusion, chill/shivering, dizziness, rash, pruritus, pyrexia, and dyspnea. The number of patients with any of these events was 44 (31.6%). Three patients (2.2%) showed worsening of COVID-19; one developed hypoxia and two died. Limitations for this study included no genome typing whether BA.1 or BA.2 lineage of the Omicron variant but the local epidemiology indicated the prevalence of BA.1. Another was sotrovimab administration for inpatients that allow precise detection of post-infusion events, confounding previous exacerbation definition including hospitalization. CONCLUSIONS For 24 h after infusion of sotrovimab, COVID-19 patients showing pre-infusion lowered oximetry below 96.5% and/or temperature more than 36.7 degrees Celsius may have temperature elevation or dyspnea, warranting close monitoring for these risk factors.
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Affiliation(s)
- Junichi Yoshida
- grid.415753.10000 0004 1775 0588Infection Control Committee, Shimonoseki City Hospital, 1-13-1 Koyo-Cho, Shimonoseki, 750-8520 Japan
| | - Kenichiro Shiraishi
- grid.177174.30000 0001 2242 4849Department of Medicine and Biosystemic Science, Kyushu University Faculty of Medicine, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582 Japan
| | - Masao Tanaka
- grid.415753.10000 0004 1775 0588Infection Control Committee, Shimonoseki City Hospital, 1-13-1 Koyo-Cho, Shimonoseki, 750-8520 Japan
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Almagro JC, Mellado-Sánchez G, Pedraza-Escalona M, Pérez-Tapia SM. Evolution of Anti-SARS-CoV-2 Therapeutic Antibodies. Int J Mol Sci 2022; 23:ijms23179763. [PMID: 36077159 PMCID: PMC9456190 DOI: 10.3390/ijms23179763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/20/2022] [Accepted: 08/25/2022] [Indexed: 01/17/2023] Open
Abstract
Since the first COVID-19 reports back in December of 2019, this viral infection caused by SARS-CoV-2 has claimed millions of lives. To control the COVID-19 pandemic, the Food and Drug Administration (FDA) and/or European Agency of Medicines (EMA) have granted Emergency Use Authorization (EUA) to nine therapeutic antibodies. Nonetheless, the natural evolution of SARS-CoV-2 has generated numerous variants of concern (VOCs) that have challenged the efficacy of the EUA antibodies. Here, we review the most relevant characteristics of these therapeutic antibodies, including timeline of approval, neutralization profile against the VOCs, selection methods of their variable regions, somatic mutations, HCDR3 and LCDR3 features, isotype, Fc modifications used in the therapeutic format, and epitope recognized on the receptor-binding domain (RBD) of SARS-CoV-2. One of the conclusions of the review is that the EUA therapeutic antibodies that still retain efficacy against new VOCs bind an epitope formed by conserved residues that seem to be evolutionarily conserved as thus, critical for the RBD:hACE-2 interaction. The information reviewed here should help to design new and more efficacious antibodies to prevent and/or treat COVID-19, as well as other infectious diseases.
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Affiliation(s)
- Juan C. Almagro
- GlobalBio, Inc., 320 Concord Ave, Cambridge, MA 02138, USA
- Unidad de Desarrollo e Investigación en Bioterapéuticos (UDIBI), Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Prolongación de Carpio y Plan de Ayala S/N, Colonia Santo Tomás, Alcaldía Miguel Hidalgo, Mexico City 11340, Mexico
- Laboratorio Nacional para Servicios Especializados de Investigación, Desarrollo e Innovación (I+D+i) para Farmoquímicos y Biotecnológicos, LANSEIDI-FarBiotec-CONACyT, Prolongación de Carpio y Plan de Ayala S/N, Colonia Santo Tomás, Alcaldía Miguel Hidalgo, Mexico City 11340, Mexico
- Correspondence: (J.C.A.); (S.M.P.-T.)
