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Siripongboonsitti T, Tawinprai K, Porntharukcharoen T, Sirisreetreerux S, Thongchai T, Soonklang K, Mahanonda N. Unveiling therapeutic dynamics: An in-depth comparative analysis of neutralizing monoclonal antibodies and favipiravir in alleviating COVID-19 outpatients impacts among middle-aged and special populations (MA-FAST). J Infect Public Health 2024; 17:102471. [PMID: 38865775 DOI: 10.1016/j.jiph.2024.102471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/31/2024] [Accepted: 06/02/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Neutralizing monoclonal antibodies (NMabs) are recognized for their efficacy against non-severe COVID-19. However, spike protein mutations may confer resistance. This study evaluates the effectiveness of favipiravir (FPV) versus NMabs in preventing severe COVID-19 in special populations. METHODS A retrospective cohort was conducted on middle-aged, elderly, diabetic, or obese patients with COVID-19 treated with either FPV or NMabs. Propensity score matching (PSM) was used for analysis. RESULTS The study included 1410 patients, resulting in four cohorts: middle-aged (36), elderly (48), diabetic (46), and obese (28) post-PSM. No significant differences were noted in 28-day emergency department (ED) visits across all groups between NMabs and FPV treatments, despite lower immunity in the FPV group. However, the diabetic group treated with FPV had higher 28-day hospitalization and oxygen supplemental, with no differences in the other groups. Intensive care unit (ICU) admissions, invasive mechanical ventilation, and mortality rates were similar between the two treatments. CONCLUSIONS Early dose-adjusted FPV showed no difference from NMabs in preventing ED visits, ICU admissions, ventilator needs, or mortality among patients with major comorbidities. Diabetic patients on FPV experienced higher hospitalizations and oxygen needs, with no observed differences in other groups. FPV may be a viable alternative, especially in settings with limited resources.
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Affiliation(s)
- Taweegrit Siripongboonsitti
- Division of Infectious Diseases, Department of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand.
| | - Kriangkrai Tawinprai
- Division of Infectious Diseases, Department of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | | | | | - Thitapha Thongchai
- Center of Learning and Research in Celebration of HRH Princess Chulabhorn 60th Birthday Anniversary, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Kamonwan Soonklang
- Center of Learning and Research in Celebration of HRH Princess Chulabhorn 60th Birthday Anniversary, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Nithi Mahanonda
- Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
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2
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Bartalucci C, Limongelli A, Nicolini LA, Ponzano M, Tigano S, Farinella ST, Carrega G, Malerba G, Magnè F, Balletto E, Giacobbe DR, Riccio G, Cenderello G, Taramasso L, Bruzzone B, Vena A, Di Biagio A, Mikulska M, De Maria A, Dentone C, Bassetti M. Neutralizing monoclonal antibodies for the prevention of severe COVID-19: a retrospective study during Omicron BA.1 variant surge. J Chemother 2024; 36:283-290. [PMID: 38095569 DOI: 10.1080/1120009x.2023.2289269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 11/27/2023] [Indexed: 06/19/2024]
Abstract
Among treatment options for Coronavirus disease 2019 (COVID-19), monoclonal antibodies (mAbs) showed to be effective in preventing disease progression, but real-world data during the Omicron variant surge are still lacking. Multicentre retrospective study evaluating the effectiveness of sotrovimab and casirivimab-imdevimab in fragile patients with mild SARS-CoV-2 infection between November 2021 and March 2022. Unfavourable outcome was defined as increased need for oxygen supplementation and/or death. Of 268 study-participants, 12 (4.48%) previously needed supplemental oxygen, while 6 (2.24%) had active solid neoplasia (2.24%); 186 (69%) have previously received SARS-CoV-2 vaccination. Overall, 22 (8%) had unfavourable outcomes (42% versus 6% of patients with and without previous oxygen need and 50% versus 7% of patients with and without active solid neoplasia). Both supplemental oxygen therapy before SARS-CoV-2 infection and solid malignant tumour have shown to be risk factors for treatment failure. Log-rank test did not identify differences between sotrovimab and casirivimab-imdevimab treatment. Despite diffusion of Omicron variant, the rate of unfavourable outcome was higher than expected. The presence of underlying risk factors, including solid cancer and previous oxygen therapy are independently associated with risk of COVID-19 progression, suggesting the need for antiviral treatments not limited to mAbs and implementation of vaccine campaign.
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Affiliation(s)
- Claudia Bartalucci
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandro Limongelli
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Marta Ponzano
- Section of Biostatistics, Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | | | | | - Gemma Malerba
- Infectious Diseases Unit, Sanremo Hospital, Imperia, Italy
| | - Federica Magnè
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisa Balletto
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | - Lucia Taramasso
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Bianca Bruzzone
- Hygiene Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Vena
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonio Di Biagio
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Malgorzata Mikulska
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea De Maria
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Dentone
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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3
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Atanasoff KE, Brambilla L, Adelsberg DC, Kowdle S, Stevens CS, Slamanig S, Hung CT, Fu Y, Lim R, Tran L, Allen R, Sun W, Duty JA, Bajic G, Lee B, Tortorella D. An in vitro experimental pipeline to characterize the epitope of a SARS-CoV-2 neutralizing antibody. mBio 2024; 15:e0247723. [PMID: 38054729 PMCID: PMC10870823 DOI: 10.1128/mbio.02477-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/17/2023] [Indexed: 12/07/2023] Open
Abstract
IMPORTANCE The COVID-19 pandemic remains a significant public health concern for the global population; the development and characterization of therapeutics, especially ones that are broadly effective, will continue to be essential as severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) variants emerge. Neutralizing monoclonal antibodies remain an effective therapeutic strategy to prevent virus infection and spread so long as they recognize and interact with circulating variants. The epitope and binding specificity of a neutralizing anti-SARS-CoV-2 Spike receptor-binding domain antibody clone against many SARS-CoV-2 variants of concern were characterized by generating antibody-resistant virions coupled with cryo-EM structural analysis and VSV-spike neutralization studies. This workflow can serve to predict the efficacy of antibody therapeutics against emerging variants and inform the design of therapeutics and vaccines.
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Affiliation(s)
- Kristina E. Atanasoff
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Luca Brambilla
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel C. Adelsberg
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shreyas Kowdle
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christian S. Stevens
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stefan Slamanig
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Chuan-Tien Hung
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yanwen Fu
- Sorrento Therapeutics, Inc., San Diego, California, USA
| | - Reyna Lim
- Sorrento Therapeutics, Inc., San Diego, California, USA
| | - Linh Tran
- Sorrento Therapeutics, Inc., San Diego, California, USA
| | - Robert Allen
- Sorrento Therapeutics, Inc., San Diego, California, USA
| | - Weina Sun
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - J. Andrew Duty
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Center for Therapeutic Antibody Development, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Goran Bajic
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Benhur Lee
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Domenico Tortorella
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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4
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Siripongboonsitti T, Nontawong N, Tawinprai K, Suptawiwat O, Soonklang K, Poovorawan Y, Mahanonda N. Efficacy of combined COVID-19 convalescent plasma with oral RNA-dependent RNA polymerase inhibitor treatment versus neutralizing monoclonal antibody therapy in COVID-19 outpatients: a multi-center, non-inferiority, open-label randomized controlled trial (PlasMab). Microbiol Spectr 2023; 11:e0325723. [PMID: 37975699 PMCID: PMC10714803 DOI: 10.1128/spectrum.03257-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023] Open
Abstract
IMPORTANCE This pivotal study reveals that high neutralizing titer COVID-19 convalescent plasma therapy (CPT) combined with favipiravir (FPV) is non-inferior to sotrovimab in preventing hospitalization and severe outcomes in outpatients with mild-to-moderate COVID-19 and high-risk comorbidities. It underscores the potential of CPT-FPV as a viable alternative to neutralizing monoclonal antibodies like sotrovimab, especially amid emerging variants with spike protein mutations. The study's unique approach, comparing a monoclonal antibody with CPT, demonstrates the efficacy of early intervention using high neutralizing antibody titer CPT, even in populations with a significant proportion of elderly patients. These findings are crucial, considering the alternative treatment challenges, especially in resource-limited countries, posed by the rapidly mutating SARS-CoV-2 virus and the need for adaptable therapeutic strategies.
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Affiliation(s)
- Taweegrit Siripongboonsitti
- Division of Infectious Diseases, Department of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | | | - Kriangkrai Tawinprai
- Division of Infectious Diseases, Department of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Ornpreya Suptawiwat
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Kamonwan Soonklang
- Center of Learning and Research in Celebration of HRH Princess Chulabhorn 60th Birthday Anniversary, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Yong Poovorawan
- Department of Pediatrics, Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nithi Mahanonda
- Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
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5
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Price JK, de Avila L, Stepanova M, Weinstein AA, Pham H, Keo W, Racila A, Gerber S, Lam BP, Gerber LH, Younossi ZM. Severe, Persistent, Disruptive Fatigue Post-SARS-CoV-2 Disproportionately Affects Young Women. Int J Gen Med 2023; 16:4393-4404. [PMID: 37789881 PMCID: PMC10544141 DOI: 10.2147/ijgm.s423910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/14/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction Post-acute SARS-CoV-2 (PASC) symptoms are often persistent, disruptive, and difficult to treat effectively. Fatigue is often among the most frequently reported symptoms and may indicate a more challenging road to recovery. Purpose To describe the natural history, symptomology, and risk profile of long-term post-acute SARS-CoV-2. Patients and Methods Participants treated for SARS-CoV-2 within a large, community health system in the US were enrolled prospectively in a longitudinal, observational PASC study examining participants at enrollment and 6 months. Medical history, symptom reporting, validated measures of cognition, and patient-reported outcomes (PROs), were performed for all participants and repeated during study follow-up visits. Results A total of 323 participants completed baseline evaluations. Sixty one participants indicated clinically significant fatigue (23.1% at baseline); a representative sample of 141 enrollees also completed a baseline Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) in-depth fatigue reporting questionnaire, 37 had severe fatigue. The severely fatigued (FACIT-F ≤29.7) were significantly younger, female, had more anxiety and depression, had a higher resting heart rate, reported more sick days, and were less physically active post-COVID. They were more likely to have a diagnosis of chronic kidney disease (13.5% vs 2.9%) but less likely to have a history of cancer (8.1% vs 23.1). Participants who were severely fatigued reported health, diet, weight, and sleep were worse than those not severely fatigued post-COVID (p = 0.02 to 0.0002). Fatigue was significantly correlated with impairment of all PROs administered after COVID-19 infection. Conclusion Fatigue is a common symptom post-COVID-19 infection and is associated with lower reported well-being and function. Those with severe fatigue tended to be younger and female and have a past medical history of anxiety, depression, kidney disease, and more sedentary lifestyles.
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Affiliation(s)
- Jillian Kallman Price
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Leyla de Avila
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Maria Stepanova
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, USA
- Inova Medicine, Inova Health System, Falls Church, VA, USA
| | - Ali A Weinstein
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| | - Huong Pham
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Wisna’odom Keo
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Andrei Racila
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Suzannah Gerber
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Brian P Lam
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, USA
- Inova Medicine, Inova Health System, Falls Church, VA, USA
| | - Lynn H Gerber
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
- Inova Medicine, Inova Health System, Falls Church, VA, USA
| | - Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, USA
- Inova Medicine, Inova Health System, Falls Church, VA, USA
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6
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Agrawal P, Damania D, Cseh A, Grab J, Strom L, Frank B, Patel D, Clyatt G. Impact of COVID vaccine and comorbidities in patients receiving casirivimab-imdevimab monoclonal antibody during SARS-CoV-2 B.1.617.2 (Delta) surge: A real-world study. Vaccine 2023; 41:5195-5200. [PMID: 37451874 DOI: 10.1016/j.vaccine.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/26/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Several randomized trials and real-world studies depicted the role of monoclonal antibody infusion in reducing hospitalization, and halting progression from asymptomatic to symptomatic COVID pneumonia, viral titer, and death. No data exists to show outcomes of patients who received casirivimab-imdevimab infusion based on their vaccination status and underlying comorbidities. This study aims to provide outcomes of casirivimab-imdevimab treatment during the SARS-CoV-2 B1.617.2 (Delta) surge among fully vaccinated and not fully vaccinated individuals. METHODS COVID-19-positive patients who received casirivimab-imdevimab infusion during the Delta surge were analyzed to compare their underlying comorbidities and the rate of 28-days all-cause and COVID-related ED visits or hospitalization, among fully vaccinated and not fully vaccinated individuals. RESULTS A total of 3,586 patients received casirivimab-imdevimab infusion. COVID-related hospitalizations were directly related to the number of comorbidities (OR:1.745, 95 % CI:1.469-2.074). Vaccinated patients with ≥3 comorbidities had lower rates of 28-day COVID-related ED visits or hospitalization (p = 0.044) and those with ≥4 comorbidities had lower rates of 28-day All-cause ED visits or hospitalization (p = 0.029). Hypertension (OR:2.418, 95 %CI:1.341-4.360), immunocompromised state (OR:5.250, 95 %CI: 1.912-14.417), age ≥ 65 (OR:4.045, 95 %CI:2.224-7.358) increased the probability of hospitalization due to COVID and being fully vaccinated lowered the likelihood of hospitalization (OR: 0.472, 95 %CI: 0.239-0.933). Vaccinated patients had a lower length of COVID-related hospitalization (2 days vs 4.5 days, p < 0.001). CONCLUSION COVID vaccination status and comorbidities are significant predictors of outcomes after casirivimab-imdevimab treatment. Despite having higher comorbidities, patients who were fully vaccinated at the time of casirivimab-imdevimab infusion had a lower length of hospitalization and reduced 28-day COVID ED visits or hospitalizations. Future trials should also compare outcomes based on the patient's vaccination status.
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Affiliation(s)
- Pankaj Agrawal
- Department of Medicine, South Georgia Medical Center, 2501 N Patterson St., Valdosta, GA, United States.
| | - Dushyant Damania
- Pulmonary Critical Care, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Attila Cseh
- Economics, Valdosta State University, Valdosta, GA, United States
| | - John Grab
- Edward Via College of Osteopathic Medicine, Auburn, AL, United States
| | - Laura Strom
- Edward Via College of Osteopathic Medicine, Auburn, AL, United States
| | - Brianna Frank
- Edward Via College of Osteopathic Medicine, Auburn, AL, United States
| | - Dhruv Patel
- Philadelphia College of Osteopathic Medicine- Moultrie, GA, United States
| | - Griffin Clyatt
- Philadelphia College of Osteopathic Medicine- Moultrie, GA, United States
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7
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Levine AC, Fukuta Y, Huaman MA, Ou J, Meisenberg BR, Patel B, Paxton JH, Hanley DF, Rijnders BJA, Gharbharan A, Rokx C, Zwaginga JJ, Alemany A, Mitjà O, Ouchi D, Millat-Martinez P, Durkalski-Mauldin V, Korley FK, Dumont LJ, Callaway CW, Libster R, Marc GP, Wappner D, Esteban I, Polack F, Sullivan DJ. Coronavirus Disease 2019 Convalescent Plasma Outpatient Therapy to Prevent Outpatient Hospitalization: A Meta-Analysis of Individual Participant Data From 5 Randomized Trials. Clin Infect Dis 2023; 76:2077-2086. [PMID: 36809473 PMCID: PMC10273382 DOI: 10.1093/cid/ciad088] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/06/2023] [Accepted: 02/14/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Outpatient monoclonal antibodies are no longer effective and antiviral treatments for coronavirus disease 2019 (COVID-19) disease remain largely unavailable in many countries worldwide. Although treatment with COVID-19 convalescent plasma (CCP) is promising, clinical trials among outpatients have shown mixed results. METHODS We conducted an individual participant data meta-analysis from outpatient trials to assess the overall risk reduction for all-cause hospitalizations by day 28 in transfused participants. Relevant trials were identified by searching Medline, Embase, medRxiv, World Health Organization COVID-19 Research Database, Cochrane Library, and Web of Science from January 2020 to September 2022. RESULTS Five included studies from 4 countries enrolled and transfused 2620 adult patients. Comorbidities were present in 1795 (69%). The virus neutralizing antibody dilutional titer levels ranged from 8 to 14 580 in diverse assays. One hundred sixty of 1315 (12.2%) control patients were hospitalized, versus 111 of 1305 (8.5%) CCP-treated patients, yielding a 3.7% (95% confidence interval [CI], 1.3%-6.0%; P = .001) absolute risk reduction and 30.1% relative risk reduction for all-cause hospitalization. The hospitalization reduction was greatest in those with both early transfusion and high titer with a 7.6% absolute risk reduction (95% CI, 4.0%-11.1%; P = .0001) accompanied by at 51.4% relative risk reduction. No significant reduction in hospitalization was seen with treatment >5 days after symptom onset or in those receiving CCP with antibody titers below the median titer. CONCLUSIONS Among outpatients with COVID-19, treatment with CCP reduced the rate of all-cause hospitalization and may be most effective when given within 5 days of symptom onset and when antibody titer is higher.
