1
|
Amani B, Khodavirdilou L, Rajabkhah K, Kardan Moghaddam V, Akbarzadeh A, Amani B. Efficacy and safety of bamlanivimab in patients with COVID-19: A systematic review and meta-analysis. World J Virol 2024; 13:88660. [PMID: 38616851 PMCID: PMC11008398 DOI: 10.5501/wjv.v13.i1.88660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/09/2023] [Accepted: 12/29/2023] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Monoclonal antibodies (mAbs) have shown clinical benefits against coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several studies have reported the use of bamlanivimab as a promising treatment option for COVID-19. AIM To synthesize the latest evidence for the efficacy and safety of bamlanivimab alone in the treatment of adult patients with COVID-19. METHODS A literature search was conducted in PubMed, Cochrane Library, Web of Science, medRxiv, and Google Scholar using "SARS-CoV-2", "COVID-19", "LY-CoV555", and "Bamlanivimab" keywords up to January 25, 2023. The quality of included studies was assessed using the Cochrane bias tools. The Comprehensive Meta-Analysis software version 3.0 was used to analyze the data. RESULTS A total of 30 studies involving 47368 patients were included. A significant difference was observed between the bamlanivimab and standard of care/placebo groups in terms of mortality rate [risk ratio (RR) = 50, 95% confidence interval (CI): 0.36-0.70], hospitalization rate (RR = 0.51; 95%CI: 0.39-0.68), and emergency department (ED) visits (RR = 0.69; 95%CI: 0.47-0.99); while the two groups exhibited no significant difference in terms of intensive care unit (ICU) admission (P > 0.05). Compared to other mAbs, bamlanivimab was associated with a higher rate of hospitalization (RR = 1.44; 95%CI: 1.07-1.94). However, no significant difference was detected between the bamlanivimab and other mAbs groups in terms of mortality rate, ICU admission, and ED (P > 0.05). The incidence of any adverse events was similar between the bamlanivimab and control groups (P > 0.05). CONCLUSION Although the results suggest the efficacy and safety of bamlanivimab in COVID-19 patients, further research is required to confirm the efficacy of this drug for the current circulating SARS-CoV-2 variants.
Collapse
Affiliation(s)
- Behnam Amani
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran 1416634793, Iran
| | - Lida Khodavirdilou
- Department of Pharmaceutical Sciences, Jerry H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX 79106, United States
| | - Kourosh Rajabkhah
- Deputy of Research and Technology, Tehran University of Medical Sciences, Tehran 1416634793, Iran
| | - Vida Kardan Moghaddam
- School of Medicine and Dentistry, Griffith University, Queensland, Brisbane 4222, Australia
| | - Arash Akbarzadeh
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran 1416634793, Iran
| | - Bahman Amani
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran 1416634793, Iran
| |
Collapse
|
2
|
Leider JP, Lim S, DeBruin D, Waterman AT, Smith B, Ghimire U, Huhtala H, Zirnhelt Z, Lynfield R, Hick JL. Using a web platform for equitable distribution of COVID-19 monoclonal antibodies: a case study in resource allocation. Front Public Health 2023; 11:1226935. [PMID: 38106886 PMCID: PMC10722896 DOI: 10.3389/fpubh.2023.1226935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023] Open
Abstract
While medical countermeasures in COVID-19 have largely focused on vaccinations, monoclonal antibodies (mAbs) were early outpatient treatment options for COVID-positive patients. In Minnesota, a centralized access platform was developed to offer access to mAbs that linked over 31,000 patients to care during its operation. The website allowed patients, their representative, or providers to screen the patient for mAbs against Emergency Use Authorization (EUA) criteria and connect them with a treatment site if provisionally eligible. A validated clinical risk scoring system was used to prioritize patients during times of scarcity. Both an ethics and a clinical subject matter expert group advised the Minnesota Department of Health on equitable approaches to distribution across a range of situations as the pandemic evolved. This case study outlines the implementation of this online platform and clinical outcomes of its users. We assess the impact of referral for mAbs on hospitalizations and death during a period of scarcity, finding in particular that vaccination conferred a substantially larger protection against hospitalization than a referral for mAbs, but among unvaccinated users that did not get a referral, chances of hospitalization increased by 4.1 percentage points.
Collapse
Affiliation(s)
- Jonathon P. Leider
- Center for Public Health Systems, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Sarah Lim
- Minnesota Department of Health, Saint Paul, MN, United States
| | - Debra DeBruin
- Center for Bioethics, University of Minnesota, Minneapolis, MN, United States
| | | | - Barbara Smith
- Health Sciences Technology, University of Minnesota, Minneapolis, MN, United States
| | - Umesh Ghimire
- Center for Public Health Systems, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Haley Huhtala
- Health Sciences Technology, University of Minnesota, Minneapolis, MN, United States
| | | | - Ruth Lynfield
- Minnesota Department of Health, Saint Paul, MN, United States
| | - John L. Hick
- Hennepin Healthcare, Minneapolis, MN, United States
| |
Collapse
|
3
|
Wynia MK, Beaty LE, Bennett TD, Carlson NE, Davis CB, Kwan BM, Mayer DA, Ong TC, Russell S, Steele JD, Stocker HR, Wogu AF, Zane RD, Sokol RJ, Ginde AA. Real-World Evidence of Neutralizing Monoclonal Antibodies for Preventing Hospitalization and Mortality in COVID-19 Outpatients. Chest 2023; 163:1061-1070. [PMID: 36441040 PMCID: PMC9613796 DOI: 10.1016/j.chest.2022.10.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/22/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Neutralizing monoclonal antibodies (mAbs) were authorized for the treatment of COVID-19 outpatients based on clinical trials completed early in the pandemic, which were underpowered for mortality and subgroup analyses. Real-world data studies are promising for further assessing rapidly deployed therapeutics. RESEARCH QUESTION Did mAb treatment prevent progression to severe disease and death across pandemic phases and based on risk factors, including prior vaccination status? STUDY DESIGN AND METHODS This observational cohort study included nonhospitalized adult patients with SARS-CoV-2 infection from November 2020 to October 2021 using electronic health records from a statewide health system plus state-level vaccine and mortality data. Using propensity matching, we selected approximately 2.5 patients not receiving mAbs for each patient who received mAb treatment under emergency use authorization. The primary outcome was 28-day hospitalization; secondary outcomes included mortality and hospitalization severity. RESULTS Of 36,077 patients with SARS-CoV-2 infection, 2,675 receiving mAbs were matched to 6,677 patients not receiving mAbs. Compared with mAb-untreated patients, mAb-treated patients had lower all-cause hospitalization (4.0% vs 7.7%; adjusted OR, 0.48; 95% CI, 0.38-0.60) and all-cause mortality (0.1% vs 0.9%; adjusted OR, 0.11; 95% CI, 0.03-0.29) to day 28; differences persisted to day 90. Among hospitalized patients, mAb-treated patients had shorter hospital length of stay (5.8 vs 8.5 days) and lower risk of mechanical ventilation (4.6% vs 16.6%). Results were similar for preventing hospitalizations during the Delta variant phase (adjusted OR, 0.35; 95% CI, 0.25-0.50) and across subgroups. Number-needed-to-treat (NNT) to prevent hospitalization was lower for subgroups with higher baseline risk of hospitalization; for example, multiple comorbidities (NNT = 17) and not fully vaccinated (NNT = 24) vs no comorbidities (NNT = 88) and fully vaccinated (NNT = 81). INTERPRETATION Real-world data revealed a strong association between receipt of mAbs and reduced hospitalization and deaths among COVID-19 outpatients across pandemic phases. Real-world data studies should be used to guide practice and policy decisions, including allocation of scarce resources.