| | - Gabriela Mellado-Sánchez
- Unidad de Desarrollo e Investigación en Bioterapéuticos (UDIBI), Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Prolongación de Carpio y Plan de Ayala S/N, Colonia Santo Tomás, Alcaldía Miguel Hidalgo, Mexico City 11340, Mexico
- Laboratorio Nacional para Servicios Especializados de Investigación, Desarrollo e Innovación (I+D+i) para Farmoquímicos y Biotecnológicos, LANSEIDI-FarBiotec-CONACyT, Prolongación de Carpio y Plan de Ayala S/N, Colonia Santo Tomás, Alcaldía Miguel Hidalgo, Mexico City 11340, Mexico
| | - Martha Pedraza-Escalona
- CONACyT-Unidad de Desarrollo e Investigación en Bioterapéuticos (UDIBI), Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Prolongación de Carpio y Plan de Ayala S/N, Colonia Santo Tomás, Alcaldía Miguel Hidalgo, Mexico City 11340, Mexico
| | - Sonia M. Pérez-Tapia
- Unidad de Desarrollo e Investigación en Bioterapéuticos (UDIBI), Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Prolongación de Carpio y Plan de Ayala S/N, Colonia Santo Tomás, Alcaldía Miguel Hidalgo, Mexico City 11340, Mexico
- Laboratorio Nacional para Servicios Especializados de Investigación, Desarrollo e Innovación (I+D+i) para Farmoquímicos y Biotecnológicos, LANSEIDI-FarBiotec-CONACyT, Prolongación de Carpio y Plan de Ayala S/N, Colonia Santo Tomás, Alcaldía Miguel Hidalgo, Mexico City 11340, Mexico
- Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Prolongación de Carpio y Plan de Ayala S/N, Colonia Santo Tomás, Alcaldía Miguel Hidalgo, Mexico City 11340, Mexico
- Correspondence: (J.C.A.); (S.M.P.-T.)
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Marcacci G, Coppola N, Madonna E, Becchimanzi C, De Pascalis S, D'Ovidio S, Crisci S, Maiolino P, De Filippi R, Pinto A. Post-exposure prophylaxis with sotrovimab for Omicron (B.1.1.529) SARS-CoV-2 variant during the aplastic phase of autologous stem cell transplantation. Infect Agent Cancer 2022; 17:41. [PMID: 35922822 PMCID: PMC9351203 DOI: 10.1186/s13027-022-00454-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/22/2022] [Indexed: 11/24/2022] Open
Abstract
Background To date, there is no information on the safety and efficacy of the novel anti-sarbecoviruses monoclonal antibody sotrovimab administered, as a post-exposure prophylactic measure, during the aplastic phase of autologous stem cell transplantation (ASCT). Methods We describe the outcomes of a Multiple Myeloma (MM) patient, who was threateningly exposed to the Omicron (B.1.1.529) SARS-CoV-2 variant, two days after having received a myeloablative regimen of high-dose melphalan. The patient fulfilled all CDC criteria for prolonged close contacts with an index patient who tested positive for a molecular nasopharyngeal swab (Omicron; B.1.1.529) soon after admission to the ward. Given the high risks of morbidity and mortality in the case of COVID-19 developing during the aplastic phase of transplantation, we adopted a post-exposure prophylaxis intervention based on intravenous (i.v.) sotrovimab. Results Sotrovimab (500 mg i.v.) was administered at day + 2 from stem cells reinfusion, i.e. 4 days after myeloablative chemotherapy, and at day + 5 from the last close contact with the Omicron-positive index case. The patient was fully protected from SARS-CoV-2 infection throughout his clinical course and remained molecularly negative at the day + 30 from the transplant. We compared times to engraftment and transplant-related toxicities of the sotrovimab-treated patient with the last 15 MM patients transplanted at our Centre, evidencing no unexpected safety signals, infusion-related reactions, or alarming effects on engraftment kinetics. Conclusions We have shown here for the first time that administration of sotrovimab during the pre-engraftment phase of ASCT is effective, safe, and not associated with delays in hemopoietic recovery. As compared to MM patients who received the same myeloablative conditioning regimen, the patient given sotrovimab during the aplastic phase did not show any significant differences in engraftment kinetics and toxicity outcomes. Post-exposure prophylaxis with sotrovimab may represent a valuable approach in the stem cell transplantation setting for patients with high-risk exposure to a confirmed COVID-19 case sustained by highly infectious SARS-CoV-2 variants escaping the vaccine-derived immunity due to antigenic shifts in the spike proteins.