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Affiliation(s)
- Adam C Levine
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Yuriko Fukuta
- Infectious Disease, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Moises A Huaman
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jiangda Ou
- Division of Brain Injury Outcomes, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Barry R Meisenberg
- Department of Hematology–Oncology, Anne Arundel Medical Center, Annapolis, Maryland, USA
| | - Bela Patel
- Division of Critical Care Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - James H Paxton
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Daniel F Hanley
- Division of Brain Injury Outcomes, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bart J A Rijnders
- Department of Internal Medicine, Section of Infectious Diseases and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, University Medical Center, Rotterdam, The Netherlands
| | - Arvind Gharbharan
- Department of Internal Medicine, Section of Infectious Diseases and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, University Medical Center, Rotterdam, The Netherlands
| | - Casper Rokx
- Department of Internal Medicine, Section of Infectious Diseases and Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, University Medical Center, Rotterdam, The Netherlands
| | - Jaap Jan Zwaginga
- Department of Haematology, Leiden University Medical Centre, Leiden, The Netherlands
- Center for Clinical Transfusion Research, Sanquin Blood Supply, Amsterdam, The Netherlands
| | - Andrea Alemany
- Fight Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Oriol Mitjà
- Fight Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Lihir Medical Centre, International SOS, Lihir Island, Papua New Guinea
| | - Dan Ouchi
- Fight Infectious Diseases Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Pere Millat-Martinez
- ISGlobal, Department of Infectious Diseases, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Valerie Durkalski-Mauldin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Frederick K Korley
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Larry J Dumont
- Vitalant Research Institute, Research Department, Denver, Colorado, USA
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Romina Libster
- Fundación INFANT, Buenos Aires, Argentina
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | | | | | - Fernando Polack
- Fundación INFANT, Buenos Aires, Argentina
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - David J Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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8
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Yetmar ZA, Yao JD, Razonable RR. SARS-CoV-2 spike codon mutations and risk of hospitalization after antispike monoclonal antibody therapy in solid organ transplant recipients. J Med Virol 2023; 95:e28885. [PMID: 37334976 PMCID: PMC10583774 DOI: 10.1002/jmv.28885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/27/2023] [Accepted: 06/07/2023] [Indexed: 06/21/2023]
Abstract
Neutralizing antispike monoclonal antibody (mAb) therapies were highly efficacious in preventing coronavirus disease 2019 (COVID-19) hospitalization. While severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants may harbor spike protein mutations conferring reduced in vitro susceptibility to these antibodies, the effect of these mutations on clinical outcomes is not well characterized. We conducted a case-control study of solid organ transplant recipients who received an antispike mAb for treatment of mild-to-moderate COVID-19 and had an available sample from initial COVID-19 diagnosis for genotypic sequencing. Patients whose SARS-CoV-2 isolate had at least one spike codon mutation conferring at least fivefold decreased in vitro susceptibility were classified as resistant. Overall, 9 of 41 patients (22%) had at least one spike codon mutation that confers reduced susceptibility to the antispike mAb used for treatment. Specifically, 9 of 12 patients who received sotrovimab had S371L mutation that was predicted to confer a 9.7-fold reduced susceptibility. However, among 22 patients who required hospitalization, 5 had virus with resistance mutation. In contrast, among 19 control patients who did not require hospitalization, 4 also had virus-containing resistance mutations (p > 0.99). In conclusion, spike codon mutations were common, though mutations that conferred a 9.7-fold reduced susceptibility did not predict subsequent hospitalization after treatment with antispike mAb.
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Affiliation(s)
- Zachary A. Yetmar
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph D. Yao
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Raymund R. Razonable
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
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9
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Atanasoff KE, Brambilla L, Adelsberg DC, Kowdle S, Stevens CS, Hung CT, Fu Y, Lim R, Tran L, Allen R, Andrew Duty J, Bajic G, Lee B, Tortorella D. An in vitro experimental pipeline to characterize the binding specificity of SARS-CoV-2 neutralizing antibodies. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.04.20.537738. [PMID: 37131698 PMCID: PMC10153249 DOI: 10.1101/2023.04.20.537738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has led to over 760 million cases and >6.8 million deaths worldwide. We developed a panel of human neutralizing monoclonal antibodies (mAbs) targeting the SARS-CoV-2 Spike protein using Harbour H2L2 transgenic mice immunized with Spike receptor binding domain (RBD) (1). Representative antibodies from genetically-distinct families were evaluated for inhibition of replication-competent VSV expressing SARS-CoV-2 Spike (rcVSV-S) in place of VSV-G. One mAb (denoted FG-10A3) inhibited infection of all rcVSV-S variants; its therapeutically-modified version, STI-9167, inhibited infection of all tested SARS-CoV-2 variants, including Omicron BA.1 and BA.2, and limited virus proliferation in vivo (1). To characterize the binding specificity and epitope of FG-10A3, we generated mAb-resistant rcVSV-S virions and performed structural analysis of the antibody/antigen complex using cryo-EM. FG-10A3/STI-9167 is a Class 1 antibody that prevents Spike-ACE2 binding by engaging a region within the Spike receptor binding motif (RBM). Sequencing of mAb-resistant rcVSV-S virions identified F486 as a critical residue for mAb neutralization, with structural analysis revealing that both the variable heavy and light chains of STI-9167 bound the disulfide-stabilized 470-490 loop at the Spike RBD tip. Interestingly, substitutions at position 486 were later observed in emerging variants of concern BA.2.75.2 and XBB. This work provides a predictive modeling strategy to define the neutralizing capacity and limitations of mAb therapeutics against emerging SARS-CoV-2 variants. Importance The COVID-19 pandemic remains a significant public health concern for the global population; development and characterization of therapeutics, especially ones that are broadly effective, will continue to be essential as SARS-CoV-2 variants emerge. Neutralizing monoclonal antibodies remain an effective therapeutic strategy to prevent virus infection and spread with the caveat that they interact with the circulating variants. The epitope and binding specificity of a broadly neutralizing anti-SARS-CoV-2 Spike RBD antibody clone against many SARS-CoV-2 VOC was characterized by generating antibody-resistant virions coupled with cryo-EM structural analysis. This workflow can serve to predict the efficacy of antibody therapeutics against emerging variants and inform the design of therapeutics and vaccines.
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10
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Amani B, Amani B. Efficacy and safety of regdanvimab in patients with mild to moderate COVID-19: A rapid review and meta-analysis. Br J Clin Pharmacol 2023; 89:1282-1290. [PMID: 36717356 DOI: 10.1111/bcp.15676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 01/07/2023] [Accepted: 01/18/2023] [Indexed: 02/01/2023] Open
Abstract
AIMS This study aimed to evaluate the efficacy and safety of regdanvimab, an anti-SARS-COV-2 monoclonal antibody approved by the European Medicines Agency in November 2021, for the treatment of confirmed COVID-19 disease. METHODS Cochrane Library, PubMed, medRxiv and Google Scholar were searched for relevant evidence up to October 27, 2022. The quality of included studies was assessed using the Cochrane risk of bias tools. Data were analysed using RevMan software. RESULTS Eight studies involving 4793 patients were included. A significant difference was observed between the regdanvimab and no-regdanvimab groups in terms of length of hospital stay (mean difference [MD] = -1.15, 95% confidence interval [CI]: -1.80 to -0.43), clinical recovery (odds ratio [OR] = 2.09, 95% CI: 1.38 to 3.18), disease progression (OR = 0.23, 95% CI: 0.16 to 0.33), the need for oxygen therapy (OR = 0.33, 95% CI: 0.25 to 0.43) and duration of oxygen therapy (MD = -3.00, 95% CI: -4.44 to -1.56). However, no significant difference was detected between 2 groups regarding mortality rate (OR = 0.46, 95% CI: 0.11 to 1.89), need for mechanical ventilation (OR = 0.39, 95% CI: 0.08 to 1.89) and hospital admission rate (OR = 0.61, 95% CI: 0.35 to 1.03). The incidence of adverse events was similar in both groups (OR = 0.96, 95% CI: 0.77 to 1.18). CONCLUSION Regdanvimab was not effective in reducing mortality and hospital admission rate in patients with mild to moderate COVID-19, but it was effective in improving other efficacy outcomes. Further research is needed to confirm these findings.
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Affiliation(s)
- Behnam Amani
- Department of Epidemiology, School of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Bahman Amani
- Department of Epidemiology, School of Health, Ilam University of Medical Sciences, Ilam, Iran
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11
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COVID-19 Management Strategies in Solid Organ Transplant Recipients. Infect Dis Clin North Am 2023:S0891-5520(23)00024-7. [PMID: 37142512 PMCID: PMC10028355 DOI: 10.1016/j.idc.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Solid organ transplant recipients are at high risk of severe coronavirus disease-2019 (COVID-19). If left untreated, it results in high rates of hospitalization, intensive care unit admission and death. Early diagnosis of COVID-19 is essential to ensure the early administration of therapeutics. Treatment of mild-to-moderate COVID-19 with remdesivir, ritonavir-boosted nirmatrelvir, or an anti-spike neutralizing monoclonal antibody may prevent progression to severe and critical COVID-19. Among patients with severe and critical COVID-19, treatment with intravenous remdesivir and immunomodulation is recommended. This review article discusses strategies in the management of solid organ transplant recipients with COVID-19.
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12
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Alemany A, Millat-Martinez P, Corbacho-Monné M, Suñer C, Galvan-Casas C, Carrera C, Ouchi D, Prat N, Ara J, Nadal N, Riel R, Funollet B, Ojeda-Ciurana C, Balague LE, Salvador-González B, Arcarons AF, Vidal-Alaball J, Del Cura-González MI, Barrientos RR, Ramos-Blanes R, Bou AA, Mondou E, Torres M, Campins N, Sanz A, Tang Y, Rodriguez-Arias MÀ, Bassat Q, Clotet B, Mitjà O. Subcutaneous anti-COVID-19 hyperimmune immunoglobulin for prevention of disease in asymptomatic individuals with SARS-CoV-2 infection: a double-blind, placebo-controlled, randomised clinical trial. EClinicalMedicine 2023; 57:101898. [PMID: 36936402 PMCID: PMC10005687 DOI: 10.1016/j.eclinm.2023.101898] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Anti-COVID-19 hyperimmune immunoglobulin (hIG) can provide standardized and controlled antibody content. Data from controlled clinical trials using hIG for the prevention or treatment of COVID-19 outpatients have not been reported. We assessed the safety and efficacy of subcutaneous anti-COVID-19 hyperimmune immunoglobulin 20% (C19-IG20%) compared to placebo in preventing development of symptomatic COVID-19 in asymptomatic individuals with SARS-CoV-2 infection. METHODS We did a multicentre, randomized, double-blind, placebo-controlled trial, in asymptomatic unvaccinated adults (≥18 years of age) with confirmed SARS-CoV-2 infection within 5 days between April 28 and December 27, 2021. Participants were randomly assigned (1:1:1) to receive a blinded subcutaneous infusion of 10 mL with 1 g or 2 g of C19-IG20%, or an equivalent volume of saline as placebo. The primary endpoint was the proportion of participants who remained asymptomatic through day 14 after infusion. Secondary endpoints included the proportion of individuals who required oxygen supplementation, any medically attended visit, hospitalisation, or ICU, and viral load reduction and viral clearance in nasopharyngeal swabs. Safety was assessed as the proportion of patients with adverse events. The trial was terminated early due to a lack of potential benefit in the target population in a planned interim analysis conducted in December 2021. ClinicalTrials.gov registry: NCT04847141. FINDINGS 461 individuals (mean age 39.6 years [SD 12.8]) were randomized and received the intervention within a mean of 3.1 (SD 1.27) days from a positive SARS-CoV-2 test. In the prespecified modified intention-to-treat analysis that included only participants who received a subcutaneous infusion, the primary outcome occurred in 59.9% (91/152) of participants receiving 1 g C19-IG20%, 64.7% (99/153) receiving 2 g, and 63.5% (99/156) receiving placebo (difference in proportions 1 g C19-IG20% vs. placebo, -3.6%; 95% CI -14.6% to 7.3%, p = 0.53; 2 g C19-IG20% vs placebo, 1.1%; -9.6% to 11.9%, p = 0.85). None of the secondary clinical efficacy endpoints or virological endpoints were significantly different between study groups. Adverse event rate was similar between groups, and no severe or life-threatening adverse events related to investigational product infusion were reported. INTERPRETATION Our findings suggested that administration of subcutaneous human hyperimmune immunoglobulin C19-IG20% to asymptomatic individuals with SARS-CoV-2 infection was safe but did not prevent development of symptomatic COVID-19. FUNDING Grifols.