Collapse
Affiliation(s)
- Matthew K Wynia
- Center for Bioethics and Humanities, University of Colorado, Anschutz Medical Campus, Aurora, CO; Department of Health Systems Management and Policy, Colorado School of Public Health, Aurora, CO; Department of Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Laurel E Beaty
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Tellen D Bennett
- Colorado Clinical and Translational Sciences Institute, University of Colorado, Anschutz Medical Campus, Aurora, CO; Section of Informatics and Data Science, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Nichole E Carlson
- Colorado Clinical and Translational Sciences Institute, University of Colorado, Anschutz Medical Campus, Aurora, CO; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Christopher B Davis
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Bethany M Kwan
- Colorado Clinical and Translational Sciences Institute, University of Colorado, Anschutz Medical Campus, Aurora, CO; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO; Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO
| | - David A Mayer
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Toan C Ong
- Section of Informatics and Data Science, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Seth Russell
- Section of Informatics and Data Science, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | | | - Heather R Stocker
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Adane F Wogu
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Richard D Zane
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Ronald J Sokol
- Colorado Clinical and Translational Sciences Institute, University of Colorado, Anschutz Medical Campus, Aurora, CO; Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Adit A Ginde
- Colorado Clinical and Translational Sciences Institute, University of Colorado, Anschutz Medical Campus, Aurora, CO; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO.
| |
Collapse
|
4
|
Sherman G, Lamb GS, Sharma TS, Lloyd EC, Nagel J, Dandam NN, Oliveira CR, Sheikha HS, Anosike BI, Lee P, Vora SB, Patel K, Sue PK, Rubbab B, Yarbrough AM, Ganapathi L, Nakamura MM. Monoclonal Antibody Use for Coronavirus Disease 2019 in Pediatric Patients: A Multicenter Retrospective Study. J Pediatric Infect Dis Soc 2023; 12:152-155. [PMID: 36928172 PMCID: PMC10112679 DOI: 10.1093/jpids/piac124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/23/2022] [Indexed: 03/18/2023]
Abstract
Monoclonal antibodies for COVID-19 are authorized in high-risk patients aged ≥12 years, but evidence in pediatric patients is limited. In our cohort of 142 patients treated at seven pediatric hospitals between 12/1/20 and 7/31/21, 9% developed adverse events, 6% were admitted for COVID-19 within 30 days, and none received ventilatory support or died.
Collapse
Affiliation(s)
- Gilad Sherman
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School
| | - Gabriella S Lamb
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School
| | - Tanvi S Sharma
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School
| | - Elizabeth C Lloyd
- Department of Pediatrics, University of Michigan and CS Mott Children's Hospital, Ann Arbor, Michigan, USA
| | - Jerod Nagel
- Department of Pharmacy, University of Michigan and CS Mott Children's Hospital, Ann Arbor, Michigan, USA
| | - Nada N Dandam
- Department of Pharmacy, University of Michigan and CS Mott Children's Hospital, Ann Arbor, Michigan, USA
| | - Carlos R Oliveira
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Hassan S Sheikha
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Brenda I Anosike
- Department of Pediatrics, Children's Hospital at Montefiore, New York, New York, USA
| | - Philip Lee
- Department of Pediatrics, Children's Hospital at Montefiore, New York, New York, USA
| | - Surabhi B Vora
- Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Karisma Patel
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Paul K Sue
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Beenish Rubbab
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - April M Yarbrough
- Department of Pharmacy, Children's of Alabama, Birmingham, Alabama, USA
| | - Lakshmi Ganapathi
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School
| | - Mari M Nakamura
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School
- Antimicrobial Stewardship Program, Boston Children's Hospital, Boston, MA, USA
| |
Collapse
|
5
|
Ambrose N, Amin A, Anderson B, Barrera-Oro J, Bertagnolli M, Campion F, Chow D, Danan R, D'Arinzo L, Drews A, Erlandson K, Fitzgerald K, Garcia M, Gaspar FW, Gong C, Hanna G, Jones S, Lopansri B, Musser J, O'Horo J, Piantadosi S, Pritt B, Razonable RR, Roberts S, Sandmeyer S, Stein D, Vahidy F, Webb B, Yttri J. Neutralizing Monoclonal Antibody Use and COVID-19 Infection Outcomes. JAMA Netw Open 2023; 6:e239694. [PMID: 37093599 PMCID: PMC10126875 DOI: 10.1001/jamanetworkopen.2023.9694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