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Affiliation(s)
- Gianpaolo Marcacci
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Via Mariano Semmola 49, 80131, Naples, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Emanuela Madonna
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Via Mariano Semmola 49, 80131, Naples, Italy
| | - Cristina Becchimanzi
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Via Mariano Semmola 49, 80131, Naples, Italy
| | - Stefania De Pascalis
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Silvia D'Ovidio
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Via Mariano Semmola 49, 80131, Naples, Italy
| | - Stefania Crisci
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Via Mariano Semmola 49, 80131, Naples, Italy
| | - Piera Maiolino
- Pharmacy Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Naples, Italy
| | - Rosaria De Filippi
- Department of Clinical Medicine and Surgery, Università Degli Studi Federico II, Naples, Italy
| | - Antonio Pinto
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione 'G. Pascale', IRCCS, Via Mariano Semmola 49, 80131, Naples, Italy.
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Wilhelm A, Widera M, Grikscheit K, Toptan T, Schenk B, Pallas C, Metzler M, Kohmer N, Hoehl S, Marschalek R, Herrmann E, Helfritz FA, Wolf T, Goetsch U, Ciesek S. Limited neutralisation of the SARS-CoV-2 Omicron subvariants BA.1 and BA.2 by convalescent and vaccine serum and monoclonal antibodies. EBioMedicine 2022; 82:104158. [PMID: 35834885 DOI: 10.1101/2021.12.07.21267432] [Citation(s) in RCA: 157] [Impact Index Per Article: 78.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND In recent months, Omicron variants of SARS-CoV-2 have become dominant in many regions of the world, and case numbers with Omicron subvariants BA.1 and BA.2 continue to increase. Due to numerous mutations in the spike protein, the efficacy of currently available vaccines, which are based on Wuhan-Hu 1 isolate of SARS-CoV-2, is reduced, leading to breakthrough infections. Efficacy of monoclonal antibody therapy is also likely impaired. METHODS In our in vitro study using A549-AT cells constitutively expressing ACE2 and TMPRSS2, we determined and compared the neutralizing capacity of vaccine-elicited sera, convalescent sera and monoclonal antibodies against authentic SARS-CoV-2 Omicron BA.1 and BA.2 compared with Delta. FINDINGS Almost no neutralisation of Omicron BA.1 and BA.2 was observed using sera from individuals vaccinated with two doses 6 months earlier, regardless of the type of vaccine taken. Shortly after the booster dose, most sera from triple BNT162b2-vaccinated individuals were able to neutralise both Omicron variants. In line with waning antibody levels three months after the booster, only weak residual neutralisation was observed for BA.1 (26%, n = 34, 0 median NT50) and BA.2 (44%, n = 34, 0 median NT50). In addition, BA.1 but not BA.2 was resistant to the neutralising monoclonal antibodies casirivimab/imdevimab, while BA.2 exhibited almost a complete evasion from the neutralisation induced by sotrovimab. INTERPRETATION Both SARS-CoV-2 Omicron subvariants BA.1 and BA.2 escape antibody-mediated neutralisation elicited by vaccination, previous infection with SARS-CoV-2, and monoclonal antibodies. Waning immunity renders the majority of tested sera obtained three months after booster vaccination negative in BA.1 and BA.2 neutralisation. Omicron subvariant specific resistance to the monoclonal antibodies casirivimab/imdevimab and sotrovimab emphasizes the importance of genotype-surveillance and guided application. FUNDING This study was supported in part by the Goethe-Corona-Fund of the Goethe University Frankfurt (M.W.) and the Federal Ministry of Education and Research (COVIDready; grant 02WRS1621C (M.W.).