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Affiliation(s)
- Andrea Alemany
- Fight Infectious Diseases Foundation, Badalona, Spain
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Facultat de Medicina-Universitat de Barcelona, Barcelona, Spain
- Corresponding author. Department of Infectious Diseases and Fight Infectious Diseases Foundation, Hospital Germans Trias Pujol, Badalona, Catalonia, Spain.
| | | | - Marc Corbacho-Monné
- Fight Infectious Diseases Foundation, Badalona, Spain
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Facultat de Medicina-Universitat de Barcelona, Barcelona, Spain
- Hospital Universitari Parc Taulí, I3PT, 08028, Sabadell, Spain
| | - Clara Suñer
- Fight Infectious Diseases Foundation, Badalona, Spain
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Cristina Galvan-Casas
- Fight Infectious Diseases Foundation, Badalona, Spain
- Department of Dermatology, Hospital Universitario de Móstoles, Madrid, Spain
| | - Caty Carrera
- Fight Infectious Diseases Foundation, Badalona, Spain
- Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Barcelona, Spain
| | - Dan Ouchi
- Fight Infectious Diseases Foundation, Badalona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Núria Prat
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - Jordi Ara
- Gerència Territorial Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
| | - Nuria Nadal
- Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Ricard Riel
- Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Blanca Funollet
- Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Carmen Ojeda-Ciurana
- Gerència Territorial Metropolitana Sud, Institut Català de la Salut, Barcelona, Spain
| | - Lluis Esteve Balague
- Gerència Territorial Metropolitana Sud, Institut Català de la Salut, Barcelona, Spain
| | - Betlem Salvador-González
- Gerència Territorial Metropolitana Sud, Institut Català de la Salut, Barcelona, Spain
- Unitat de Suport a la Recerca Costa de Ponent, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), l’Hospitalet de Llobregat, Spain
| | - Anna Forcada Arcarons
- Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Barcelona, Spain
| | - Josep Vidal-Alaball
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Facultat de Medicina, Universitat de Vic - Universitat Central de Catalunya (UVIC-UCC), Vic, Spain
| | - María Isabel Del Cura-González
- Unidad de Investigación, Gerencia Asistencial de Atención Primaria, Madrid, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud -RICAPPS- ISCIII, Spain
| | - Ricardo Rodríguez Barrientos
- Unidad de Investigación, Gerencia Asistencial de Atención Primaria, Madrid, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud -RICAPPS- ISCIII, Spain
| | - Rafel Ramos-Blanes
- Unitat de Suport a la Recerca de Girona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Girona, Spain
| | - Alberto Alum Bou
- Unitat de Suport a la Recerca de Girona, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Girona, Spain
| | - Elsa Mondou
- Scientific Innovation Office, Grifols, Barcelona, Spain
| | - Mireia Torres
- Scientific Innovation Office, Grifols, Barcelona, Spain
| | - Neus Campins
- Scientific Innovation Office, Grifols, Barcelona, Spain
| | - Ana Sanz
- Scientific Innovation Office, Grifols, Barcelona, Spain
| | | | - Miquel Àngel Rodriguez-Arias
- Fight Infectious Diseases Foundation, Badalona, Spain
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- ICREA, Pg Lluís Companys 23, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Bonaventura Clotet
- Fight Infectious Diseases Foundation, Badalona, Spain
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Facultat de Medicina, Universitat de Vic - Universitat Central de Catalunya (UVIC-UCC), Vic, Spain
- IrsiCaixa AIDS Research Institute, Germans Trias i Pujol Research Institute, Can Ruti Campus, Badalona, Spain
| | | | - Oriol Mitjà
- Fight Infectious Diseases Foundation, Badalona, Spain
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Facultat de Medicina, Universitat de Vic - Universitat Central de Catalunya (UVIC-UCC), Vic, Spain
- Lihir Medical Centre, International SOS, Lihir Island, Papua New Guinea
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13
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Chow MYT, Pan HW, Seow HC, Lam JKW. Inhalable neutralizing antibodies - promising approach to combating respiratory viral infections. Trends Pharmacol Sci 2023; 44:85-97. [PMID: 36566131 DOI: 10.1016/j.tips.2022.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/21/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
Monoclonal antibodies represent an exciting class of therapeutics against respiratory viral infections. Notwithstanding their specificity and affinity, the conventional parenteral administration is suboptimal in delivering antibodies for neutralizing activity in the airways due to the poor distribution of macromolecules to the respiratory tract. Inhaled therapy is a promising approach to overcome this hurdle in a noninvasive manner, while advances in antibody engineering have led to the development of unique antibody formats which exhibit properties desirable for inhalation. In this Opinion, we examine the major challenges surrounding the development of inhaled antibodies, identify knowledge gaps that need to be addressed and provide strategies from a drug delivery perspective to enhance the efficacy and safety of neutralizing antibodies against respiratory viral infections.
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Affiliation(s)
- Michael Y T Chow
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Harry W Pan
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Han Cong Seow
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China
| | - Jenny K W Lam
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China; School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK.
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14
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Price JK, Gerber LH, Stepanova M, de Avila L, Weinstein AA, Pham H, Nader F, Afendy M, Terra K, Austin P, Keo W, Racila A, Estep JM, Gerber S, Verma M, Golabi P, Lam BP, Younossi Z. Post-Acute SARS-CoV-2 Symptoms are Fewer, Less Intense Over Time in People Treated with Mono-Clonal Antibodies for Acute Infection. Int J Gen Med 2023; 16:1479-1490. [PMID: 37123886 PMCID: PMC10145429 DOI: 10.2147/ijgm.s406571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/01/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Many with post-acute SARS-CoV-2 (PASC) have persistent symptoms impacting physical and cognitive function, decreased health and health-related life quality. Monoclonal antibody (mAb) treatment was available to acutely infected patients which might improve these outcomes. Purpose To compare patient perception of PASC symptoms for those receiving bamlanivimab or casirivimab and imdevimab (mAbs) to those not receiving this treatment (non-mAbs). To compare changes between these groups in symptoms, function and quality of life over a 6-month follow-up. Patients and Methods Consented adults >28 days post-infection with positive SARS-CoV-2 qPCR or antigen test and SARS-CoV-2 infection between March of 2020 and July of 2022 were enrolled. This prospective, repeated measure observational study reports baseline through 6-month follow-up. Extensive sociodemographic data, detailed medical history, COVID-19 symptom history, and standardized measures of well-being, depression, anxiety, stigma, cognition, symptom assessment, distress, and health status were collected. Results 323 participants [101 mAb, 221 non-mAb, 52.7±15.5 years, 47.7% male, body mass index (BMI) 31.4±8.4] were analyzed. Fewer symptoms at baseline were reported in mAb versus non-mAb participants (1.06±1.31 vs 1.78±2.15, respectively p=0.0177) 6 months: (0.911±1.276 mAb vs.1.75±2.22 non-mAb, p=0.0427). Both groups showed significant within-group decreases in symptom number (52 to 21 mAb, 126 to 63 non-mAb) and symptom burden (p=0.0088 mAb, p<0.00001 non-mAb). mAb patients had significantly shorter infection-to-baseline interval (days) (120.4±55.3 mAb vs 194.0±89.3 non-mAb, p<0.00001); less frequent history of myocardial infarction (0.0 vs 3.9%, p=0.0464); headache (2.0% vs.11.8%, p=0.0046), rash (3.1% vs 9.9%, p=0.0377), and miscellaneous muscle complaints (2.0% vs 12.3%, p=0.0035), plus significantly better 6-month mood. (2.2% vs 13.2%, p=0.0390). Conclusion mAb treated participants had reduced symptom burden and consistently reported fewer symptoms than non-mAb at all time points despite less time since acute illness. Both groups reported a statistically significant decrease in symptoms by 6-month visit with no statistically significant differences between them at follow-up.
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Affiliation(s)
- Jillian Kallman Price
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
- Correspondence: Jillian Kallman Price, Research Investigator, Outcomes Research, Beatty Liver and Obesity Research Program, Center for Integrated Research, Department of Medicine, Inova Health System, Claude Moore Health Education and Research Building, Inova Fairfax Medical Campus, 3300 Gallows Road, Falls Church, VA, 22042, USA, Tel +1-703-776-3032, Fax +1-703- 776-4386, Email
| | - Lynn H Gerber
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
- Inova Medicine, Inova Health System, Falls Church, VA, USA
| | - Maria Stepanova
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
- Inova Medicine, Inova Health System, Falls Church, VA, USA
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, USA
| | - Leyla de Avila
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Ali A Weinstein
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| | - Huong Pham
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Fatema Nader
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Mariam Afendy
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Kathy Terra
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, USA
| | - Patrick Austin
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Wisna’odom Keo
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Andrei Racila
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - James Michael Estep
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Suzannah Gerber
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Manisha Verma
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Pegah Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Brian P Lam
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
- Inova Medicine, Inova Health System, Falls Church, VA, USA
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, USA
| | - Zobair Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
- Inova Medicine, Inova Health System, Falls Church, VA, USA
- Center for Liver Disease, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, USA
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15
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Hussein M, Wei W, Mastey V, Sanchez RJ, Wang D, Murdock DJ, Hirshberg B, Weinreich DM, Jalbert JJ. Real-world effectiveness of casirivimab and imdevimab among patients diagnosed with COVID-19 in the ambulatory setting: a retrospective cohort study using a large claims database. BMJ Open 2022; 12:e064953. [PMID: 36535724 PMCID: PMC9764096 DOI: 10.1136/bmjopen-2022-064953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To assess the real-world effectiveness of casirivimab and imdevimab (CAS+IMD) versus no COVID-19 antibody treatment among patients diagnosed with COVID-19 in the ambulatory setting, including patients diagnosed during the Delta-dominant period prior to Omicron emergence. DESIGN Retrospective cohort study. SETTING Komodo Health closed claims database. PARTICIPANTS 13 273 128 patients diagnosed with COVID-19 (December 2020 through September 2021) were treated with CAS+IMD or untreated but treatment eligible under the Emergency Use Authorization (EUA). Each treated patient was exact and propensity score matched without replacement to up to five untreated EUA-eligible patients. INTERVENTIONS CAS+IMD. PRIMARY AND SECONDARY OUTCOME MEASURES Composite endpoint of 30-day all-cause mortality or COVID-19-related hospitalisation. Kaplan-Meier estimators were used to calculate outcome risks overall and across subgroups: age, COVID-19 vaccination status, immunocompromised status, and timing of diagnosis (December 2020 to June 2021, and July to September 2021). Cox proportional hazards models were used to estimate adjusted HRs (aHRs) and 95% CIs. RESULTS Among 75 159 CAS+IMD-treated and 1 670 338 EUA-eligible untreated patients, 73 759 treated patients were matched to 310 688 untreated patients; matched patients were ~50 years, ~60% were women and generally well balanced across risk factors. The 30-day risk of the composite outcome was 2.1% and 5.2% in the CAS+IMD-treated and CAS+IMD-untreated patients, respectively; equivalent to a 60% lower risk (aHR 0.40; 95% CI, 0.38 to 0.42). The effect of CAS+IMD was consistent across subgroups, including those who received a COVID-19 vaccine (aHR 0.48, 95% CI, 0.41 to 0.56), and those diagnosed during the Delta-dominant period (aHR 0.40, 95% CI, 0.38 to 0.42). CONCLUSIONS The real-world effectiveness of CAS+IMD is consistent with the efficacy for reducing all-cause mortality or COVID-19-related hospitalisation reported in clinical trials. Effectiveness is maintained across patient subgroups, including those prone to breakthrough infections, and was effective against susceptible variants including Delta. .
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Affiliation(s)
| | - Wenhui Wei
- Regeneron Pharmaceuticals Inc, Tarrytown, New York, USA
| | - Vera Mastey
- Regeneron Pharmaceuticals Inc, Tarrytown, New York, USA
| | | | - Degang Wang
- Regeneron Pharmaceuticals Inc, Tarrytown, New York, USA
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16
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Levine AC, Fukuta Y, Huaman MA, Ou J, Meisenberg BR, Patel B, Paxton JH, Hanley DF, Rijnders BJA, Gharbharan A, Rokx C, Zwaginga JJ, Alemany A, Mitjà O, Ouchi D, Millat-Martinez P, Durkalski-Mauldin V, Korley FK, Dumont LJ, Callaway CW, Libster R, Marc GP, Wappner D, Esteban I, Polack F, Sullivan DJ. COVID-19 Convalescent Plasma Outpatient Therapy to Prevent Outpatient Hospitalization: A Meta-analysis of Individual Participant Data From Five Randomized Trials. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.12.16.22283585. [PMID: 36561181 PMCID: PMC9774226 DOI: 10.1101/2022.12.16.22283585] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Monoclonal antibody and antiviral treatments for COVID-19 disease remain largely unavailable worldwide, and existing monoclonal antibodies may be less active against circulating omicron variants. Although treatment with COVID-19 convalescent plasma (CCP) is promising, randomized clinical trials (RCTs) among outpatients have shown mixed results. Methods We conducted an individual participant data meta-analysis from all outpatient CCP RCTs to assess the overall risk reduction for all-cause hospitalizations by day 28 in all participants who had transfusion initiated. Relevant trials were identified by searching MEDLINE, Embase, MedRxiv, WHO, Cochrane Library, and Web of Science from January 2020 to September 2022. Results Five included studies from four countries enrolled and transfused 2,620 adult patients. Comorbidities were present in 1,795 (69%). The anti-Spike or virus neutralizing antibody titer range across all trials was broad. 160 (12.2%) of 1315 control patients were hospitalized, versus 111 (8.5%) of 1305 CCP-treated patients, yielding a 3.7% (95%CI: 1.3%-6.0%; p=.001) ARR and 30.1% RRR for all-cause hospitalization. The effect size was greatest in those with both early transfusion and high titer with a 7.6% ARR (95%CI: 4.0%-11.1%; p=.0001) accompanied by at 51.4% RRR. No significant reduction in hospitalization was seen with treatment > 5 days after symptom onset or in those receiving CCP with antibody titers below the median titer. Conclusions Among outpatients with COVID-19, treatment with CCP reduced the rate of all-cause hospitalization. CCP may be most effective when given within 5 days of symptom onset and when antibody titer is higher. Key Points While the outpatient COVID-19 randomized controlled trial meta-analysis indicated heterogeneity in participant risk factors and convalescent plasma, the combined CCP efficacy for reducing hospitalization was significant, improving with transfusion within 5 days of symptom onset and high antibody neutralization levels.
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Affiliation(s)
- Adam C. Levine
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Yuriko Fukuta
- Department of Medicine – Infectious Disease, Baylor College of Medicine, Houston, Texas, USA
| | - Moises A. Huaman
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jiangda Ou
- Division of Brain Injury Outcomes, Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Barry R. Meisenberg
- Department of Hematology – Oncology, Anne Arundel Medical Center, Annapolis, Maryland, USA
| | - Bela Patel
- Division of Critical Care Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, Texas, USA
| | - James H. Paxton
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Daniel F. Hanley
- Division of Brain Injury Outcomes, Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Bart JA Rijnders
- Department of Internal Medicine, Section of Infectious Diseases and department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Arvind Gharbharan
- Department of Internal Medicine, Section of Infectious Diseases and department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Casper Rokx
- Department of Internal Medicine, Section of Infectious Diseases and department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jaap Jan Zwaginga
- Department of Haematology, Leiden University Medical Centre, Leiden, The Netherlands and; CCTR, Sanquin Blood Supply, Amsterdam, The Netherlands
| | - Andrea Alemany
- Fight Infectious Diseases Foundation, Badalona, Spain; Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Oriol Mitjà
- Fight Infectious Diseases Foundation, Badalona, Spain; Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain,Universitat de Vic-Universitat Central de Catalunya, Vic, Spain; Lihir Medical Centre, International SOS, Lihir Island, Papua New Guinea
| | - Dan Ouchi
- Fight Infectious Diseases Foundation, Badalona, Spain; Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | | | - Larry J. Dumont
- Vitalant Research Institute, Denver, CO; University of Colorado School of Medicine, Aurora, CO
| | | | - Romina Libster
- Fundación INFANT, Buenos Aires, Argentina,Vanderbilt University, Nashville, TN, USA
| | | | | | | | - Fernando Polack
- Fundación INFANT, Buenos Aires, Argentina,Vanderbilt University, Nashville, TN, USA
| | - David J. Sullivan
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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17
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Jalbert JJ, Hussein M, Mastey V, Sanchez RJ, Wang D, Murdock D, Fariñas L, Bussey J, Duart C, Hirshberg B, Weinreich DM, Wei W. Effectiveness of Subcutaneous Casirivimab and Imdevimab in Ambulatory Patients with COVID-19. Infect Dis Ther 2022; 11:2125-2139. [PMID: 36181639 PMCID: PMC9526200 DOI: 10.1007/s40121-022-00691-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/22/2022] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Data on real-world effectiveness of subcutaneous (SC) casirivimab and imdevimab (CAS+IMD) for the treatment of coronavirus disease 2019 (COVID-19) are limited. The objective of this study was to assess the effectiveness of SC CAS+IMD versus no antibody treatment among patients with COVID-19. METHODS This retrospective cohort study linked Komodo Health and CDR Maguire Health and Medical data. Patients diagnosed with COVID-19 in ambulatory settings (August 1-October 30, 2021) treated with SC CAS+IMD were exact- and propensity score-matched to fewer than five untreated treatment-eligible patients and followed for the composite endpoint of 30-day all-cause mortality or COVID-19-related hospitalization. Kaplan-Meier estimators were used to calculate outcome risk overall and across subgroups. Cox proportional-hazards models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI). RESULTS Of 13,522 patients treated with CAS+IMD, 12,972 were matched to 41,848 untreated patients. The 30-day composite outcome risk was 1.9% (95% CI 1.7-2.2) and 4.4% (95% CI 4.2-4.6) in the treated and untreated cohorts, respectively; treated patients had a 49% lower relative risk of the composite outcome (aHR 0.51; 95% CI 0.46-0.58) and a 67% relative risk of 30-day mortality (aHR 0.33, 95% CI 0.18-0.60). Effectiveness was consistent across vaccination status and various subgroups. DISCUSSION Patients with COVID-19 benefitted from treatment with SC CAS+IMD versus untreated patients. The results were consistent across subgroups of patients, including older adults, immunocompromised patients, and patients vaccinated against COVID-19. Results were robust across numerous sensitivity analyses. CONCLUSION SC CAS+IMD is effective in reducing 30-day COVID-19-related hospitalization or mortality in real-world outpatient settings during the Delta-dominant period.