Importance Evidence on the effectiveness and safety of COVID-19 therapies across a diverse population with varied risk factors is needed to inform clinical practice. Objective To assess the safety of neutralizing monoclonal antibodies (nMAbs) for the treatment of COVID-19 and their association with adverse outcomes. Design, Setting, and Participants This retrospective cohort study included 167 183 patients from a consortium of 4 health care systems based in California, Minnesota, Texas, and Utah. The study included nonhospitalized patients 12 years and older with a positive COVID-19 laboratory test collected between November 9, 2020, and January 31, 2022, who met at least 1 emergency use authorization criterion for risk of a poor outcome. Exposure Four nMAb products (bamlanivimab, bamlanivimab-etesevimab, casirivimab-imdevimab, and sotrovimab) administered in the outpatient setting. Main Outcomes and Measures Clinical and SARS-CoV-2 genomic sequence data and propensity-adjusted marginal structural models were used to assess the association between treatment with nMAbs and 4 outcomes: all-cause emergency department (ED) visits, hospitalization, death, and a composite of hospitalization or death within 14 days and 30 days of the index date (defined as the date of the first positive COVID-19 test or the date of referral). Patient index dates were categorized into 4 variant epochs: pre-Delta (November 9, 2020, to June 30, 2021), Delta (July 1 to November 30, 2021), Delta and Omicron BA.1 (December 1 to 31, 2021), and Omicron BA.1 (January 1 to 31, 2022). Results Among 167 183 patients, the mean (SD) age was 47.0 (18.5) years; 95 669 patients (57.2%) were female at birth, 139 379 (83.4%) were White, and 138 900 (83.1%) were non-Hispanic. A total of 25 241 patients received treatment with nMAbs. Treatment with nMAbs was associated with lower odds of ED visits within 14 days (odds ratio [OR], 0.76; 95% CI, 0.68-0.85), hospitalization within 14 days (OR, 0.52; 95% CI, 0.45-0.59), and death within 30 days (OR, 0.14; 95% CI, 0.10-0.20). The association between nMAbs and reduced risk of hospitalization was stronger in unvaccinated patients (14-day hospitalization: OR, 0.51; 95% CI, 0.44-0.59), and the associations with hospitalization and death were stronger in immunocompromised patients (hospitalization within 14 days: OR, 0.31 [95% CI, 0.24-0.41]; death within 30 days: OR, 0.13 [95% CI, 0.06-0.27]). The strength of associations of nMAbs increased incrementally among patients with a greater probability of poor outcomes; for example, the ORs for hospitalization within 14 days were 0.58 (95% CI, 0.48-0.72) among those in the third (moderate) risk stratum and 0.41 (95% CI, 0.32-0.53) among those in the fifth (highest) risk stratum. The association of nMAb treatment with reduced risk of hospitalizations within 14 days was strongest during the Delta variant epoch (OR, 0.37; 95% CI, 0.31-0.43) but not during the Omicron BA.1 epoch (OR, 1.29; 95% CI, 0.68-2.47). These findings were corroborated in the subset of patients with viral genomic data. Treatment with nMAbs was associated with a significant mortality benefit in all variant epochs (pre-Delta: OR, 0.16 [95% CI, 0.08-0.33]; Delta: OR, 0.14 [95% CI, 0.09-0.22]; Delta and Omicron BA.1: OR, 0.10 [95% CI, 0.03-0.35]; and Omicron BA.1: OR, 0.13 [95% CI, 0.02-0.93]). Potential adverse drug events were identified in 38 treated patients (0.2%). Conclusions and Relevance In this study, nMAb treatment for COVID-19 was safe and associated with reductions in ED visits, hospitalization, and death, although it was not associated with reduced risk of hospitalization during the Omicron BA.1 epoch. These findings suggest that targeted risk stratification strategies may help optimize future nMAb treatment decisions.
Collapse
Affiliation(s)
| | - Alpesh Amin
- Department of Medicine, University of California, Irvine
- Hospital Medicine Program, University of California, Irvine
| | | | - Julio Barrera-Oro
- Biomedical Advanced Research and Development Authority (BARDA), Administration for Strategic Preparedness and Response, US Department of Health and Human Services, Washington, District of Columbia
| | - Monica Bertagnolli
- Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Francis Campion
- The MITRE Corporation, Bedford, Massachusetts
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
| | - Daniel Chow
- Department of Radiological Sciences, University of California, Irvine
| | - Risa Danan
- The MITRE Corporation, Bedford, Massachusetts
| | | | - Ashley Drews
- Division of Infectious Diseases, Department of Medicine, Houston Methodist, Houston, Texas
- Houston Methodist Academic Institute, Houston, Texas
- Weill Cornell Medical College, New York, New York
| | - Karl Erlandson
- Biomedical Advanced Research and Development Authority (BARDA), Administration for Strategic Preparedness and Response, US Department of Health and Human Services, Washington, District of Columbia
| | | | | | | | - Carlene Gong
- Booz Allen Hamilton in support of BARDA, Washington, District of Columbia
| | - George Hanna
- Tunnell Government Services in support of BARDA, Princeton, New Jersey
| | - Stephen Jones
- Center for Health Data Science and Analytics, Houston Methodist, Houston, Texas
| | - Bert Lopansri
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Health, Murray, Utah
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City
| | - James Musser
- Laboratory of Molecular and Translational Human Infectious Disease Research, Center for Infectious Diseases, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York
- Department of Microbiology and Immunology, Weill Cornell Medical College, New York, New York
| | - John O'Horo
- Center for Individualized Medicine-Mayo Clinic Research, Rochester, Minnesota
| | - Steven Piantadosi
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bobbi Pritt
- Center for Individualized Medicine-Mayo Clinic Research, Rochester, Minnesota
| | - Raymund R Razonable
- Center for Individualized Medicine-Mayo Clinic Research, Rochester, Minnesota
| | | | - Suzanne Sandmeyer
- Department of Biological Chemistry, School of Medicine, University of California, Irvine
- Department of Microbiology and Molecular Genetics, School of Medicine, University of California, Irvine
| | - David Stein
- The MITRE Corporation, Bedford, Massachusetts
| | - Farhaan Vahidy
- Center for Health Data Science and Analytics, Houston Methodist, Houston, Texas
- Department of Neurosurgery, Houston Methodist, Houston, Texas
- Department of Population Health Science, Weill Cornell Medical College, New York, New York