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Affiliation(s)
- Alexander Wilhelm
- Institute for Medical Virology, University Hospital Frankfurt, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany
| | - Marek Widera
- Institute for Medical Virology, University Hospital Frankfurt, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany.
| | - Katharina Grikscheit
- Institute for Medical Virology, University Hospital Frankfurt, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany
| | - Tuna Toptan
- Institute for Medical Virology, University Hospital Frankfurt, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany
| | - Barbara Schenk
- Institute for Medical Virology, University Hospital Frankfurt, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany
| | - Christiane Pallas
- Institute for Medical Virology, University Hospital Frankfurt, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany
| | - Melinda Metzler
- Institute for Medical Virology, University Hospital Frankfurt, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany
| | - Niko Kohmer
- Institute for Medical Virology, University Hospital Frankfurt, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany
| | - Sebastian Hoehl
- Institute for Medical Virology, University Hospital Frankfurt, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany
| | - Rolf Marschalek
- Institute of Pharmaceutical Biology, Goethe University, Frankfurt am Main, Germany
| | - Eva Herrmann
- Institute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt, 60596 Frankfurt, Germany
| | - Fabian A Helfritz
- Bürgerhospital Frankfurt, Nibelungenallee 37-41, 60318 Frankfurt am Main, Germany
| | - Timo Wolf
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany
| | - Udo Goetsch
- Health Protection Authority of the City of Frankfurt am Main, 60313 Frankfurt am Main, Germany
| | - Sandra Ciesek
- Institute for Medical Virology, University Hospital Frankfurt, Goethe University Frankfurt, 60596 Frankfurt am Main, Germany; German Centre for Infection Research (DZIF), partner site Frankfurt, Germany; Fraunhofer Institute for Molecular Biology and Applied Ecology, Branch Translational Medicine and Pharmacology, 60596 Frankfurt am Main, Germany.
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Wilhelm A, Widera M, Grikscheit K, Toptan T, Schenk B, Pallas C, Metzler M, Kohmer N, Hoehl S, Marschalek R, Herrmann E, Helfritz FA, Wolf T, Goetsch U, Ciesek S. Limited neutralisation of the SARS-CoV-2 Omicron subvariants BA.1 and BA.2 by convalescent and vaccine serum and monoclonal antibodies. EBioMedicine 2022; 82:104158. [PMID: 35834885 DOI: 10.1016/j.ebiom.2022.104158] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/23/2022] [Accepted: 06/28/2022] [Indexed: 12/22/2022] Open
Abstract
Background In recent months, Omicron variants of SARS-CoV-2 have become dominant in many regions of the world, and case numbers with Omicron subvariants BA.1 and BA.2 continue to increase. Due to numerous mutations in the spike protein, the efficacy of currently available vaccines, which are based on Wuhan-Hu 1 isolate of SARS-CoV-2, is reduced, leading to breakthrough infections. Efficacy of monoclonal antibody therapy is also likely impaired. Methods In our in vitro study using A549-AT cells constitutively expressing ACE2 and TMPRSS2, we determined and compared the neutralizing capacity of vaccine-elicited sera, convalescent sera and monoclonal antibodies against authentic SARS-CoV-2 Omicron BA.1 and BA.2 compared with Delta. Findings Almost no neutralisation of Omicron BA.1 and BA.2 was observed using sera from individuals vaccinated with two doses 6 months earlier, regardless of the type of vaccine taken. Shortly after the booster dose, most sera from triple BNT162b2-vaccinated individuals were able to neutralise both Omicron variants. In line with waning antibody levels three months after the booster, only weak residual neutralisation was observed for BA.1 (26%, n = 34, 0 median NT50) and BA.2 (44%, n = 34, 0 median NT50). In addition, BA.1 but not BA.2 was resistant to the neutralising monoclonal antibodies casirivimab/imdevimab, while BA.2 exhibited almost a complete evasion from the neutralisation induced by sotrovimab. Interpretation Both SARS-CoV-2 Omicron subvariants BA.1 and BA.2 escape antibody-mediated neutralisation elicited by vaccination, previous infection with SARS-CoV-2, and monoclonal antibodies. Waning immunity renders the majority of tested sera obtained three months after booster vaccination negative in BA.1 and BA.2 neutralisation. Omicron subvariant specific resistance to the monoclonal antibodies casirivimab/imdevimab and sotrovimab emphasizes the importance of genotype-surveillance and guided application. Funding This study was supported in part by the Goethe-Corona-Fund of the Goethe University Frankfurt (M.W.) and the Federal Ministry of Education and Research (COVIDready; grant 02WRS1621C (M.W.).