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Affiliation(s)
- Jessica J Jalbert
- Regeneron Pharmaceuticals, Inc., 1 Rockwood Road, Sleepy Hollow, NY, 10510, USA.
| | | | - Vera Mastey
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - Degang Wang
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - Dana Murdock
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | | | | | | | | | - Wenhui Wei
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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18
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Srinivasan V, Weinstein SE, Bhimani A, Clemons NC, Dinolfo M, Shin CS, Grier J, Lopez A, Braggs J, Boucher J, Batiste QN, Garner OB, Yang S, Vijayan T. On variants and vaccines: The effectiveness of Covid-19 monoclonal antibody therapy during two distinct periods in the pandemic. PLoS One 2022; 17:e0278394. [PMID: 36454767 PMCID: PMC9714735 DOI: 10.1371/journal.pone.0278394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 11/15/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND While Covid-19 monoclonal antibody therapies (Mab) have been available in the outpatient setting for over a year and a half, little is known about the impact of emerging variants and vaccinations on the effectiveness of Mab therapies. We sought to determine the effectiveness of Covid-19 Mab therapies during the first two waves of the pandemic in Los Angeles County and assess the impact of vaccines, variants, and other confounding factors. METHODS AND FINDINGS We retrospectively examined records for 2209 patients of with confirmed positive molecular SARS-CoV2 test either referred for outpatient Mab therapy or receiving Mab treatment in the emergency department (ED) between December 2020 and 2021. Our primary outcome was the combined 30-day incidence of ED visit, hospitalization, or death following the date of referral. Additionally, SARS-CoV2 isolates of hospitalized patients receiving Mabs were sequenced. The primary outcome was significantly reduced with combination therapy compared to bamlanivimab or no treatment (aHR 0·60; 95% CI ·37, ·99), with greater benefit in unvaccinated, moderate-to-high-risk patients (aHR ·39; 95% CI ·20, ·77). Significant associations with the primary outcome included history of lung disease (HR 7·13; 95% CI 5·12, 9·95), immunocompromised state (HR 6·59; 95% CI 2·91-14·94), and high social vulnerability (HR 2·29, 95% CI 1·56-3·36). Two predominant variants were noted during the period of observation: the Epsilon variant and the Delta variant. CONCLUSIONS Only select monoclonal antibody therapies significantly reduced ED visits, hospitalizations, and death due to COVID-19 during. Vaccination diminished effectiveness of Mabs. Variant data and vaccination status should be considered when assessing the benefit of novel COVID-19 treatments.
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Affiliation(s)
- Vinay Srinivasan
- David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California, United States of America
| | - Stacey E. Weinstein
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, United States of America
- Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, California, United States of America
| | - Azra Bhimani
- Division of Infectious Diseases, David Geffen School of Medicine, UCLA, Los Angeles, California, United States of America
| | - Nathan C. Clemons
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, United States of America
| | - Melissa Dinolfo
- Ambulatory and Community Practices, UCLA Health, Los Angeles, California, United States of America
| | - Christina S. Shin
- Department of Pharmaceutical Services, Ronald Reagan UCLA Medical Center, Los Angeles, California, United States of America
| | - Jacqueline Grier
- Faculty Practice Group–Ambulatory Care Coordination, UCLA Health, Los Angeles, California, United States of America
| | - Antonio Lopez
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, United States of America
| | - Jamia Braggs
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, United States of America
| | - Joni Boucher
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, United States of America
| | - Quanna N. Batiste
- Department of Ambulatory Nursing, UCLA Health, Los Angeles, California, United States of America
- School of Nursing, UCLA, Los Angeles, California, United States of America
| | - Omai B. Garner
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, United States of America
| | - Shangxin Yang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, United States of America
| | - Tara Vijayan
- Division of Infectious Diseases, David Geffen School of Medicine, UCLA, Los Angeles, California, United States of America
- * E-mail:
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19
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DeWolf S, Laracy JC, Perales MA, Kamboj M, van den Brink MRM, Vardhana S. SARS-CoV-2 in immunocompromised individuals. Immunity 2022; 55:1779-1798. [PMID: 36182669 PMCID: PMC9468314 DOI: 10.1016/j.immuni.2022.09.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/24/2022] [Accepted: 09/08/2022] [Indexed: 12/15/2022]
Abstract
Immunocompromised individuals and particularly those with hematologic malignancies are at increased risk for SARS-CoV-2-associated morbidity and mortality due to immunologic deficits that limit prevention, treatment, and clearance of the virus. Understanding the natural history of viral infections in people with impaired immunity due to underlying conditions, immunosuppressive therapy, or a combination thereof has emerged as a critical area of investigation during the COVID-19 pandemic. Studies focused on these individuals have provided key insights into aspects of innate and adaptive immunity underlying both the antiviral immune response and excess inflammation in the setting of COVID-19. This review presents what is known about distinct states of immunologic vulnerability to SARS-CoV-2 and how this information can be harnessed to improve prevention and treatment strategies for immunologically high-risk populations.
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Affiliation(s)
- Susan DeWolf
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Justin C Laracy
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA
| | - Mini Kamboj
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marcel R M van den Brink
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA; Department of Immunology, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Santosha Vardhana
- Weill Cornell Medical College, New York, NY, USA; Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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20
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Kwan BM, Sobczak C, Beaty L, Wynia MK, DeCamp M, Owen V, Ginde AA. Clinician Perspectives on Monoclonal Antibody Treatment for High-Risk Outpatients with COVID-19: Implications for Implementation and Equitable Access. J Gen Intern Med 2022; 37:3426-3434. [PMID: 35790666 PMCID: PMC9255528 DOI: 10.1007/s11606-022-07702-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 06/15/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is an urgent need to identify and address factors influencing uptake and equitable access to monoclonal antibody (mAb) treatment for high-risk outpatients with COVID-19. OBJECTIVE To assess clinician knowledge, beliefs, and experiences regarding obtaining mAb treatment for eligible patients. DESIGN AND PARTICIPANTS Survey of clinicians (N = 374) practicing in the state of Colorado who care for patients with COVID-19 in primary care, emergency medicine, and other clinical settings. MAIN MEASURE(S) Diffusion of innovation theory concepts including knowledge, perceived strength of evidence, barriers, and experience with, ease of use, preparedness, and feasibility, appropriateness, and acceptability of mAb referral systems and processes. KEY RESULTS Most respondents indicated little to no knowledge about mAb therapies for COVID-19 (67%, 74%, 77%, for bamlanivimab, bamlanivimab+etesivimab, and casirivimab+imdevimab, respectively). About half reported little to no familiarity with eligibility criteria (50.9%) and did not know the strength of evidence (31%, 43%, 52%, for bamlanivimab, bamlanivimab+etesivimab, and casirivimab+imdevimab, respectively). Lack of knowledge or confidence in treatment was a top barrier to mAbs use; other barriers included complicated referral processes, patients not eligible when seen, and out-of-pocket costs concerns. Respondents rated four mAb referral steps as generally acceptable, appropriate, and feasible to complete in their primary outpatient clinical setting. Only 24% indicated their clinical setting was very prepared to facilitate referrals, 40% had ever referred a patient for mAbs, and 43% intended to refer a patient in the next month. CONCLUSIONS Clinician education on strength of evidence and eligibility criteria for mAbs is needed. However, education alone is not sufficient. Given the urgent need to rapidly scale up access to treatment and reduce hospitalizations and death from COVID-19, more efficient, equitable systems and processes for referral and delivery of care, such as those coordinated by health systems, public health departments, or disaster management services, are warranted.
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Affiliation(s)
- Bethany M Kwan
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
- Colorado Clinical & Translational Sciences Institute, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Chelsea Sobczak
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Laurel Beaty
- Center for Innovative Design & Analysis, Colorado School of Public Health, Aurora, CO, USA
| | - Matthew K Wynia
- Colorado Clinical & Translational Sciences Institute, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew DeCamp
- Colorado Clinical & Translational Sciences Institute, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Vanessa Owen
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Colorado Clinical & Translational Sciences Institute, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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21
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Stepanova M, Lam B, Younossi E, Felix S, Ziayee M, Price J, Pham H, de Avila L, Terra K, Austin P, Jeffers T, Escheik C, Golabi P, Cable R, Srishord M, Venkatesan C, Henry L, Gerber L, Younossi ZM. The impact of variants and vaccination on the mortality and resource utilization of hospitalized patients with COVID-19. BMC Infect Dis 2022; 22:702. [PMID: 35996076 PMCID: PMC9394045 DOI: 10.1186/s12879-022-07657-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/25/2022] [Indexed: 12/15/2022] Open
Abstract
Background COVID-19 outcomes among hospitalized patients may have changed due to new variants, therapies and vaccine availability. We assessed outcomes of adults hospitalized with COVID-19 from March 2020–February 2022. Methods Data were retrieved from electronic health medical records of adult COVID-19 patients hospitalized in a large community health system. Duration was split into March 2020–June 2021 (pre-Delta period), July–November 2021 (Delta period), and December 2021–February 2022 (Omicron period). Results Of included patients (n = 9582), 75% were admitted during pre-Delta, 9% during Delta, 16% during Omicron period. The COVID-positive inpatients were oldest during Omicron period but had lowest rates of COVID pneumonia and resource utilization (p < 0.0001); 46% were vaccinated during Delta and 61% during Omicron period (p < 0.0001). After adjustment for demographics and comorbidities, vaccination was associated with lower inpatient mortality (OR = 0.47 (0.34–0.65), p < 0.0001). The Omicron period was independently associated with lower risk of inpatient mortality (OR = 0.61 (0.45–0.82), p = 0.0010). Vaccination and Omicron period admission were also independently associated with lower healthcare resource utilization (p < 0.05). Magnitudes of associations varied between age groups with strongest protective effects seen in younger patients. Conclusion Outcomes of COVID-19 inpatients were evolving throughout the pandemic and were affected by changing demographics, virus variants, and vaccination. Key point In this observational study of almost 10,000 patients hospitalized from March 2020–February 2022 with COVID-19, age and having multiple comorbidities remained consistent risk factors for mortality regardless of the variant. Vaccination was high in our hospitalized patients. Vaccination conveyed less severe illness and was associated with lower inpatient mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07657-z.
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Affiliation(s)
- Maria Stepanova
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA. .,Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, VA, USA. .,Medicine Service Line, Inova Health System, Falls Church, VA, USA. .,Betty and Guy Beatty Center for Integrated Research, Claude Moore Health Education and Research bldg., 3300 Gallows rd, Falls Church, VA, 22042, USA.
| | - Brian Lam
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.,Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, VA, USA.,Medicine Service Line, Inova Health System, Falls Church, VA, USA
| | - Elena Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Sean Felix
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Mariam Ziayee
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Jillian Price
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Huong Pham
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Leyla de Avila
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Kathy Terra
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Patrick Austin
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Thomas Jeffers
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Carey Escheik
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Pegah Golabi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.,Medicine Service Line, Inova Health System, Falls Church, VA, USA
| | - Rebecca Cable
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - Manirath Srishord
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.,Medicine Service Line, Inova Health System, Falls Church, VA, USA
| | - Chapy Venkatesan
- Medicine Service Line, Inova Health System, Falls Church, VA, USA
| | - Linda Henry
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.,Medicine Service Line, Inova Health System, Falls Church, VA, USA
| | - Lynn Gerber
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.,Medicine Service Line, Inova Health System, Falls Church, VA, USA
| | - Zobair M Younossi
- Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA. .,Department of Medicine, Center for Liver Disease, Inova Fairfax Medical Campus, Falls Church, VA, USA. .,Medicine Service Line, Inova Health System, Falls Church, VA, USA. .,Betty and Guy Beatty Center for Integrated Research, Claude Moore Health Education and Research bldg., 3300 Gallows rd, Falls Church, VA, 22042, USA.
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22
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Effectiveness of REGEN-COV antibody combination in preventing severe COVID-19 outcomes. Nat Commun 2022; 13:4480. [PMID: 35918340 PMCID: PMC9344792 DOI: 10.1038/s41467-022-32253-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/21/2022] [Indexed: 12/01/2022] Open
Abstract
REGEN-COV, a combination of the monoclonal antibodies casirivimab and imdevimab, has been approved as a treatment for high-risk patients infected with SARS-CoV-2 within five days of their diagnosis. We performed a retrospective cohort study, and used data repositories of Israel’s largest healthcare organization to determine the real-world effectiveness of REGEN-COV treatment against COVID-19-related hospitalization, severe disease, and death. We compared patients infected with Delta variant and treated with REGEN-COV (n = 289) to those infected but not-treated with REGEN-COV (n = 1,296). Demographic and clinical characteristics were used to match patients and for further adjustment as part of the C0x model. Estimated treatment effectiveness was defined as one minus the hazard ratio. Treatment effectiveness of REGEN-COV was 56.4% (95% CI: 23.7–75.1%) in preventing COVID-19 hospitalization, 59.2% (95% CI: 19.9–79.2%) in preventing severe COVID-19, and 93.5% (95% CI: 52.1–99.1%) in preventing COVID-19 death in the 28 days after treatment. In conclusion, REGEN-COV was effective in reducing the risk of severe sequelae in high-risk COVID-19 patients. REGEN-COV is a SARS-CoV-2 combined monoclonal antibody treatment which has been shown to be effective in randomised controlled trials. Here, the authors assess its real-world effectiveness using data from Israel during the Delta wave and find that it reduced the risk of hospitalisation, severe disease and death.
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23
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Martinez MA, Chen TY, Choi H, Hwang M, Navarathna D, Hao L, Gale M, Camus G, Ramirez HE, Jinadatha C. Extended Remdesivir Infusion for Persistent Coronavirus Disease 2019 Infection. Open Forum Infect Dis 2022; 9:ofac382. [PMID: 36039098 PMCID: PMC9384609 DOI: 10.1093/ofid/ofac382] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/28/2022] [Indexed: 01/26/2023] Open
Abstract
Persistent severe acute respiratory syndrome coronavirus 2 infection is difficult to treat. Here, we report a case of 5-month persistent coronavirus disease 2019 in an immunocompromised patient who was successfully treated with 30 consecutive days of remdesivir. Prolonged remdesivir infusion with concurrent cycle threshold monitoring might provide a potential solution to cure these patients with difficult-to-treat infections.