| | - Brandon Webb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Health, Murray, Utah
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City
| | | |
Collapse
|
6
|
Ravi G, Eerike M, Konda VR, Bisoi D, Raj GM, Priyadarshini R, Mali KR, Chaliserry LF. Efficacy and Safety of Anti-SARS-CoV-2 Monoclonal Antibodies: An Updated Review. Monoclon Antib Immunodiagn Immunother 2023; 42:77-94. [PMID: 37129306 DOI: 10.1089/mab.2022.0036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Monoclonal antibodies (mAbs) had received emergency use authorization for mild-to-moderate coronavirus disease 2019 (COVID-19) or for prophylaxis against COVID-19, including casirivimab plus imdevimab (C+I), bamlanivimab plus etesevimab (B+E), tixagevimab plus cilgavimab (T+CG), and sotrovimab (S) and bebtelovimab (BEB). This systematic review was done to assess the efficacy and safety of the same. PubMed, Embase, Scopus, medRxiv, bioRxiv, and FDA fact sheets were searched for the studies published between January 2021 and May 2022, and appropriate search terms related to the mentioned mAbs were used for data collection. Review included original research including randomized clinical trials and observational studies published or preprints. Studies included in the review had compared with placebo or standard of care or no treatment or mAbs with each other and also of various doses. Data extraction was done and reviewed the same for both efficacy and safety. Total of 20 studies were included in this review. The rate of hospitalization within 30 days showed ∼2% in comparison to ∼7% with placebo. Significant reduction in viral load was more observed with combination mAbs. Combination therapy showed faster virological cure against the Gamma variant. With C + I as postexposure prophylaxis (PEP), 29.0% of asymptomatic participants developed symptomatic COVID-19. Pre-exposure prophylaxis with T+CG reduced the incidence of infection by 77%. Infusion-related reaction was the most common adverse event (AE). The neutralizing mAbs reduced hospitalization in mild-to-moderate patients with infusion-related reactions as common AE. The response was better in the seronegative patients. Most of these studies were conducted in unvaccinated individuals and against Alpha, Gamma, and Delta variants.
Collapse
Affiliation(s)
- Gandham Ravi
- Department of Pharmacology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | - Madhavi Eerike
- Department of Pharmacology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | - Venugopala Rao Konda
- Department of Pharmacology, TRR Institute of Medical Sciences, Patancheru, India
| | - Debasis Bisoi
- Department of Pharmacology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | - Gerard Marshall Raj
- Department of Pharmacology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | - Rekha Priyadarshini
- Department of Pharmacology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | - Kalpana Ramanna Mali
- Department of Pharmacology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | - Leo Francis Chaliserry
- Department of Pharmacology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| |
Collapse
|
7
|
COVID-19 Management Strategies in Solid Organ Transplant Recipients. Infect Dis Clin North Am 2023:S0891-5520(23)00024-7. [PMID: 37142512 PMCID: PMC10028355 DOI: 10.1016/j.idc.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Solid organ transplant recipients are at high risk of severe coronavirus disease-2019 (COVID-19). If left untreated, it results in high rates of hospitalization, intensive care unit admission and death. Early diagnosis of COVID-19 is essential to ensure the early administration of therapeutics. Treatment of mild-to-moderate COVID-19 with remdesivir, ritonavir-boosted nirmatrelvir, or an anti-spike neutralizing monoclonal antibody may prevent progression to severe and critical COVID-19. Among patients with severe and critical COVID-19, treatment with intravenous remdesivir and immunomodulation is recommended. This review article discusses strategies in the management of solid organ transplant recipients with COVID-19.
Collapse
|
8
|
A multimodal strategy to improve race/ethnic group equity in administration of neutralizing monoclonal antibody treatment for COVID-19 outpatients. J Clin Transl Sci 2023; 7:e37. [PMID: 36845303 PMCID: PMC9947608 DOI: 10.1017/cts.2022.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/17/2022] [Accepted: 12/13/2022] [Indexed: 02/12/2023] Open
Abstract
Introduction Racial and ethnic minority groups have higher rates of SARS-CoV-2 infection, severe illness, and death; however, they receive monoclonal antibody (mAb) treatment at lower rates than non-Hispanic White patients. We report data from a systematic approach to improve equitable provision of COVID-19 neutralizing monoclonal antibody treatment. Methods Treatment was administered at a community health urgent care clinic affiliated with a safety-net urban hospital. The approach included a stable treatment supply, a same-day test and treat model, a referral process, patient outreach, and financial support. We analyzed the race/ethnicity data descriptively and compared proportions using a chi-square test. Results Over 17 months, 2524 patients received treatment. Compared to the demographics of county COVID-19-positive cases, a greater proportion of patients who received mAb treatment were Hispanic (44.7% treatment vs. 36.5% positive cases, p < 0.001), a lower proportion were White Non-Hispanic (40.7% treatment vs. 46.3% positive cases, p < 0.001), equal proportion were Black (8.2% treatment vs. 7.4% positive cases, P = 0.13), and equal proportion occurred for other race patients. Discussion Implementation of multiple systematic strategies to administer COVID-19 monoclonal antibodies resulted in an equitable race/ethnic distribution of treatment.