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Martin-Blondel G, Marcelin AG, Soulié C, Kaisaridi S, Lusivika-Nzinga C, Dorival C, Nailler L, Boston A, Melenotte C, Cabié A, Choquet C, Coustillères F, Martellosio JP, Gaube G, Trinh-Duc A, Ronchetti AM, Pourcher V, Chauveau M, Lacombe K, Peiffer-Smadja N, Housset P, Perrot A, Pialoux G, Martin A, Dubee V, Devaux M, Frey J, Cazanave C, Liblau R, Carrat F, Yordanov Y. Sotrovimab to prevent severe COVID-19 in high-risk patients infected with Omicron BA.2. J Infect 2022; 85:e104-e108. [PMID: 35803386 PMCID: PMC9254651 DOI: 10.1016/j.jinf.2022.06.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Guillaume Martin-Blondel
- Service des Maladies Infectieuses et Tropicales, CHU de Toulouse, France; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III., France.
| | - Anne-Genevieve Marcelin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, laboratoire de virologie, Paris, France
| | - Cathia Soulié
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, laboratoire de virologie, Paris, France
| | - Sofia Kaisaridi
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), 75012 Paris, France
| | - Clovis Lusivika-Nzinga
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), 75012 Paris, France
| | - Céline Dorival
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), 75012 Paris, France
| | - Laura Nailler
- ANRS MIE (France Recherche Nord & Sud Sida-HIV Hépatites, Maladies Infectieuses Emergentes), Paris, France
| | - Anaïs Boston
- ANRS MIE (France Recherche Nord & Sud Sida-HIV Hépatites, Maladies Infectieuses Emergentes), Paris, France
| | - Cléa Melenotte
- Service de maladies infectieuses, Hôpital Necker Enfants malades, APHP, Paris, France
| | - André Cabié
- Université des Antilles INSERM PCCEI UMR 1058 Université de Montpellier EFS, CHU de Martinique and INSERM CIC 1424, Fort-de-France, Martinique, France
| | | | | | - Jean-Philippe Martellosio
- Service de Médecine interne, maladies infectieuses et tropicales, Centre hospitalier universitaire de Poitiers, Poitiers, France
| | - Géraldine Gaube
- Service des Maladies Infectieuses et Tropicales, CHU de Toulouse, France
| | | | - Anne-Marie Ronchetti
- Department of Clinical Hematology, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | - Valerie Pourcher
- Service des Maladies Infectieuses et tropicales, Hôpital de la Pitié Salpêtrière, Assistance Publique Hôpitaux de Paris, Université de Paris Sorbonne, Paris France
| | - Marie Chauveau
- Department of Infectious Diseases, Hotel-Dieu Hospital and INSERM CIC 1413, Nantes University Hospital, Nantes, France
| | - Karine Lacombe
- Sorbonne Université, Inserm IPLESP UMR-S1136, Infectious Diseases department, St Antoine Hospital, APHP, Paris, France
| | - Nathan Peiffer-Smadja
- Infectious Disease Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, F-75018 Paris, France
| | - Pierre Housset
- Department of Nephrology, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | - Aurore Perrot
- CHU de Toulouse, IUCT-O, Université de Toulouse, UPS, Service d'Hématologie, Toulouse, France
| | - Gilles Pialoux
- Département de Maladies Infectieuses, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Université de Paris Sorbonne, Paris France
| | - Aurélie Martin
- Department of infectious and Tropical Diseases, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Vincent Dubee
- Department of infectious diseases, University Hospital of Angers, Angers, France
| | - Mathilde Devaux
- CHI Poissy-Saint-Germain-en-Laye, Saint-Germain-en-Laye, France
| | - Jérôme Frey
- Service des Urgences - SAMU 57 - SMUR, Hôpital de Mercy - CHR Metz Thionville, France
| | - Charles Cazanave