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Affiliation(s)
- Mario A Martinez
- Division of Infectious Diseases, Baylor Scott and White Health, Temple, Texas, USA
| | - Ting-Yi Chen
- Department of Medicine, Central Texas Veterans Health Care System, Temple, Texas, USA
| | - Hosoon Choi
- Department of Research, Central Texas Veterans Health Care System, Temple, Texas, USA
| | - Munok Hwang
- Department of Research, Central Texas Veterans Health Care System, Temple, Texas, USA
| | - Dhammika Navarathna
- Department of Microbiology and Pathology, Central Texas Veterans Health Care System, Temple, Texas, USA
| | - Linhue Hao
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, Washington, USA
| | - Michael Gale
- Center for Innate Immunity and Immune Disease, Department of Immunology, University of Washington, Seattle, Washington, USA
| | | | - Hector E Ramirez
- Division of Infectious Diseases, Baylor Scott and White Health, Temple, Texas, USA
| | - Chetan Jinadatha
- Correspondence: Chetan Jinadatha, MD, MPH, Department of Medicine, Central Texas Veterans Health Care System, 1901 South Veterans Drive, Temple, TX 76504, USA ()
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Somersan-Karakaya S, Mylonakis E, Menon VP, Wells JC, Ali S, Sivapalasingam S, Sun Y, Bhore R, Mei J, Miller J, Cupelli L, Forleo-Neto E, Hooper AT, Hamilton JD, Pan C, Pham V, Zhao Y, Hosain R, Mahmood A, Davis JD, Turner KC, Kim Y, Cook A, Kowal B, Soo Y, DiCioccio AT, Geba GP, Stahl N, Lipsich L, Braunstein N, Herman GA, Yancopoulos GD, Weinreich DM. Casirivimab and Imdevimab for the Treatment of Hospitalized Patients With COVID-19. J Infect Dis 2022; 227:23-34. [PMID: 35895508 PMCID: PMC9384575 DOI: 10.1093/infdis/jiac320] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The open-label RECOVERY study reported improved survival in hospitalized, SARS-CoV-2 seronegative patients treated with casirivimab and imdevimab (CAS + IMD). METHODS In this phase 1/2/3, double-blind, placebo-controlled trial conducted prior to widespread circulation of Delta and Omicron, hospitalized COVID-19 patients were randomized (1:1:1) to 2.4 g or 8.0 g CAS + IMD or placebo, and characterized at baseline for viral load and SARS-CoV-2 serostatus. RESULTS In total, 1336 patients on low-flow or no supplemental (low-flow/no) oxygen were treated. The primary endpoint was met in seronegative patients, the least-squares mean difference (CAS + IMD versus placebo) for time-weighted average change from baseline in viral load through day 7 was -0.28 log10 copies/mL (95% confidence interval [CI], -.51 to -.05; P = .0172). The primary clinical analysis of death or mechanical ventilation from day 6 to 29 in patients with high viral load had a strong positive trend but did not reach significance. CAS + IMD numerically reduced all-cause mortality in seronegative patients through day 29 (relative risk reduction, 55.6%; 95% CI, 24.2%-74.0%). No safety concerns were noted. CONCLUSIONS In hospitalized COVID-19 patients on low-flow/no oxygen, CAS + IMD reduced viral load and likely improves clinical outcomes in the overall population, with the benefit driven by seronegative patients, and no harm observed in seropositive patients. CLINICAL TRIALS REGISTRATION NCT04426695.
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Affiliation(s)
- Selin Somersan-Karakaya
- Correspondence: Selin Somersan-Karakaya, MD, Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Road, Tarrytown, NY 10591-6707 ()
| | | | - Vidya P Menon
- NYC Health + Hospitals/Lincoln, The Bronx, New York, USA
| | | | - Shazia Ali
- Current affiliation: Priovant Therapeutics, Durham, NC
| | | | | | - Rafia Bhore
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Jingning Mei
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Jutta Miller
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Lisa Cupelli
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | | | | | - Cynthia Pan
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Viet Pham
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Yuming Zhao
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | - Adnan Mahmood
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - John D Davis
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | - Yunji Kim
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Amanda Cook
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Bari Kowal
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Yuhwen Soo
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | - Gregory P Geba
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Neil Stahl
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | | | - Ned Braunstein
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
| | - Gary A Herman
- Regeneron Pharmaceuticals, Inc, Tarrytown, New York, USA
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Real-world effectiveness of casirivimab plus indevimab in a dedicated ambulatory unit created for patients with early COVID-19 during a massive delta variant wave. Eur J Clin Microbiol Infect Dis 2022; 41:1145-1149. [PMID: 35896762 PMCID: PMC9330989 DOI: 10.1007/s10096-022-04474-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/18/2022] [Indexed: 12/03/2022]
Abstract
Only limited real-life data are available on the effects of neutralizing monoclonal antibodies in high-risk patients who have early COVID-19 and do not require supplemental oxygen. We prospectively studied 217 patients infected by the delta variant who received casirivimab plus indevimab in a dedicated ambulatory unit created during our 4th COVID wave. Mean age was 64 years, 94% had at least one comorbidity, and mean duration of symptoms was 2.9 days. Oxygen requirement, hospitalization, and mortality rates were 10, 6, and 2.8%, respectively. These results suggest benefits of early administration of neutralizing antibodies in high-risk patients infected with the delta variant.
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Long-term SARS-CoV-2 Asymptomatic Carriage in an Immunocompromised Host: Clinical, Immunological, and Virological Implications. J Clin Immunol 2022; 42:1371-1378. [PMID: 35779200 DOI: 10.1007/s10875-022-01313-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/22/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE SARS-CoV-2 infection in immunocompromised hosts is challenging, and prolonged viral shedding can be a common complication in these patients. We describe the clinical, immunological, and virological course of a patient with eosinophilic granulomatosis with polyangiitis, who developed the status of long-term asymptomatic SARS-CoV-2 carrier for more than 7 months. METHODS Over the study period, the patient underwent 20 RT-PCR tests for SARS-CoV-2 detection on nasopharyngeal swabs. In addition, viral cultures and genetic investigation of SARS-CoV-2 were performed. As for immunological assessment, serological and specific T-cell testing was provided at different time points. RESULTS Despite the patient showing a deep drug-induced B and T adaptive immunity impairment, he did not experience COVID-19 progression to severe complications, and the infection remained asymptomatic during the follow-up period, but he was not able to achieve viral clearance for more than 7 months. The infection was finally cleared by SARS-CoV-2-specific monoclonal antibody treatment, after that remdesivir and convalescent plasma failed in this scope. The genetic investigations evidenced that the infection was sustained by multiple viral subpopulations that had apparently evolved intra-host during the infection. CONCLUSION Our case suggests that people with highly impaired B- and T-cell adaptive immunity can prevent COVID-19 progression to severe complications, but they may not be able to clear SARS-CoV-2 infection. Immunocompromised hosts with a long-term infection may play a role in the emergence of viral variants.
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Nagaoka K, Kawasuji H, Takegoshi Y, Murai Y, Kaneda M, Ueno A, Miyajima Y, Niimi H, Morinaga Y, Yamamoto Y. Effect of Casirivimab/Imdevimab Treatment on Serum Type I Interferon Levels in SARS-CoV-2 Infection. Viruses 2022; 14:v14071399. [PMID: 35891380 PMCID: PMC9318908 DOI: 10.3390/v14071399] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 11/28/2022] Open
Abstract
The effects of casirivimab and imdevimab (C/I) on the innate immune response against SARS-CoV-2 infection remain unclear. We evaluated the effect of C/I on type I interferon (IFN-I) and cytokines in patients with SARS-CoV-2 infection. This prospective observational study recruited consecutive patients hospitalized with SARS-CoV-2 infection. Blood levels of IFN-I and cytokines before and after C/I administration were assessed using enzyme-linked immunoassay. The study enrolled 29 patients in the C/I group. In addition, 11 patients who received remdesivir and dexamethasone (R/D group) during the early phase (≤5 days after the onset of symptoms) were included as a comparator group. After treatment, IFN-α and IFN-β levels decreased significantly in both the C/I group and R/D group, whilst the post-treatment neutrophil-to-lymphoid ratio increased in the early C/I group but not the R/D group. In the C/I group, temporal temperature elevation and hypoxemia were observed after treatment in 58.6% and 41.4% of the cohort, respectively. However, most patients recovered by 5 days after treatment. This study could demonstrate the high therapeutic effect of C/I with an antibody-dependent enhancement-like response and decreased IFN-I production, which was likely due to the immediate induction of an antibody-dependent immune response against SARS-CoV-2.
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Affiliation(s)
- Kentaro Nagaoka
- Department of Clinical Infectious Diseases, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan; (H.K.); (Y.T.); (Y.M.); (M.K.); (A.U.); (Y.M.); (Y.Y.)
- Correspondence:
| | - Hitoshi Kawasuji
- Department of Clinical Infectious Diseases, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan; (H.K.); (Y.T.); (Y.M.); (M.K.); (A.U.); (Y.M.); (Y.Y.)
| | - Yusuke Takegoshi
- Department of Clinical Infectious Diseases, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan; (H.K.); (Y.T.); (Y.M.); (M.K.); (A.U.); (Y.M.); (Y.Y.)
| | - Yushi Murai
- Department of Clinical Infectious Diseases, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan; (H.K.); (Y.T.); (Y.M.); (M.K.); (A.U.); (Y.M.); (Y.Y.)
| | - Makito Kaneda
- Department of Clinical Infectious Diseases, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan; (H.K.); (Y.T.); (Y.M.); (M.K.); (A.U.); (Y.M.); (Y.Y.)
| | - Akitoshi Ueno
- Department of Clinical Infectious Diseases, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan; (H.K.); (Y.T.); (Y.M.); (M.K.); (A.U.); (Y.M.); (Y.Y.)
| | - Yuki Miyajima
- Department of Clinical Infectious Diseases, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan; (H.K.); (Y.T.); (Y.M.); (M.K.); (A.U.); (Y.M.); (Y.Y.)
| | - Hideki Niimi
- Department of Clinical Laboratory and Molecular Pathology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan;
| | - Yoshitomo Morinaga
- Department of Microbiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan;
| | - Yoshihiro Yamamoto
- Department of Clinical Infectious Diseases, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama 930-0194, Japan; (H.K.); (Y.T.); (Y.M.); (M.K.); (A.U.); (Y.M.); (Y.Y.)
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Arias M, Oliveros H, Lechtig S, Bustos RH. Biologics in COVID-19 So Far: Systematic Review. Pharmaceuticals (Basel) 2022; 15:ph15070783. [PMID: 35890081 PMCID: PMC9321859 DOI: 10.3390/ph15070783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 12/17/2022] Open
Abstract
This systematic review aimed to reevaluate the available evidence of the use of biologics as treatment candidates for the treatment of severe and advanced COVID-19 disease; what are the rationale for their use, which are the most studied, and what kind of efficacy measures are described? A search through Cochrane, Embase, Pubmed, Medline, medrxiv.org, and Google scholar was performed on the use of biologic interventions in COVID-19/SARS-CoV-2 infection, viral pneumonia, and sepsis, until 11 January 2022. Throughout the research, we identified 4821 records, of which 90 were selected for qualitative analysis. Amongst the results, we identified five popular targets of use: IL6 and IL1 inhibitors, interferons, mesenchymal stem cells treatment, and anti-spike antibodies. None of them offered conclusive evidence of their efficacy with consistency and statistical significance except for some studies with anti-spike antibodies; however, Il6 and IL1 inhibitors as well as interferons show encouraging data in terms of increased survival and favorable clinical course that require further studies with better methodology standardization.
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Affiliation(s)
- Milton Arias
- Department of Clinical Pharmacology, Evidence-Based Therapeutics Group, Faculty of Medicine, Universidad de La Sabana and Clínica Universidad de La Sabana, Autopista Norte de Bogotá, Chía 140013, Colombia; (M.A.); (S.L.)
| | - Henry Oliveros
- Department of Epidemiology, Health Research Group, Faculty of Medicine, Universidad de La Sabana, Campus del Puente del Común, Km. 7, Autopista Norte de Bogotá, Chía 140013, Colombia;
| | - Sharon Lechtig
- Department of Clinical Pharmacology, Evidence-Based Therapeutics Group, Faculty of Medicine, Universidad de La Sabana and Clínica Universidad de La Sabana, Autopista Norte de Bogotá, Chía 140013, Colombia; (M.A.); (S.L.)
| | - Rosa-Helena Bustos
- Department of Clinical Pharmacology, Evidence-Based Therapeutics Group, Faculty of Medicine, Universidad de La Sabana and Clínica Universidad de La Sabana, Autopista Norte de Bogotá, Chía 140013, Colombia; (M.A.); (S.L.)
- Correspondence: ; Tel.: +57-1608615555
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Savoldi A, Morra M, De Nardo P, Cattelan AM, Mirandola M, Manfrin V, Scotton P, Giordani MT, Brollo L, Panese S, Lanzafame M, Scroccaro G, Berkell M, Lippi G, Konnova A, Smet M, Malhotra-Kumar S, Kumar-Singh S, Tacconelli E. Clinical efficacy of different monoclonal antibody regimens among non-hospitalised patients with mild to moderate COVID-19 at high risk for disease progression: a prospective cohort study. Eur J Clin Microbiol Infect Dis 2022; 41:1065-1076. [PMID: 35727429 PMCID: PMC9209841 DOI: 10.1007/s10096-022-04464-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/31/2022] [Indexed: 11/25/2022]
Abstract
This study aimed to compare the clinical progression of COVID-19 in high-risk outpatients treated with the monoclonal antibodies (mAb) bamlanivimab, bamlanivimab-etesevimab and casirivimab-imdevimab. This is an observational, multi-centre, prospective study conducted from 18 March to 15 July 2021 in eight Italian tertiary-care hospitals including mild-to-moderate COVID-19 outpatients receiving bamlanivimab (700 mg), bamlanivimab-etesevimab (700–1400 mg) or casirivimab-imdevimab (1200–1200 mg). All patients were at high risk of COVID-19 progression according to Italian Medicines Agency definitions. In a patient subgroup, SARS-CoV-2 variant and anti-SARS-CoV-2 serology were analysed at baseline. Factors associated with 28-day all-cause hospitalisation were identified using multivariable multilevel logistic regression (MMLR) and summarised with adjusted odds ratio (aOR) and 95% confidence interval (CI). A total of 635 outpatients received mAb: 161 (25.4%) bamlanivimab, 396 (62.4%) bamlanivimab-etesevimab and 78 (12.2%) casirivimab-imdevimab. Ninety-five (15%) patients received full or partial SARS-CoV-2 vaccination. The B.1.1.7 (Alpha) variant was detected in 99% of patients. Baseline serology showed no significant differences among the three mAb regimen groups. Twenty-eight-day all-cause hospitalisation was 11.3%, with a significantly higher proportion (p 0.001) in the bamlanivimab group (18.6%), compared to the bamlanivimab-etesevimab (10.1%) and casirivimab-imdevimab (2.6%) groups. On MMLR, aORs for 28-day all-cause hospitalisation were significantly lower in patients receiving bamlanivimab-etesevimab (aOR 0.51, 95% CI 0.30–0.88 p 0.015) and casirivimab-imdevimab (aOR 0.14, 95% CI 0.03–0.61, p 0.009) compared to those receiving bamlanivimab. No patients with a history of vaccination were hospitalised. The study suggests differences in clinical outcomes among the first available mAb regimens for treating high-risk COVID-19 outpatients. Randomised trials are needed to compare efficacy of mAb combination regimens in high-risk populations and according to circulating variants.