Collapse
|
9
|
COVID-19 monoclonal antibody treatment impact on symptoms and post-COVID conditions among high-risk patients at a Federally Qualified Health Center. BMC Infect Dis 2023; 23:105. [PMID: 36814187 PMCID: PMC9944776 DOI: 10.1186/s12879-023-08057-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Monoclonal antibody (mAb) treatment for COVID-19 is associated with improved clinical outcomes. However, there is limited information regarding the impact of treatment on symptoms and the prevalence of post-COVID Conditions (PCC). Understanding of the association between time to mAb infusion and the development of PCC is also limited. METHODS This longitudinal study was conducted among patients with COVID-19 who received mAb infusions at a Federally Qualified Health Center in San Diego, CA. A series of telephone interviews were conducted at baseline and follow-up (14 days and 28+ days). A comprehensive symptom inventory was completed and physical and mental health status were measured using PROMIS-29 and PHQ-2. Pearson's Chi-squared tests and independent two-sample t-tests were performed to test for association between time to mAb infusion and outcomes at follow-up. A Poisson regression model was used to analyze whether time to mAb infusion predicts risk of developing PCC. RESULTS Participants (N = 411) were 53% female, ranged in age from 16 to 92 years (mean 50), and a majority (56%) were Latino/Hispanic. Cross-sectional findings revealed a high symptom burden at baseline (70% of patients had cough, 50% had fever, and 44% had headache). The prevalence of many symptoms decreased substantially by the final follow-up survey (29% of patients had cough, 3% had fever, and 28% had headache). Longitudinal findings indicated that 10 symptoms decreased in prevalence from baseline to final follow-up, 2 remained the same, and 14 increased. The severity of symptoms and most patient-reported physical and mental health measure scores decreased over time. The prevalence of PCC was 69% when PCC was defined as ≥ 1 symptom at final follow-up. Time to mAb infusion was not significantly associated with any outcome at follow-up. Time to infusion was not associated with PCC status at final follow-up in the crude or adjusted Poisson regression models. CONCLUSIONS The prevalence of PCC was high among this patient population following COVID-19 mAb treatment. Time to mAb infusion did not predict the development of PCC. Further research in these areas is essential to answer urgent clinical questions about effective treatments of COVID-19.
Collapse
|
10
|
Ucciferri C, Moffa L, Moffa S, Vecchiet J, Falasca K. Are monoclonal antibodies effective in patients with severe obesity in SARS-CoV-2 infected? Immun Inflamm Dis 2023; 11:e771. [PMID: 36840489 PMCID: PMC9910163 DOI: 10.1002/iid3.771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 02/11/2023] Open
Abstract
It is important to block SARS-CoV-2 infection immediately with early therapies, such as monoclonal antibodies (MonoAbs). Also, several studies show that obesity is associated with a high risk of severe COVID-19 disease. We enrolled 32 SARS-CoV-2 infected patients who received MonoAbs, all patients were not vaccinated for SARS-CoV-2, and they received therapy after 7 ± 2 days from the onset of COVID-19 symptoms. In the days following administration, patients followed home therapy with Pidotimod 800 mg bid for 10 days and cholecalciferol 2000 UI for 20 days, prescribed the same day they received MonoAbs therapy. Our study found that there are no differences in the therapeutic response between obese and nonobese patients with SARS-CoV-2 infection undergoing MonoAbs therapy, in fact, none of them underwent hospitalization. Furthermore, the effect of the immunostimulant Pidotimod and cholecalciferol may have contributed to the resolution of COVID-19 symptoms in these patients.
Collapse
Affiliation(s)
- Claudio Ucciferri
- Department of Medicine and Science of Aging, Clinic of Infectious DiseasesUniversity “G. D'Annunzio”ChietiPescaraItaly
| | - Livia Moffa
- Department of Medicine and Science of Aging, Clinic of Infectious DiseasesUniversity “G. D'Annunzio”ChietiPescaraItaly
| | - Samanta Moffa
- Department of PharmacyUniversity “G. D'Annunzio”ChietiPescaraItaly
| | - Jacopo Vecchiet
- Department of Medicine and Science of Aging, Clinic of Infectious DiseasesUniversity “G. D'Annunzio”ChietiPescaraItaly
| | - Katia Falasca
- Department of Medicine and Science of Aging, Clinic of Infectious DiseasesUniversity “G. D'Annunzio”ChietiPescaraItaly
| |
Collapse
|
11
|
Milito C, Firinu D, Bez P, Villa A, Punziano A, Lagnese G, Costanzo G, van Leeuwen LPM, Piazza B, Deiana CM, d’Ippolito G, Del Giacco SR, Rattazzi M, Spadaro G, Quinti I, Scarpa R, Dalm VASH, Cinetto F. A beacon in the dark: COVID-19 course in CVID patients from two European countries: Different approaches, similar outcomes. Front Immunol 2023; 14:1093385. [PMID: 36845159 PMCID: PMC9944020 DOI: 10.3389/fimmu.2023.1093385] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/09/2023] [Indexed: 02/10/2023] Open
Abstract
Background CVID patients present an increased risk of prolonged SARS-CoV-2 infection and re-infection and a higher COVID-19-related morbidity and mortality compared to the general population. Since 2021, different therapeutic and prophylactic strategies have been employed in vulnerable groups (vaccination, SARS-CoV-2 monoclonal antibodies and antivirals). The impact of treatments over the last 2 years has not been explored in international studies considering the emergence of viral variants and different management between countries. Methods A multicenter retrospective/prospective real-life study comparing the prevalence and outcomes of SARS-CoV-2 infection between a CVID cohort from four Italian Centers (IT-C) and one cohort from the Netherlands (NL-C), recruiting 773 patients. Results 329 of 773 CVID patients were found positive for SARS-CoV-2 infection between March 1st, 2020 and September 1st 2022. The proportion of CVID patients infected was comparable in both national sub-cohorts. During all waves, chronic lung disease, "complicated" phenotype, chronic immunosuppressive treatment and cardiovascular comorbidities impacted on hospitalization, whereas risk factors for mortality were older age, chronic lung disease, and bacterial superinfections. IT-C patients were significantly more often treated, both with antivirals and mAbs, than NL-C patients. Outpatient treatment, available only in Italy, started from the Delta wave. Despite this, no significant difference was found for COVID-19 severity between the two cohorts. However, pooling together specific SARS-CoV-2 outpatient treatments (mAbs and antivirals), we found a significant effect on the risk of hospitalization starting from Delta wave. Vaccination with ≥ 3 doses shortened RT-PCR positivity, with an additional effect only in patients receiving antivirals. Conclusions The two sub-cohorts had similar COVID-19 outcomes despite different treatment approaches. This points out that specific treatment should now be reserved for selected subgroups of CVID patients, based on pre-existing conditions.