- CHU de Bordeaux, Infectious and Tropical Diseases Department, Bordeaux, France - University of Bordeaux, UMR 5234 CNRS, Microbiologie Fondamentale et Pathogénicité, Antimicrobial Resistance in Mycoplasmas and Gram-Negative Bacteria, Bordeaux, France
| | - Roland Liblau
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) INSERM UMR1291 - CNRS UMR5051 - Université Toulouse III., France
| | - Fabrice Carrat
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), 75012 Paris, France; Unité de Santé Publique, AP-HP, Hôpital Saint-Antoine, 75012 Paris, France
| | - Youri Yordanov
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, Service d'Accueil des Urgences, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, Paris, France
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Vellas C, Tremeaux P, Del Bello A, Latour J, Jeanne N, Ranger N, Danet C, Martin-Blondel G, Delobel P, Kamar N, Izopet J. Resistance mutations in SARS-CoV-2 omicron variant in patients treated with Sotrovimab. Clin Microbiol Infect 2022:S1198-743X(22)00258-0. [PMID: 35595125 DOI: 10.1016/j.cmi.2022.05.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 04/28/2022] [Accepted: 05/03/2022] [Indexed: 11/22/2022]
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García-Lledó A, Gómez-Pavón J, González Del Castillo J, Hernández-Sampelayo T, Martín-Delgado MC, Martín Sánchez FJ, Martínez-Sellés M, Molero García JM, Moreno Guillén S, Rodríguez-Artalejo FJ, Ruiz-Galiana J, Cantón R, De Lucas Ramos P, García-Botella A, Bouza E. Pharmacological treatment of COVID-19: an opinion paper. Rev Esp Quimioter 2022; 35:115-130. [PMID: 34894208 PMCID: PMC8972693 DOI: 10.37201/req/158.2021] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas del Hospital General Universitario Gregorio Marañón, Universidad Complutense. CIBERES. Ciber de Enfermedades Respiratorias. Madrid, Spain.
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Singh AK, Singh A, Singh R, Misra A. An updated practical guideline on use of molnupiravir and comparison with agents having emergency use authorization for treatment of COVID-19. Diabetes Metab Syndr 2022; 16:102396. [PMID: 35051686 PMCID: PMC8755553 DOI: 10.1016/j.dsx.2022.102396] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 01/11/2022] [Accepted: 01/11/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Molnupiravir is a newer oral antiviral drug that has recently received emergency use authorization (EUA) in USA, UK and India. We aim to conduct an update on our previous systematic review to provide practical clinical guideline for using molnupiravir in patients with COVID-19. METHODS We systematically searched the electronic database of PubMed, MedRxiv and Google Scholar until January 5, 2022, using key MeSH keywords. RESULTS Final result of phase 3 study in 1433 non-hospitalized COVID-19 patients showed a significant reduction in composite risk of hospital admission or death (absolute risk difference, -3.0% [95% confidence interval {CI}, -5.9 to -0.1%]; 1-sided P = 0.02) although with a non-significant 31% relative risk reduction (RRR). RRR for death alone was 89% (95% CI, 14 to 99; P-value not reported). Number needed to treat to prevent 1 death or 1 hospitalization or death composite appears to be closely competitive to other agents having EUA in people with COVID-19. However, cost-wise molnupiravir is comparatively cheaper compared to all other agents. CONCLUSION Molnupiravir could be a useful agent in non-pregnant unvaccinated adults with COVID-19 who are at increased risk of severity including hospitalization. However, it is effective only when used within 5-days of onset of symptoms. A 5-days course seems to be safe without any obvious short-term side effects.