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Affiliation(s)
- Alessia Savoldi
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Matteo Morra
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Pasquale De Nardo
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy.
| | - Anna Maria Cattelan
- Infectious Disease Unit, Hospital of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Massimo Mirandola
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy.,School of Health Sciences, University of Brighton, Brighton, UK
| | - Vinicio Manfrin
- Division of Infectious and Tropical Diseases, S. Bortolo Hospital, Viale Ferdinando Rodolfi 37, 36100, Vicenza, Italy
| | | | - Maria Teresa Giordani
- Infectious Diseases Unit, Alto Vicentino Santorso Hospital, Azienda ULSS 7via Garziere 42, Santorso, Vicenza, Italy
| | - Lucio Brollo
- Division of Internal Medicine and Cardiology, Infectious Diseases and COVID-19 Section, Jesolo Hospital Via Levantina, 104, 30016, Jesolo, Italy
| | - Sandro Panese
- Infectious Diseases Unit, Azienda ULSS 3 Serenissima, Ss. Giovanni E Paolo Hospital, Castello 6777, 30122, Venice, Italy
| | - Massimiliano Lanzafame
- Division of Infectious Diseases, Ospedale Santa Maria Della Misericordia Hospital, Viale Tre Martiri 140, Rovigo, Rovigo, Italy
| | | | - Matilda Berkell
- Lab of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium.,Molecular Pathology Group, Cell Biology & Histology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Angelina Konnova
- Molecular Pathology Group, Cell Biology & Histology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Mathias Smet
- Lab of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Surbhi Malhotra-Kumar
- Lab of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Samir Kumar-Singh
- Molecular Pathology Group, Cell Biology & Histology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
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Kosinsky Y, Peskov K, Stanski DR, Wetmore D, Vinetz J. Semi-Mechanistic Pharmacokinetic-Pharmacodynamic Model of Camostat Mesylate-Predicted Efficacy against SARS-CoV-2 in COVID-19. Microbiol Spectr 2022; 10:e0216721. [PMID: 35412356 PMCID: PMC9047529 DOI: 10.1128/spectrum.02167-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/28/2022] [Indexed: 12/15/2022] Open
Abstract
The SARS-CoV-2 coronavirus, which causes COVID-19, uses a viral surface spike protein for host cell entry and the human cell-surface transmembrane serine protease, TMPRSS2, to process the spike protein. Camostat mesylate, an orally available and clinically used serine protease inhibitor, inhibits TMPRSS2, supporting clinical trials to investigate its use in COVID-19. A one-compartment pharmacokinetic (PK)/pharmacodynamic (PD) model for camostat and the active metabolite FOY-251 was developed, incorporating TMPRSS2 reversible covalent inhibition by FOY-251, and empirical equations linking TMPRSS2 inhibition of SARS-CoV-2 cell entry. The model predicts that 95% inhibition of TMPRSS2 is required for 50% inhibition of viral entry efficiency. For camostat 200 mg dosed four times daily, 90% inhibition of TMPRSS2 is predicted to occur but with only about 40% viral entry inhibition. For 3-fold higher camostat dosing, marginal improvement of viral entry rate inhibition, up to 54%, is predicted. Because respiratory tract viral load may be associated with negative outcome, even modestly reducing viral entry and respiratory tract viral load may reduce disease progression. This modeling also supports medicinal chemistry approaches to enhancing PK/PD and potency of the camostat molecule. IMPORTANCE Strategies to repurpose already-approved drugs for the treatment of COVID-19 has been attractive since the beginning of the pandemic. Camostat mesylate, a serine protease inhibitor approved in Japan for the treatment of acute exacerbations of chronic pancreatitis, inhibits TMPRSS1, a host cell surface serine protease essential for SARS-CoV-2 viral entry. In vitro experiments provided data suggesting that camostat might be effective in the treatment of COVID-19. Multiple clinical trials were planned to test the hypothesis that camostat would be beneficial for treating COVID-19 (for example, clinicaltrials.gov, NCT04353284). The present work used a one-compartment pharmacokinetic (PK)/pharmacodynamic (PD) mathematical model for camostat and the active metabolite FOY-251, incorporating TMPRSS2 reversible covalent inhibition by FOY-251, and empirical equations linking TMPRSS2 inhibition of SARS-CoV-2 cell entry. This work is valuable to guide further development of camostat mesylate and possible medicinal chemistry derivatives for the treatment of COVID-19.
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Affiliation(s)
| | - Kirill Peskov
- M&S Decisions LLC, Moscow, Russia
- Sechenov First Moscow State Medical University, Moscow, Russia
- STU “Sirius,” Sochi, Russia
| | | | - Diana Wetmore
- Harrington Discovery Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Joseph Vinetz
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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Burgasova OA, Dolinniy SV, Tetova VB, Ogarkova DA, Odnoralov MA, Bakalin VV, Smetanina SV, Antipyat NA, Taranova MV. Experience of tocilizumab in hospital patients with moderate COVID-19. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2022. [DOI: 10.24075/brsmu.2022.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Severe form of COVID 19 has been linked to the phenomenon of dysregulated inflammation with excessive cytokine release and elevated interleukin 6 (IL6) levels. Suppressive agents enabling specific inhibition of cytokines, notably monoclonal antibodies to IL6 and its receptors, have been applied as a rescue therapy in COVID 19 despite the underexplored clinical scope for these biologic medications. This study aimed to evaluate the clinical utility of IL6 receptor antagonist tocilizumab in moderate symptomatic COVID 19 prone to aggravation. The retrospective cohort study enrolled two groups of hospitalized patients (a total of n = 72) diagnosed with moderate COVID-19. The main group received a single 400 mg dose of tocilizumab (TCZ) on top of standard therapy. The comparative analysis included statistical evaluation for a number of clinical and laboratory parameters at reference time points and disease outcomes with regard to treatment strategy. Overall, TCZ administration provided no advantages in terms of oxygen supplementation status, disease progression, or survival. Lethal cases constituted 19.2% (10 pts) and 5% (1 pt) in TCZ and comparison groups, respectively. The results indicate that administration of monoclonal antibody drugs in hospital patients with COVID-19 must follow differential schemes with regard to the disease severity and comorbidities, as well as proper commencement schedules.
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Affiliation(s)
- OA Burgasova
- Peoples’ Friendship University of Russia, Moscow, Russia
| | - SV Dolinniy
- Clinical Hospital for Infectious Diseases №1, Moscow, Russia
| | - VB Tetova
- Peoples’ Friendship University of Russia, Moscow, Russia
| | - DA Ogarkova
- Gamaleya National Research Center for Epidemiology and Microbiology, Moscow, Russia
| | - MA Odnoralov
- Peoples’ Friendship University of Russia, Moscow, Russia
| | - VV Bakalin
- Peoples’ Friendship University of Russia, Moscow, Russia
| | - SV Smetanina
- Clinical Hospital for Infectious Diseases №1, Moscow, Russia
| | - NA Antipyat
- Clinical Hospital for Infectious Diseases №1, Moscow, Russia
| | - MV Taranova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Sakurai A, Marshall S, Ogasawara T, Ogasawara T, Aoka Y, Sakura H, Uchigata Y, Ogawa T. REGN-COV2 antibody cocktail in patients with SARS-CoV-2: Observational study from a single institution in Japan. J Infect Chemother 2022; 28:943-947. [PMID: 35414436 PMCID: PMC8986486 DOI: 10.1016/j.jiac.2022.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/16/2022] [Accepted: 03/30/2022] [Indexed: 12/15/2022]
Abstract
Introduction A new treatment for coronavirus disease (COVID-19), REGN-COV2, a cocktail consisting of two neutralizing antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been approved for patients at a risk of developing more severe disease. Methods We retrospectively reviewed patients recently diagnosed with COVID-19 with risk factors for severe infection, who were treated with the REGN-COV2 antibody cocktail between July and September 2021. The REGN-COV2 antibody cocktail was administered to patients within 7 days of disease onset, with an oxygen saturation of >93%, and with at least one comorbidity. We investigated the percentage of patients with COVID-19-related hospitalization or death, the duration of symptoms after treatment, and the adverse effects of treatment. Results A total of 108 patients were reviewed. Of them, 64% were aged ≥50 years, 31% had obesity, 36% had hypertension, and 18% had diabetes. In addition, 49% had multiple risk factors for severe COVID-19. Overall, 12 patients (11%) needed COVID-19-related hospitalization. No adverse effects of treatment were observed. Conclusions This study shows that treatment with the REGN-COV2 antibody cocktail is safe and beneficial in patients at a risk of developing severe COVID-19.
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Di Chiara C, Mengato D, De Pieri M, Longo G, Benetti E, Venturini F, Giaquinto C, Donà D. Early Use of Sotrovimab in Children: A Case Report of an 11-Year-Old Kidney Transplant Recipient Infected with SARS-CoV-2. CHILDREN (BASEL, SWITZERLAND) 2022; 9:451. [PMID: 35455495 PMCID: PMC9028505 DOI: 10.3390/children9040451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/19/2022] [Accepted: 03/20/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The use of virus-neutralizing monoclonal antibodies has been approved in fragile populations, including kidney transplant recipients, who are at risk of developing severe COVID-19. Sotrovimab is the only currently available anti-SARS-CoV-2 neutralizing monoclonal antibody with activity against the new Omicron variant of concern. While sotrovimab has been approved in adolescents and adults, studies regarding its efficacy and safety in children aged less than 12 years old and weighing less than 40 kg are still lacking. Here, we report a first case of a child, who was treated early with sotrovimab after a kidney transplant. CASE REPORT At the end of January 2022, a 11-year-old male child underwent a deceased-donor kidney transplant and became infected with SARS-CoV-2 during the first day after surgery. Due to the increased risk of developing severe COVID-19, based on the predominance of Omicron and the patient's renal function, the child was treated with sotrovimab. The clinical course was successful and no adverse reactions were reported. CONCLUSIONS For the first time, we report the well-tolerated use of sotrovimab in children under 12 years old. As the pandemic affects children across the globe, urgent data on sotrovimab dosing in children with a higher risk of developing severe COVID-19 are needed.
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Affiliation(s)
- Costanza Di Chiara
- Department for Women’s and Children’s Health, Division of Pediatric Infectious Diseases, University of Padua, 35128 Padua, Italy; (M.D.P.); (C.G.); (D.D.)
| | - Daniele Mengato
- Hospital Pharmacy Department, University Hospital of Padova, 35121 Padua, Italy; (D.M.); (F.V.)
| | - Marica De Pieri
- Department for Women’s and Children’s Health, Division of Pediatric Infectious Diseases, University of Padua, 35128 Padua, Italy; (M.D.P.); (C.G.); (D.D.)
| | - Germana Longo
- Department for Women’s and Children’s Health, Division of Pediatric Nefrology Unit, University of Padua, 35128 Padua, Italy; (G.L.); (E.B.)
| | - Elisa Benetti
- Department for Women’s and Children’s Health, Division of Pediatric Nefrology Unit, University of Padua, 35128 Padua, Italy; (G.L.); (E.B.)
| | - Francesca Venturini
- Hospital Pharmacy Department, University Hospital of Padova, 35121 Padua, Italy; (D.M.); (F.V.)
| | - Carlo Giaquinto
- Department for Women’s and Children’s Health, Division of Pediatric Infectious Diseases, University of Padua, 35128 Padua, Italy; (M.D.P.); (C.G.); (D.D.)
| | - Daniele Donà
- Department for Women’s and Children’s Health, Division of Pediatric Infectious Diseases, University of Padua, 35128 Padua, Italy; (M.D.P.); (C.G.); (D.D.)
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McKendry R, Lemm NM, Papargyris L, Chiu C. Human Challenge Studies with Coronaviruses Old and New. Curr Top Microbiol Immunol 2022. [PMID: 35181805 DOI: 10.1007/82_2021_247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Coronavirus infections have been known to cause disease in animals since as early as the 1920s. However, only seven coronaviruses capable of causing human disease have been identified thus far. These Human Coronaviruses (HCoVs) include the causes of the common cold, but more recent coronaviruses that have emerged (i.e. SARS-CoV, MERS-CoV and SARS-CoV-2) are associated with much greater morbidity and mortality. HCoVs have been relatively under-studied compared to other common respiratory infections, as historically they have presented with mild symptoms. This has led to a relatively limited understanding of their animal reservoirs, transmission and determinants of immune protection. To address this, human infection challenge studies with HCoVs have been performed that enable a detailed clinical and immunological analysis of the host response at specific time points under controlled conditions with standardised viral inocula. Until recently, all such human challenge studies were conducted with common cold HCoVs, with the study of SARS-CoV and MERS-CoV unacceptable due to their greater pathogenicity. However, with the emergence of SARS-CoV-2 and the COVID-19 pandemic during which severe outcomes in young healthy adults have been rare, human challenge studies with SARS-CoV-2 are now being developed. Two SARS-CoV-2 human challenge studies in the UK studying individuals with and without pre-existing immunity are underway. As well as providing a platform for testing of antivirals and vaccines, such studies will be critical for understanding the factors associated with susceptibility to SARS-CoV-2 infection and thus developing improved strategies to tackle the current as well as future HCoV pandemics. Here, we summarise the major questions about protection and pathogenesis in HCoV infection that human infection challenge studies have attempted to answer historically, as well as the knowledge gaps that aim to be addressed with contemporary models.
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Affiliation(s)
- Richard McKendry
- Department of Infectious Disease, Imperial College London, London, UK
| | - Nana-Marie Lemm
- Department of Infectious Disease, Imperial College London, London, UK
| | - Loukas Papargyris
- Department of Infectious Disease, Imperial College London, London, UK
| | - Christopher Chiu
- Department of Infectious Disease, Imperial College London, London, UK.
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35
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Kountouras J, Gialamprinou D, Kotronis G, Papaefthymiou A, Economidou E, Soteriades ES, Vardaka E, Chatzopoulos D, Tzitiridou-Chatzopoulou M, Papazoglou DD, Doulberis M. Ofeleein i mi Vlaptin-Volume II: Immunity Following Infection or mRNA Vaccination, Drug Therapies and Non-Pharmacological Management at Post-Two Years SARS-CoV-2 Pandemic. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:309. [PMID: 35208631 PMCID: PMC8874934 DOI: 10.3390/medicina58020309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/06/2022] [Accepted: 02/14/2022] [Indexed: 12/15/2022]
Abstract
The persistence of the coronavirus disease 2019 (COVID-19) pandemic has triggered research into limiting transmission, morbidity and mortality, thus warranting a comprehensive approach to guide balanced healthcare policies with respect to people's physical and mental health. The mainstay priority during COVID-19 is to achieve widespread immunity, which could be established through natural contact or vaccination. Deep knowledge of the immune response combined with recent specific data indicates the potential inferiority of induced immunity against infection. Moreover, the prevention of transmission has been founded on general non-pharmacological measures of protection, albeit debate exists considering their efficacy and, among other issues, their socio-psychological burden. The second line of defense is engaged after infection and is supported by a plethora of studied agents, such as antibiotics, steroids and non-steroid anti-inflammatory drugs, antiviral medications and other biological agents that have been proposed, though variability in terms of benefits and adverse events has not allowed distinct solutions, albeit certain treatments might have a role in prevention and/or treatment of the disease. This narrative review summarizes the existing literature on the advantages and weaknesses of current COVID-19 management measures, thus underlining the necessity of acting based on the classical principle of "ofeleein i mi vlaptin", that is, to help or not to harm.
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Affiliation(s)
- Jannis Kountouras
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, 54652 Thessaloniki, Central Macedonia, Greece; (A.P.); (E.V.); (D.C.); (M.T.-C.); (M.D.)
| | - Dimitra Gialamprinou
- Second Neonatal Department and NICU, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Central Macedonia, Greece;
| | - Georgios Kotronis
- Department of Internal Medicine, General Hospital Aghios Pavlos of Thessaloniki, 55134 Thessaloniki, Central Macedonia, Greece;
| | - Apostolis Papaefthymiou
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, 54652 Thessaloniki, Central Macedonia, Greece; (A.P.); (E.V.); (D.C.); (M.T.-C.); (M.D.)
- Department of Gastroenterology, University Hospital of Larisa, Mezourlo, 41110 Larisa, Thessaly, Greece
| | - Eleftheria Economidou
- School of Economics and Management, Healthcare Management Program, Open University of Cyprus, Nicosia 12794, Cyprus; (E.E.); (E.S.S.)
| | - Elpidoforos S. Soteriades
- School of Economics and Management, Healthcare Management Program, Open University of Cyprus, Nicosia 12794, Cyprus; (E.E.); (E.S.S.)
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Environmental and Occupational Medicine and Epidemiology (EOME), Boston, MA 02115, USA
| | - Elisabeth Vardaka
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, 54652 Thessaloniki, Central Macedonia, Greece; (A.P.); (E.V.); (D.C.); (M.T.-C.); (M.D.)