Collapse
Affiliation(s)
- Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Patrick Bez
- Rare Diseases Referral Center, Internal Medicine 1, Ca’ Foncello Hospital, AULSS2 Marca Trevigiana, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Annalisa Villa
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessandra Punziano
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Gianluca Lagnese
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Giulia Costanzo
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Leanne P. M. van Leeuwen
- Department of Viroscience, Travel Clinic, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Beatrice Piazza
- Rare Diseases Referral Center, Internal Medicine 1, Ca’ Foncello Hospital, AULSS2 Marca Trevigiana, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Carla Maria Deiana
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | | | - Marcello Rattazzi
- Rare Diseases Referral Center, Internal Medicine 1, Ca’ Foncello Hospital, AULSS2 Marca Trevigiana, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Riccardo Scarpa
- Rare Diseases Referral Center, Internal Medicine 1, Ca’ Foncello Hospital, AULSS2 Marca Trevigiana, Department of Medicine (DIMED), University of Padova, Padova, Italy,*Correspondence: Riccardo Scarpa,
| | - Virgil A. S. H. Dalm
- Department of Internal Medicine, Division of Allergy and Clinical Immunology, Department of Immunology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Francesco Cinetto
- Rare Diseases Referral Center, Internal Medicine 1, Ca’ Foncello Hospital, AULSS2 Marca Trevigiana, Department of Medicine (DIMED), University of Padova, Padova, Italy
| |
Collapse
|
12
|
Tai YL, Lee MD, Chi H, Chiu NC, Lei WT, Weng SL, Liu LYM, Chen CC, Huang SY, Huang YN, Lin CY. Effects of bamlanivimab alone or in combination with etesevimab on subsequent hospitalization and mortality in outpatients with COVID-19: a systematic review and meta-analysis. PeerJ 2023; 11:e15344. [PMID: 37180576 PMCID: PMC10174063 DOI: 10.7717/peerj.15344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) has caused an enormous loss of life worldwide. The spike protein of the severe acute respiratory syndrome coronavirus 2 is the cause of its virulence. Bamlanivimab, a recombinant monoclonal antibody, has been used alone or in combination with etesevimab to provide passive immunity and improve clinical outcomes. A systematic review and meta-analysis was conducted to investigate the therapeutic effects of bamlanivimab with or without etesevimab (BAM/ETE) treatment. Methods Our study was registered in PROSPERO (registry number CRD42021270206). We searched the following electronic databases, without language restrictions, until January 2023: PubMed, Embase, medRxiv, and the Cochrane database. A systematic review and meta-analysis was conducted based on the search results. Results Eighteen publications with a total of 28,577 patients were identified. Non-hospitalized patients given bamlanivimab with or without etesevimab had a significantly lower risk of subsequent hospitalization (18 trials, odds ratio (OR): 0.37, 95% confidence interval (CI): [0.29-0.49], I2: 69%; p < 0.01) and mortality (15 trials, OR: 0.27, 95% CI [0.17-0.43], I2: 0%; p = 0.85). Bamlanivimab monotherapy also reduced the subsequent risk of hospitalization (16 trials, OR: 0.43, 95% CI [0.34-0.54], I2: 57%; p = 0.01) and mortality (14 trials, OR: 0.28, 95% CI [0.17-0.46], I2: 0%; p = 0.9). Adverse events from these medications were uncommon and tolerable. Conclusions In this meta-analysis, we found the use of bamlanivimab with or without etesevimab contributed to a significantly-reduced risk of subsequent hospitalization and mortality in non-hospitalized COVID-19 patients. However, resistance to monoclonal antibodies was observed in COVID-19 variants, resulting in the halting of the clinical use of BAM/ETE. Clinicians' experiences with BAM/ETE indicate the importance of genomic surveillance. BAM/ETE may be repurposed as a potential component of a cocktail regimen in treating future COVID variants.
Collapse
Affiliation(s)
- Yu-Lin Tai
- Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Pediatrics, Hsinchu Municipal MacKay Children’s Hospital, Hsinchu, Taiwan
| | - Ming-Dar Lee
- Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Pediatrics, Hsinchu Municipal MacKay Children’s Hospital, Hsinchu, Taiwan
| | - Hsin Chi
- Medicine, MacKay Medical College, New Taipei, Taiwan
- Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
| | - Nan-Chang Chiu
- Medicine, MacKay Medical College, New Taipei, Taiwan
- Pediatrics, MacKay Children’s Hospital, Taipei, Taiwan
| | - Wei-Te Lei
- Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Pediatrics, Hsinchu Municipal MacKay Children’s Hospital, Hsinchu, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shun-Long Weng
- Medicine, MacKay Medical College, New Taipei, Taiwan
- Department of Obstetrics and Gynecology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Lawrence Yu-Min Liu
- Medicine, MacKay Medical College, New Taipei, Taiwan
- Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Chung-Chu Chen
- Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Teaching Center of Natural Science, Minghsin University of Science and Technology, Hsinchu, Taiwan
| | - Shih-Yu Huang
- Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Ya-Ning Huang
- Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Pediatrics, Hsinchu Municipal MacKay Children’s Hospital, Hsinchu, Taiwan
| | - Chien-Yu Lin
- Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Pediatrics, Hsinchu Municipal MacKay Children’s Hospital, Hsinchu, Taiwan
- Medicine, MacKay Medical College, New Taipei, Taiwan
| |
Collapse
|
13
|
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. .
Collapse
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
| | | | | | | | | |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
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.