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Affiliation(s)
| | - Akriti Singh
- Jawaharlal Nehru Medical College & Hospital, Kalyani, West Bengal, India
| | - Ritu Singh
- G. D Hospital & Diabetes Institute, Kolkata, West Bengal, India
| | - Anoop Misra
- Fortis C-DOC Hospital for Diabetes & Allied Sciences, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India; Diabetes Foundation (India), New Delhi, India
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Drożdżal S, Rosik J, Lechowicz K, Machaj F, Szostak B, Przybyciński J, Lorzadeh S, Kotfis K, Ghavami S, Łos MJ. An update on drugs with therapeutic potential for SARS-CoV-2 (COVID-19) treatment. Drug Resist Updat 2021; 59:100794. [PMID: 34991982 PMCID: PMC8654464 DOI: 10.1016/j.drup.2021.100794] [Citation(s) in RCA: 149] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic is one of the greatest threats to human health in the 21st century with more than 257 million cases and over 5.17 million deaths reported worldwide (as of November 23, 2021. Various agents were initially proclaimed to be effective against SARS-CoV-2, the etiological agent of COVID-19. Hydroxychloroquine, lopinavir/ritonavir, and ribavirin are all examples of therapeutic agents, whose efficacy against COVID-19 was later disproved. Meanwhile, concentrated efforts of researchers and clinicians worldwide have led to the identification of novel therapeutic options to control the disease including PAXLOVID™ (PF-07321332). Although COVID-19 cases are currently treated using a comprehensive approach of anticoagulants, oxygen, and antibiotics, the novel Pfizer agent PAXLOVID™ (PF-07321332), an investigational COVID-19 oral antiviral candidate, significantly reduced hospitalization time and death rates, based on an interim analysis of the phase 2/3 EPIC-HR (Evaluation of Protease Inhibition for COVID-19 in High-Risk Patients) randomized, double-blind study of non-hospitalized adult patients with COVID-19, who are at high risk of progressing to severe illness. The scheduled interim analysis demonstrated an 89 % reduction in risk of COVID-19-related hospitalization or death from any cause compared to placebo in patients treated within three days of symptom onset (primary endpoint). However, there still exists a great need for the development of additional treatments, as the recommended therapeutic options are insufficient in many cases. Thus far, mRNA and vector vaccines appear to be the most effective modalities to control the pandemic. In the current review, we provide an update on the progress that has been made since April 2020 in clinical trials concerning the effectiveness of therapies available to combat COVID-19. We focus on currently recommended therapeutic agents, including steroids, various monoclonal antibodies, remdesivir, baricitinib, anticoagulants and PAXLOVID™ summarizing the latest original studies and meta-analyses. Moreover, we aim to discuss other currently and previously studied agents targeting COVID-19 that either show no or only limited therapeutic activity. The results of recent studies report that hydroxychloroquine and convalescent plasma demonstrate no efficacy against SARS-CoV-2 infection. Lastly, we summarize the studies on various drugs with incoherent or insufficient data concerning their effectiveness, such as amantadine, ivermectin, or niclosamide.
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Affiliation(s)
- Sylwester Drożdżal
- Department of Nephrology, Transplantation and Internal Medicine, Pomeranian Medical University in Szczecin, Poland
| | - Jakub Rosik
- Department of Physiology, Pomeranian Medical University in Szczecin, Poland
| | - Kacper Lechowicz
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland
| | - Filip Machaj
- Department of Physiology, Pomeranian Medical University in Szczecin, Poland
| | - Bartosz Szostak
- Department of Physiology, Pomeranian Medical University in Szczecin, Poland
| | - Jarosław Przybyciński
- Department of Nephrology, Transplantation and Internal Medicine, Pomeranian Medical University in Szczecin, Poland
| | - Shahrokh Lorzadeh
- Department of Molecular Genetics, Science and Research Branch, Marvdasht Branch, Islamic Azad University, Marvdasht, Iran
| | - Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland
| | - Saeid Ghavami
- Department of Human Anatomy and Cell Science, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Research Institutes of Oncology and Hematology, Cancer Care Manitoba-University of Manitoba, Winnipeg, MB R3E 0V9, Canada; Biology of Breathing Theme, Children Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB R3E 0V9, Canada; Autophagy Research Center, Shiraz University of Medical Sciences, Shiraz 7134845794, Iran; Faculty of Medicine, Katowice School of Technology, 40-555 Katowice, Poland
| | - Marek J Łos
- Biotechnology Centre, Silesian University of Technology, 44-100 Gliwice, Poland.
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