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Central Macedonia, Greece
| | - Dimitrios Chatzopoulos
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, 54652 Thessaloniki, Central Macedonia, Greece; (A.P.); (E.V.); (D.C.); (M.T.-C.); (M.D.)
| | - Maria Tzitiridou-Chatzopoulou
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, 54652 Thessaloniki, Central Macedonia, Greece; (A.P.); (E.V.); (D.C.); (M.T.-C.); (M.D.)
- Midwifery Department, School of Healthcare Sciences, University of West Macedonia, Koila, 50100 Kozani, Central Macedonia, Greece
| | - Dimitrios David Papazoglou
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
| | - Michael Doulberis
- Second Medical Clinic, School of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, 54652 Thessaloniki, Central Macedonia, Greece; (A.P.); (E.V.); (D.C.); (M.T.-C.); (M.D.)
- Division of Gastroenterology and Hepatology, Medical University Department, Kantonsspital Aarau, 5001 Aarau, Switzerland
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Weinbergerová B, Demel I, Víšek B, Válka J, Čerňan M, Jindra P, Novák J, Stejskal L, Kovácsová F, Kabut T, Szotkowski T, Hájek R, Žák P, Cetkovský P, Král Z, Mayer J. Successful Early Use of Anti-SARS-CoV-2 Monoclonal Neutralizing Antibodies in SARS-CoV-2 Infected Hematological Patients - A Czech Multicenter Experience. Hematol Oncol 2022; 40:280-286. [PMID: 35120267 PMCID: PMC9015292 DOI: 10.1002/hon.2974] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
COVID‐19 significantly impairs survival rates among hematological patients when compared to the general population. Our prospective multicentre project analyzed early administration of anti‐SARS‐CoV‐2 spike protein neutralizing monoclonal antibodies (NmAbs) – bamlanivimab (72%) and casirivimab/imdevimab (28%) – efficacy among hematological patients with early‐stage COVID‐19. Mortality rate was compared to a control cohort of 575 SARS‐CoV‐2 positive hematological patients untreated with any specific anti‐COVID‐19 therapy. 88 hematological patients with lymphomas, acute leukemias, and myeloma as their most frequent underlying diagnoses (72%) were evaluated with a 97 days median follow‐up after NmAb administration. One third of patients (32%) were treated with an anti‐CD20 monoclonal antibody before COVID‐19 diagnosis. Median time between first COVID‐19 symptom and NmAb administration was 2 days. When administering NmAb, 29%, 57%, 11%, 2%, and 1% of our patients had asymptomatic, mild, moderate, severe, and critical degrees of COVID‐19, respectively. 80% of baseline asymptomatic patients remained asymptomatic following NmAb administration. Median duration of COVID‐19 symptoms after NmAb administration was 2.5 days. Progression to severe/critical COVID‐19 occurred among a total of 17% (15/88) of our cases and numerically higher with bamlanivimab versus casirivimab/imdevimab (21% vs. 8%; p = 0.215), and myelomas (29%), lymphomas (17%) and acute leukemias (18%), respectively. During final follow‐up, nine deaths (10%) were recorded ‐ all after bamlanivimab (p = 0.056) with 8% attributed to COVID‐19. Regarding “remdesivir/convalescent plasma naïve” patients, COVID‐19 mortality rates were significantly lower in our NmAbs treated cohort compared to the control cohort of untreated SARS‐CoV‐2 positive hematological patients (6% vs. 16%, p = 0.020), respectively. Our study validated the safety and efficacy of NmAbs early use among hematological patients with newly diagnosed early‐stage COVID‐19 in terms of alleviating infection course and decreasing mortality. Results confirmed a more positive effect of a casirivimab/imdevimab combination versus bamlanivimab monotherapy.
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Affiliation(s)
- Barbora Weinbergerová
- Department of Internal Medicine - Hematology and Oncology, Masaryk University, Brno, Czech Republic.,Department of Internal Medicine - Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Ivo Demel
- Department of Haemato-oncology, University Hospital Ostrava, Ostrava, Czech Republic.,Department of Haemato-oncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Benjamin Víšek
- 4th Department of Internal Medicine-Hematology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jan Válka
- Institute of Hematology and Blood Transfusion, Prague, Prague, Czech Republic
| | - Martin Čerňan
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Pavel Jindra
- Department of Haematology and Oncology, University Hospital Pilsen, Pilsen, Czech Republic
| | - Jan Novák
- Department of Internal Medicine and Haematology, University Hospital Královské Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lukáš Stejskal
- Department of Hematology, Silesian Hospital in Opava, Opava, Czech Republic
| | - Flóra Kovácsová
- Department of Internal Medicine - Hematology and Oncology, Masaryk University, Brno, Czech Republic.,Department of Internal Medicine - Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Tomáš Kabut
- Department of Internal Medicine - Hematology and Oncology, Masaryk University, Brno, Czech Republic.,Department of Internal Medicine - Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Tomáš Szotkowski
- Department of Hemato-Oncology, Faculty of Medicine and Dentistry, Palacký University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Roman Hájek
- Department of Haemato-oncology, University Hospital Ostrava, Ostrava, Czech Republic.,Department of Haemato-oncology, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Pavel Žák
- 4th Department of Internal Medicine-Hematology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Petr Cetkovský
- Institute of Hematology and Blood Transfusion, Prague, Prague, Czech Republic
| | - Zdeněk Král
- Department of Internal Medicine - Hematology and Oncology, Masaryk University, Brno, Czech Republic.,Department of Internal Medicine - Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Jiří Mayer
- Department of Internal Medicine - Hematology and Oncology, Masaryk University, Brno, Czech Republic.,Department of Internal Medicine - Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
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37
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Suzuki Y, Shibata Y, Minemura H, Nikaido T, Tanino Y, Fukuhara A, Kanno R, Saito H, Suzuki S, Ishii T, Inokoshi Y, Sando E, Sakuma H, Kobayashi T, Kume H, Kamimoto M, Aoki H, Takama A, Kamiyama T, Nakayama M, Saito K, Tanigawa K, Sato M, Kanbe T, Kanzaki N, Azuma T, Sakamoto K, Nakamura Y, Ohtani H, Waragai M, Maeda S, Ishida T, Sugino K, Tsukada Y, Yamada R, Sato R, Onuma T, Tomita H, Saito M, Watanabe N, Rikimaru M, Kawamata T, Umeda T, Morimoto J, Togawa R, Sato Y, Saito J, Kanazawa K, Iseki K. Real-world clinical outcomes of treatment with casirivimab-imdevimab among patients with mild-to-moderate coronavirus disease 2019 during the Delta variant pandemic. Int J Med Sci 2022; 19:834-841. [PMID: 35693744 PMCID: PMC9149641 DOI: 10.7150/ijms.71132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/22/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Mutations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may reduce the efficacy of neutralizing monoclonal antibody therapy against coronavirus disease 2019 (COVID-19). We here evaluated the efficacy of casirivimab-imdevimab in patients with mild-to-moderate COVID-19 during the Delta variant surge in Fukushima Prefecture, Japan. Methods: We enrolled 949 patients with mild-to-moderate COVID-19 who were admitted to hospital between July 24, 2021 and September 30, 2021. Clinical deterioration after admission was compared between casirivimab-imdevimab users (n = 314) and non-users (n = 635). Results: The casirivimab-imdevimab users were older (P < 0.0001), had higher body temperature (≥ 38°C) (P < 0.0001) and greater rates of history of cigarette smoking (P = 0.0068), hypertension (P = 0.0004), obesity (P < 0.0001), and dyslipidemia (P < 0.0001) than the non-users. Multivariate logistic regression analysis demonstrated that receiving casirivimab-imdevimab was an independent factor for preventing deterioration (odds ratio 0.448; 95% confidence interval 0.263-0.763; P = 0.0023). Furthermore, in 222 patients who were selected from each group after matching on the propensity score, deterioration was significantly lower among those receiving casirivimab-imdevimab compared to those not receiving casirivimab-imdevimab (7.66% vs 14.0%; p = 0.021). Conclusion: This real-world study demonstrates that casirivimab-imdevimab contributes to the prevention of deterioration in COVID-19 patients after hospitalization during a Delta variant surge.
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Affiliation(s)
- Yasuhito Suzuki
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yoko Shibata
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hiroyuki Minemura
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takefumi Nikaido
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan.,Department of Pulmonary Medicine, Ohara General Hospital, Fukushima, Japan
| | - Yoshinori Tanino
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Atsuro Fukuhara
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan.,Department of Infectious Disease and Pulmonary Medicine, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Ryuzo Kanno
- Department of Thoracic Surgery, Fukushima Red Cross Hospital, Fukushima, Japan
| | - Hiroyuki Saito
- Department of Internal Medicine, Fujita General Hospital, Fukushima, Japan
| | - Shuzo Suzuki
- Department of Internal Medicine, Fujita General Hospital, Fukushima, Japan
| | - Taeko Ishii
- Department of Pulmonary Medicine, Saiseikai Fukushima General Hospital, Fukushima, Japan
| | - Yayoi Inokoshi
- Department of Pulmonary Medicine, Saiseikai Fukushima General Hospital, Fukushima, Japan
| | - Eiichiro Sando
- Department of General Internal Medicine and Clinical Infectious Diseases, Fukushima Medical University, Fukushima, Japan
| | - Hirofumi Sakuma
- Department of Internal Medicine, Saiseikai Kawamata Hospital, Fukushima, Japan
| | - Tatsuho Kobayashi
- Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Fukushima, Japan
| | - Hiroaki Kume
- Department of Infectious Disease and Pulmonary Medicine, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Masahiro Kamimoto
- Department of Internal Medicine, Takeda General Hospital, Fukushima, Japan
| | - Hideko Aoki
- Department of Pediatric Medicine, Bange Kousei General Hospital, Fukushima, Japan
| | - Akira Takama
- Department of Surgery, Yurin Hospital, Fukushima, Japan
| | - Takamichi Kamiyama
- Department of Pediatric Surgery, Iwaki City Medical Center, Fukushima, Japan
| | - Masaru Nakayama
- Department of Internal Medicine, Kashima Hospital, Fukushima, Japan
| | - Kiyoshi Saito
- Department of Neurosurgery, Fukushima Rosai Hospital, Fukushima, Japan
| | - Koichi Tanigawa
- Department of Emergency and Critical Care Medicine, Futaba Medical Center, Fukushima, Japan
| | - Masahiko Sato
- Department of Internal Medicine, Soma General Hospital, Fukushima, Japan
| | - Toshiyuki Kanbe
- Department of Pulmonary Medicine, Minami-Soma Municipal General Hospital, Fukushima, Japan
| | - Norio Kanzaki
- Department of Surgery, Onahama Chuo Clinic, Fukushima, Japan
| | - Teruhisa Azuma
- Department of General Medicine, Shirakawa Satellite for Teaching and Research, Fukushima Medical University, Fukushima, Japan
| | - Keiji Sakamoto
- Department of Cardiology and Vascular Medicine, Hoshi General Hospital, Fukushima, Japan
| | - Yuichi Nakamura
- Department of Cardiology and Vascular Medicine, Hoshi General Hospital, Fukushima, Japan
| | - Hiroshi Ohtani
- Department of Internal Medicine, Iwase General Hospital, Sukagawa, Japan
| | - Mitsuru Waragai
- Department of Surgery, Southern TOHOKU General Hospital, Fukushima, Japan
| | - Shinsaku Maeda
- Department of Pulmonary Medicine, Jusendo General Hospital, Fukushima, Japan
| | - Tokiya Ishida
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, Fukushima, Japan
| | - Keishi Sugino
- Department of Respiratory Medicine, Tsuboi Hospital, Fukushima, Japan
| | - Yasuhiko Tsukada
- Department of Emergency and Critical Care Medicine, Fukushima Medical University, Fukushima, Japan
| | - Ryuki Yamada
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Riko Sato
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takumi Onuma
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hikaru Tomita
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Mikako Saito
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Natsumi Watanabe
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Mami Rikimaru
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takaya Kawamata
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takashi Umeda
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Julia Morimoto
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Ryuichi Togawa
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yuki Sato
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Junpei Saito
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kenya Kanazawa
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Ken Iseki
- Department of Emergency and Critical Care Medicine, Fukushima Medical University, Fukushima, Japan
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Lan Q, Xia S, Lu L. Coronavirus Entry Inhibitors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1366:101-121. [DOI: 10.1007/978-981-16-8702-0_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bao H, Guo Y, Chang MH, McSweeney T, Golia AM, Cowman K, Bartash R, Anosike BI, Nori P. Expanding the scope and visibility of ambulatory stewardship programs with novel coronavirus disease 2019 (COVID-19) therapeutics. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e73. [PMID: 36483336 PMCID: PMC9726567 DOI: 10.1017/ash.2022.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 05/07/2023]
Abstract
Antimicrobial stewardship programs (ASPs) can be expanded to the outpatient setting to serve as a first line of defense against coronavirus disease 19 (COVID-19) hospitalizations and to reduce the burden on emergency departments and acute-care hospitals. Given the numerous emergency use authorizations of monoclonal antibodies and oral antivirals, ASPs possess the expertise and leadership to direct ambulatory COVID-19 initiatives and transform it into a predominantly outpatient illness. In this review, we summarize the critical role and benefits of an ASP-championed ambulatory COVID-19 therapeutics program.
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Affiliation(s)
- Hongkai Bao
- Department of Pharmacy, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York
- Author for correspondence: Hongkai Bao, Department of Pharmacy, Montefiore Health System, Wakefield Division, 600 E 233rd Street G-55, Bronx, NY10466. E-mail:
| | - Yi Guo
- Department of Pharmacy, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York
| | - Mei H. Chang
- Department of Pharmacy, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York
| | - Terrence McSweeney
- Department of Pharmacy, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York
| | - Austin M. Golia
- Department of Pharmacy, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York
| | - Kelsie Cowman
- Network Performance Group, Montefiore Health System, Bronx, New York
- Division of Infectious Diseases, Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York
| | - Rachel Bartash
- Division of Infectious Diseases, Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York
| | - Brenda I. Anosike
- Division of Infectious Diseases, Children’s Hospital at Montefiore, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York
| | - Priya Nori
- Division of Infectious Diseases, Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York
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40
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Case Report of COVID-19 Infection After Kidney Transplant Treated With Casirivimab-Imdevimab and Mycophenolate Mofetil Changed to Everolimus. Transplant Proc 2021; 54:1561-1563. [PMID: 35065832 PMCID: PMC8718884 DOI: 10.1016/j.transproceed.2021.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/21/2021] [Accepted: 12/27/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Casirivimab-imdevimab is a cocktail of 2 monoclonal antibodies designed to prevent infection by SARS-CoV-2, the virus that causes COVID-19. Casirivimab-imdevimab has been approved in Japan for treating mild to moderate COVID-19; however, to our knowledge, there are no reports of its use after kidney transplant from a live donor. Everolimus, an antineoplastic chemotherapy drug, is expected to be effective in inhibiting the spread of SARS-CoV-2 and preventing its replication, which may facilitate treatment. Here, we report a case of COVID-19 infection after kidney transplant that was initially treated with casirivimab-imdevimab and mycophenolate mofetil but was later changed to everolimus. CASE REPORT A 47-year-old man underwent living donor kidney transplant from his mother in 2017. Immunosuppression therapy was underway through the administration of tacrolimus, mycophenolate mofetil, and methylprednisolone. In early September 2021, he was diagnosed as having COVID-19 and was hospitalized on day 3. On hospitalization, mycophenolate mofetil was discontinued and casirivimab-imdevimab and heparin were started. The patient started an everolimus regimen on day 5. The clinical course was successful without rejection. There was no exacerbation of COVID-19; the patient's serum creatinine levels and renal function had otherwise remained stable. CONCLUSIONS We could safely treat a patient with casirivimab-imdevimab after kidney transplant. It is suggested that casirivimab-imdevimab can prevent COVID-19 from becoming severe and can be administered without worsening renal function. In addition, everolimus may have inhibited the spread of the virus and prevented it from replicating.