Collapse
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:
| |
Collapse
|
16
|
Lokhandwala T, Acharya M, Farrelly E, Coutinho AD, Bell CF, Svedsater H. Within-trial economic analysis of resource use from COMET-ICE: A phase 3 clinical trial evaluating sotrovimab for the treatment of patients with COVID-19 at high risk of progression. J Manag Care Spec Pharm 2022; 28:1261-1271. [PMID: 36282931 PMCID: PMC10372996 DOI: 10.18553/jmcp.2022.28.11.1261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND: Final results for the primary endpoint of the COVID-19 Monoclonal antibody Efficacy Trial-Intent to Care Early (COMET-ICE) randomized controlled trial (NCT04545060) showed a 79% (P < 0.001) adjusted relative risk reduction in longer-than-24-hour hospitalization or death due to any cause in high-risk patients with COVID-19 receiving sotrovimab compared with placebo at Day 29. Given the substantial costs associated with COVID-19 hospitalizations, there is a need to quantify the economic impact of clinical trial outcomes to inform decisionmaking. OBJECTIVE: To compare longer-than-24-hour hospitalization costs (primary objective) and total health care costs (secondary objective) associated with COVID-19 care in the sotrovimab vs placebo group in the COMET-ICE trial. METHODS: This was a 2-step, retrospective, post hoc, within-trial economic analysis. Step 1 was a health care claims (MarketScan) database analysis to source unit cost data (2020 USD) from a US payer perspective for COVID-19 care-related resource use from April 1 through June 30, 2020, among adults diagnosed with COVID-19 at high risk of progression (similar to those enrolled in the COMET-ICE trial). Cost per day for an inpatient event stratified by the following maximum respiratory support levels was obtained: no respiratory support or oxygen therapy only, noninvasive ventilation, and invasive mechanical ventilation. Cost per event was obtained for outpatient resource use. Step 2 was the within-trial economic analysis, in which unit costs from Step 1 were applied to the resource use (based on maximum respiratory support and length of stay for inpatient events and number of visits for outpatient events) observed during the first 29 days post-randomization in COMET-ICE. RESULTS: A total of 1,057 patients from the intent-to-treat COMET-ICE population were included (sotrovimab, n = 528; placebo, n = 529). Baseline demographic and clinical characteristics were well balanced between groups. During 29 days of follow-up, mean (SD) costs for the primary endpoint, longer-than-24-hour hospitalization, were $2,827 ($15,545) in the placebo group and $485 ($5,049) in the sotrovimab group (difference, -$2,342; P < 0.0001). Total health care costs were $2,850 ($15,546) in the placebo group and $525 ($5,070) in the sotrovimab group (difference, -$2,325; P = 0.0021). CONCLUSIONS: This post hoc within-trial economic analysis of COMET-ICE data shows that early treatment with sotrovimab vs placebo may be associated with lower longer-than-24-hour hospitalization costs and total health care costs for COVID-19 care in high-risk patients with COVID-19. These findings may be important in informing decision-making regarding use of sotrovimab in clinical practice. DISCLOSURES: Dr Lokhandwala and Ms Farrelly are employees of Xcenda LLC; Xcenda received funding from GSK to support the conduct of this study and did not receive funding for manuscript development. Mr Acharya and Dr Coutinho were employees of Xcenda LLC during the conduct of the study. Mr Bell and Dr Svedsater are employees of, and hold stocks/shares in, GSK. This study was funded by GSK (study 216974) and Vir Biotechnology, Inc. The study sponsors were involved in the study design; collection, analysis, and interpretation of data; writing of the report; and the decision to submit the report for publication.
Collapse
Affiliation(s)
| | - Mahip Acharya
- University of Arkansas for Medical Sciences, Little Rock
| | | | | | | | - Henrik Svedsater
- GSK, Global Value Evidence and Outcomes, Brentford, Middlesex, UK
| |
Collapse
|
17
|
Zhao Y, Wang H, Zhang Q, Hu Y, Xu Y, Liu W. Evaluation of adverse events of bamlanivimab, bamlanivimab/etesevimab used for COVID-19 based on FAERS database. Expert Opin Drug Saf 2022; 22:331-338. [PMID: 36178050 DOI: 10.1080/14740338.2023.2130888] [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: 12/15/2022]
Abstract
BACKGROUND We study the adverse events (AEs) of bamlanivimab (BAM), bamlanivimab/etesevimab (BAM/ETE) to alert risk factors during coronavirus disease 2019 (COVID-19) treatment and provide references for drug safety. RESEARCH DESIGN AND METHODS Extract AEs from the COVID-19 Emergency Use Authorization (EUA) FDA Adverse Event Reporting System (FAERS) Public Dashboard. Disproportionality analysis was performed by the proportional reporting ratio (PRR), the reporting odds ratio (ROR), the Medicines and Healthcare Products Regulatory Agency (MHRA), and the Empirical Bayes Geometric Mean (EBGM) to discover the potential risks of BAM and BAM/ETE. RESULTS : With COVID-19 drugs as the research background, the number of BAM/ETE signals is about half that of BAM, and 80% of signals overlap with BAM. Signals such as atrial fibrillation, tachycardia, and confusional state are present in BAM but not in BAM/ETE. With BAM and BAM/ETE as the research background, potential safety signals of BAM/ETE such as acute respiratory failure, hypersensitivity, and infusion related reaction require long-term observation, especially acute respiratory failure which isn't in the label. CONCLUSIONS The AEs reports on this study confirm most of the label information of BAM and BAM/ETE. BAM/ETE is relatively safe, while the risk signals such as acute respiratory failure and infusion related reaction require to be monitored.