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Implementation and Accuracy of BinaxNOW Rapid Antigen COVID-19 Test in Asymptomatic and Symptomatic Populations in a High-Volume Self-Referred Testing Site. Microbiol Spectr 2021; 9:e0100821. [PMID: 34851137 PMCID: PMC8668078 DOI: 10.1128/spectrum.01008-21] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rapid antigen tests are simple to perform and provide results within 15 min. We describe our implementation and assess performance of the BinaxNOW COVID-19 Antigen Test (Abbott Laboratories) in 6,099 adults at a self-referred walk-up testing site. Participants were grouped by self-reported COVID-19 exposure and symptom status. Most (89%) were asymptomatic, of whom 17% reported potential exposure. Overall test sensitivity compared with reference laboratory reverse-transcription [RT] PCR testing was 81% (95% confidence interval [CI] 75%, 86%). It was higher in symptomatic (87%; 95% CI 80%, 91%) than asymptomatic (71%; 95% CI 61%, 80%) individuals. Sensitivity was 82% (95% CI 66%, 91%) for asymptomatic individuals with potential exposure and 64% (95% CI 51%, 76%) for those with no exposure. Specificity was greater than 99% for all groups. BinaxNOW has high accuracy among symptomatic individuals and is below the FDA threshold for emergency use authorization in asymptomatic individuals. Nonetheless, rapid antigen testing quickly identifies positive among those with symptoms and/or close contact exposure and could expedite isolation and treatment. IMPORTANCE The BinaxNOW rapid antigen COVID-19 test had a sensitivity of 87% in symptomatic and 71% asymptomatic individuals when performed by health care workers in a high-throughput setting. The performance may expedite isolation decisions or referrals for time-sensitive monoclonal antibody treatment in communities where timely COVID PCR tests are unavailable.
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Sotrovimab: is it effective in early treatment of mild and moderate COVID-19 infections? A retrospective study. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2021. [PMCID: PMC8685821 DOI: 10.1186/s43168-021-00104-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background The monoclonal antibody sotrovimab is manufactured to antagonize many types of coronaviruses including the SARS-CoV-2. It is used mainly to treat mild and moderate COVID-19 infection and to prevent the progression of the disease from critical disease to severe. Objectives To assess the effectiveness of sotrovimab in the early treatment of mild and moderate COVID-19 infections and prevention of disease progression to severe and critical disease. Methods This study was performed on 220 outpatients who have already received sotrovimab in Obaidullah Hospital, United Arab Emirates. All patients underwent the following before receiving sotrovimab: routine laboratory studies (CBC, liver function tests, and kidney function tests) and other laboratory tests (C reactive protein (CRP), D dimer, and chest x-ray). All patients received sotrovimab in a dose of 500 mg once intravenous infusion over 30 min. All laboratory studies and CXR are repeated after 1 week of receiving the dose of sotrovimab. Results The outcome was 43 patients deteriorated (19.5%) and 177 patients improved (80.5%). The progress of patients’ symptoms after receiving sotrovimab where the shortness of breath (SOB) deteriorated in 43 patients (19.5%) and improved in 177 patients (80.5%). The cough symptom deteriorated in 43 patients (19.5%), improved in 177 patients (80.5%). The progress of patients' radiology (chest x-ray) where it is deteriorated in 43 patients (19.5%) and improved in 177 patients (80.5%). The rate of hospitalization after receiving sotrovimab where 41 patients were hospitalized (18.6%) and 179 patients were not hospitalized (81.4%). There was a statistically significant difference before and after using sotrovimab in vital signs, inflammatory markers, kidney function tests, electrolytes, endocrine functions, and hepatic profile. Conclusion Among adults with mild and moderate COVID-19, the use of sotrovimab significantly improved resolution of symptoms, outcome, radiology, or laboratory marker and decreased hospitalization. The findings support using sotrovimab in the early treatment of mild and moderate COVID-19. Wide-scale studies may be required for clarifying the effects of sotrovimab in the treatment of mild and moderate COVID-19 infections.
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Lee JY, Lee JY, Ko JH, Hyun M, Kim HA, Cho S, Lee YD, Song J, Shin S, Peck KR. Effectiveness of Regdanvimab Treatment in High-Risk COVID-19 Patients to Prevent Progression to Severe Disease. Front Immunol 2021; 12:772320. [PMID: 34899724 PMCID: PMC8657590 DOI: 10.3389/fimmu.2021.772320] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Objective To evaluate clinical effectiveness of regdanvimab, a monoclonal antibody agent for treating coronavirus 2019 (COVID-19). Methods A retrospective cohort study was conducted at two general hospitals during the study period of December 2020 to May 2021. Mild COVID-19 patients with risk factors for disease progression admitted to the hospitals within seven days of symptom onset were enrolled and followed until discharge or referral. Multivariate analyses for disease progression were conducted in the total and propensity score (PS)-matched cohorts. Results A total of 778 mild COVID-19 patients were included and classified as the regdanvimab (n = 234) and supportive care (n = 544) groups. Significantly fewer patients required O2 supplementation via nasal prong in the regdanvimab group (8.1%) than in the supportive care group (18.4%, P < 0.001). The decreased risk for O2 support by regdanvimab treatment was noticed in the multivariate analysis of the total cohort (HR 0.570, 95% CI 0.343-0.946, P = 0.030), but it was not statistically significant in the PS-matched cohort (P = 0.057). Progression to severe disease was also significantly lower in the regdanvimab group (2.1%) than in the supportive care group (9.6%, P < 0.001). The significantly reduced risk for progression to severe disease by regdanvimab treatment was observed in the analysis of both the total cohort (HR 0.262, 95% CI 0.103-0.667, P = 0.005) and PS-matched cohort (HR 0.176, 95% CI 0.060-0.516, P = 0.002). Potential risk factors for progression were investigated in the supportive care group and SpO2 < 97% and CRP elevation >1.5 mg/dL were common risk factors for O2 support and progression to severe disease. Among the patients with any of these factors, regdanvimab treatment was associated with decreased risk for progression to severe disease with slightly lower HR (HR 0.202, 95% CI 0.062-0.657, P = 0.008) than that of the total cohort. Conclusion Regdanvimab treatment was associated with a decreased risk of progression to severe disease.
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Affiliation(s)
- Ji Yeon Lee
- Division of Infectious Diseases, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
| | - Jee Young Lee
- Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea
| | - Jae-Hoon Ko
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Miri Hyun
- Division of Infectious Diseases, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
| | - Hyun Ah Kim
- Division of Infectious Diseases, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
| | - Seongcheol Cho
- Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea
| | - Yong Dae Lee
- Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea
| | - Junghoon Song
- Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea
| | - Seunghwan Shin
- Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, South Korea
| | - Kyong Ran Peck
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Tuli HS, Sak K, Aggarwal P, Iqubal A, Upadhaya SK, Kaur J, Kaur G, Aggarwal D. Molecular Evolution of Severe Acute Respiratory Syndrome Coronavirus 2: Hazardous and More Hazardous Strains Behind the Coronavirus Disease 2019 Pandemic and Their Targeting by Drugs and Vaccines. Front Cell Infect Microbiol 2021; 11:763687. [PMID: 34970505 PMCID: PMC8712944 DOI: 10.3389/fcimb.2021.763687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/19/2021] [Indexed: 12/13/2022] Open
Abstract
Within almost the last 2 years, the world has been shaken by the coronavirus disease 2019 (COVID-19) pandemic, which has affected the lives of all people. With nearly 4.92 million deaths by October 19, 2021, and serious health damages in millions of people, COVID-19 has been the most serious global challenge after the Second World War. Besides lost lives and long-term health problems, devastating impact on economics, education, and culture will probably leave a lasting impression on the future. Therefore, the actual extent of losses will become obvious only after years. Moreover, despite the availability of different vaccines and vaccination programs, it is still impossible to forecast what the next steps of the virus are or how near we are to the end of the pandemic. In this article, the route of molecular evolution of the coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is thoroughly compiled, highlighting the changes that the virus has undergone during the last 2 years and discussing the approaches that the medical community has undertaken in the fight against virus-induced damages.
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Affiliation(s)
- Hardeep Singh Tuli
- Department of Biotechnology, Maharishi Markandeshwar (Deemed to be University), Mullana, India
| | - Katrin Sak
- Non-Governmental Organization (NGO) Praeventio, Tartu, Estonia
| | - Poonam Aggarwal
- The Basic Research Laboratory, Center for Cancer Research, National Cancer Institute at Frederick, National Institutes of Health, Frederick, MD, United States
| | - Ashif Iqubal
- Department of Pharmacology, School of Pharmaceutical Education and Research (Formerly Faculty of Pharmacy), Jamia Hamdard (Deemed to be University), Delhi, India
| | - Sushil K. Upadhaya
- Department of Biotechnology, Maharishi Markandeshwar (Deemed to be University), Mullana, India
| | - Jagjit Kaur
- Graduate School of Biomedical Engineering, ARC Centre of Excellence in Nanoscale BioPhotonics (CNBP), Faculty of Engineering, The University of New South Wales, Sydney, NSW, Australia
| | - Ginpreet Kaur
- Shobhaben Pratapbhai Patel School of Pharmacy and Technology Management, Shri Vile Parle Kelavani Mandal, Narsee Monjee Institute of Management Studies (SVKM’S NMIMS), Mumbai, India
| | - Diwakar Aggarwal
- Department of Biotechnology, Maharishi Markandeshwar (Deemed to be University), Mullana, India
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Rubin EB, Boiarsky JA, Canha LA, Giobbie-Hurder A, Liu M, Townsend MJ, Dougan M. Bamlanivimab Efficacy in Older and High-BMI Outpatients With COVID-19 Selected for Treatment in a Lottery-Based Allocation Process. Open Forum Infect Dis 2021; 8:ofab546. [PMID: 34888396 PMCID: PMC8651159 DOI: 10.1093/ofid/ofab546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background Given the challenges associated with timely delivery of monoclonal antibody (mAb) therapy to outpatients with coronavirus disease 2019 (COVID-19) who are most likely to benefit, it is critical to understand the effectiveness of such therapy outside the context of clinical trials. Methods This was a case-control study of 1257 adult outpatients with COVID-19, ≥65 years of age or with body mass index (BMI) ≥35, who were entered into a lottery for mAb therapy. Results Patients who were called to be offered mAb therapy had a statistically significant 44% reduction in the odds of hospitalization within 30 days of a positive severe acute respiratory syndrome coronavirus 2 test compared with those who were not called (odds ratio [OR], 0.56; 95% CI, 0.36-0.89; P=.01). Patients who actually received bamlanivimab had a statistically significant 68% reduction in the odds of hospitalization compared with those who did not receive bamlanivimab (OR, 0.32; 95% CI, 0.11-0.93; P=.04). Conclusions This study supports the effectiveness of bamlanivimab in reducing COVID-19-related hospitalizations in patients ≥65 or with BMI ≥35.
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Affiliation(s)
- Emily B Rubin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jonathan A Boiarsky
- University of California, Los Angeles Medical Center, Los Angeles, California, USA
| | - Lauren A Canha
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anita Giobbie-Hurder
- Division of Biostatistics, Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Mofei Liu
- Division of Biostatistics, Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Michael Dougan
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Du L, Yang Y, Zhang X. Neutralizing antibodies for the prevention and treatment of COVID-19. Cell Mol Immunol 2021; 18:2293-2306. [PMID: 34497376 PMCID: PMC8424621 DOI: 10.1038/s41423-021-00752-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/18/2021] [Indexed: 02/07/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) initiates the infection process by binding to the viral cellular receptor angiotensin-converting enzyme 2 through the receptor-binding domain (RBD) in the S1 subunit of the viral spike (S) protein. This event is followed by virus-cell membrane fusion mediated by the S2 subunit, which allows virus entry into the host cell. Therefore, the SARS-CoV-2 S protein is a key therapeutic target, and prevention and treatment of coronavirus disease 2019 (COVID-19) have focused on the development of neutralizing monoclonal antibodies (nAbs) that target this protein. In this review, we summarize the nAbs targeting SARS-CoV-2 proteins that have been developed to date, with a focus on the N-terminal domain and RBD of the S protein. We also describe the roles that binding affinity, neutralizing activity, and protection provided by these nAbs play in the prevention and treatment of COVID-19 and discuss the potential to improve nAb efficiency against multiple SARS-CoV-2 variants. This review provides important information for the development of effective nAbs with broad-spectrum activity against current and future SARS-CoV-2 strains.
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Affiliation(s)
- Lanying Du
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA.
| | - Yang Yang
- Roy J. Carver Department of Biochemistry, Biophysics and Molecular Biology, Iowa State University, Ames, IA, USA
| | - Xiujuan Zhang
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
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Zhang X, Lin B, Yang G, Liu L, Lu J, Lu Z, Xue Y. Delayed SARS-CoV-2 Clearance in Patients with Obesity. Infect Drug Resist 2021; 14:2823-2827. [PMID: 34326650 PMCID: PMC8315284 DOI: 10.2147/idr.s319029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/13/2021] [Indexed: 12/23/2022] Open
Abstract
Objective The present study aimed to investigate the correlation between obesity and virus persistence in patients with COVID-19. Design and Methods A total of 57 patients with laboratory-confirmed COVID-19 were admitted to two clinical centers, and data were analyzed retrospectively. Among them, 18 patients with body mass index (BMI) ≥ 25 kg/m2 were diagnosed with obesity, and dynamics of viral replication were compared. Results Eighteen patients were diagnosed with obesity. The correlations between BMI and white blood cell, C-reactive protein, and cycle threshold (Ct) values of ORF1ab were not significant (all P > 0.05). On day 7 after admission, virus clearance was achieved in 13 (33.3%) patients with BMI < 25 kg/m2 and 5 (27.8%) patients with BMI ≥ 25 kg/m2 (χ2 = 0.176, P =0.68). On day 14, the RNA tests were negative in 37 (94.9%) patients with BMI < 25 kg/m2 and 13 (72.2%) patients with BMI ≥ 25 kg/m2 (χ2 = 5.865, P = 0.03). Multivariable analysis showed that only BMI ≥ 25 kg/m2 (P = 0.02) was the independent risk factor for virus clearance on day 14. Conclusion Obesity may affect the clearance of SARS-CoV-2, and BMI should be assessed in patients with COVID-19, although they are not seriously ill.
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Affiliation(s)
- Xiujun Zhang
- Institute of Hepatology, The Third People's Hospital of Changzhou, Changzhou, People's Republic of China.,Department of Liver Diseases, The Third People's Hospital of Changzhou, Changzhou, People's Republic of China
| | - Bin Lin
- Department of Infectious Diseases, The First People's Hospital of Jintan, Changzhou, People's Republic of China
| | - Gang Yang
- Department of Respiratory Diseases, The Second People's Hospital of Wuhu, Wuhu, People's Republic of China
| | - Longgen Liu
- Institute of Hepatology, The Third People's Hospital of Changzhou, Changzhou, People's Republic of China.,Department of Liver Diseases, The Third People's Hospital of Changzhou, Changzhou, People's Republic of China
| | - Jianchun Lu
- Institute of Hepatology, The Third People's Hospital of Changzhou, Changzhou, People's Republic of China.,Department of Liver Diseases, The Third People's Hospital of Changzhou, Changzhou, People's Republic of China
| | - Zhaohui Lu
- Department of Respiratory Diseases, The Second People's Hospital of Wuhu, Wuhu, People's Republic of China
| | - Yuan Xue
- Institute of Hepatology, The Third People's Hospital of Changzhou, Changzhou, People's Republic of China.,Department of Liver Diseases, The Third People's Hospital of Changzhou, Changzhou, People's Republic of China
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