Collapse
Affiliation(s)
- Yunfei Zhao
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou 450001, China
| | - Huiling Wang
- School of Pharmaceutical Sciences, Zhengzhou Railway Vocational and Technical College, Zhengzhou, China
| | - Qingsong Zhang
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou 450001, China
| | - Yongxin Hu
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou 450001, China
| | - Yulong Xu
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou 450001, China
| | - Wei Liu
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou 450001, China
| |
Collapse
|
18
|
Antispike monoclonal antibodies for prevention and treatment of coronavirus disease-2019 in solid organ transplant recipients. Curr Opin Organ Transplant 2022; 27:269-276. [PMID: 36354253 DOI: 10.1097/mot.0000000000000981] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE OF REVIEW Coronavirus disease-2019 (COVID-19) disproportionately causes severe outcomes in solid organ transplant recipients (SOTR). Antispike monoclonal antibodies have been authorized for therapy and prophylaxis for COVID-19. Here, we review the current state of antispike monoclonal antibodies and their role for SOTRs. RECENT FINDINGS Bamlanivimab with or without etesevimab, casirivimab-imdevimab and sotrovimab have reduced the rates of hospitalization and severe disease in high-risk patients with mild-to-moderate COVID-19. Multiple retrospective studies have also demonstrated monoclonal antibodies are effective in SOTR populations. However, the evolution of resistant severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concerns has resulted in revocation of the authorization of bamlanivimab with or without etesevimab, and casirivimab-imdevimab as treatment and postexposure prophylaxis (PEP). Sotrovimab and bebtelovimab are currently authorized for treatment of the predominant circulating SARS-CoV-2 B.1.1.529 (Omicron), but not as pre or PEP. Tixagevimab-cilgavimab, a long-acting antibody combination preparation, is authorized for preexposure prophylaxis in high-risk immunocompromised populations, including SOTRs, who are less likely to mount an effective immune response following vaccination series and booster. SUMMARY Antispike monoclonal antibodies are useful for the prevention and treatment of mild-to-moderate COVID-19 in SOTRs. However, their clinical use should be determined by the evolving epidemiology of SARS-CoV-2 variants in the community.
Collapse
|
19
|
Garzi G, Cinetto F, Firinu D, Di Napoli G, Lagnese G, Punziano A, Bez P, Cinicola BL, Costanzo G, Scarpa R, Pulvirenti F, Rattazzi M, Spadaro G, Quinti I, Milito C. Real-life data on monoclonal antibodies and antiviral drugs in Italian inborn errors of immunity patients during COVID-19 pandemic. Front Immunol 2022; 13:947174. [PMID: 35967382 PMCID: PMC9367468 DOI: 10.3389/fimmu.2022.947174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/29/2022] [Indexed: 12/16/2022] Open
Abstract
BackgroundSince the beginning of the COVID-19 pandemic, patients with Inborn Errors of Immunity have been infected by SARS-CoV-2 virus showing a spectrum of disease ranging from asymptomatic to severe COVID-19. A fair number of patients did not respond adequately to SARS-CoV-2 vaccinations, thus early therapeutic or prophylactic measures were needed to prevent severe or fatal course or COVID-19 and to reduce the burden of hospitalizations.MethodsLongitudinal, multicentric study on patients with Inborn Errors of Immunity immunized with mRNA vaccines treated with monoclonal antibodies and/or antiviral agents at the first infection and at reinfection by SARS-CoV-2. Analyses of efficacy were performed according to the different circulating SARS-CoV-2 strains.ResultsThe analysis of the cohort of 192 SARS-CoV-2 infected patients, across 26 months, showed the efficacy of antivirals on the risk of hospitalization, while mabs offered a positive effect on hospitalization, and COVID-19 severity. This protection was consistent across the alpha, delta and early omicron waves, although the emergence of BA.2 reduced the effect of available mabs. Hospitalized patients treated with mabs and antivirals had a lower risk of ICU admission. We reported 16 re-infections with a length of SARS-CoV-2 positivity at second infection shorter among patients treated with mabs. Treatment with antivirals and mabs was safe.ConclusionsThe widespread use of specific therapy, vaccination and better access to care might have contributed to mitigate risk of mortality, hospital admission, and severe disease. However, the rapid spread of new viral strains underlines that mabs and antiviral beneficial effects should be re- evaluated over time.
Collapse
Affiliation(s)
- Giulia Garzi
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesco Cinetto
- Department of Medicine—DIMED, University of Padova, Padua, Italy
- Rare Diseases Referral Center, Internal Medicine I, Ca’ Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy
| | - Giulia Di Napoli
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Gianluca Lagnese
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Alessandra Punziano
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Patrick Bez
- Department of Medicine—DIMED, University of Padova, Padua, Italy
- Rare Diseases Referral Center, Internal Medicine I, Ca’ Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Bianca Laura Cinicola
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giulia Costanzo
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy
| | - Riccardo Scarpa
- Department of Medicine—DIMED, University of Padova, Padua, Italy
- Rare Diseases Referral Center, Internal Medicine I, Ca’ Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Federica Pulvirenti
- Regional Reference Centre for Primary Immune Deficiencies, Azienda Ospedaliera Universitaria Policlinico Umberto I, Rome, Italy
| | - Marcello Rattazzi
- Department of Medicine—DIMED, University of Padova, Padua, Italy
- Rare Diseases Referral Center, Internal Medicine I, Ca’ Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
- *Correspondence: Isabella Quinti,
| | - Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
20
|
Milam AN, Doan DT, Childress DT, Durham SH. Evaluation of Monoclonal Antibodies in Preventing Hospitalizations, Emergency Department Visits, and Mortality in High-Risk COVID-19 Patients. J Pharm Technol 2022; 38:169-173. [PMID: 35600282 PMCID: PMC9116122 DOI: 10.1177/87551225221080027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) is a novel coronavirus that has caused an unprecedented global pandemic, with few treatment options currently available. Neutralizing monoclonal antibodies (mAbs) are a promising treatment approach to reduce hospitalizations in high-risk patients with mild-to-moderate COVID-19 infections. Objective The primary objective is to compare hospitalization rates of high-risk patients who tested positive for COVID-19 within 28 days between those who received mAb infusions versus those who did not. Secondary objectives were emergency department (ED) visits and mortality within 28 days of a positive test. Methods This single-center, institutional review board-approved, retrospective, observational cohort study included patients aged 19 years and older who tested positive for COVID-19 between December 2, 2020 and February 28, 2021. Patients who received the mAbs bamlanivimab or casirivimab/imdevimab were compared with patients who did not receive mAb infusions to examine hospitalization rates, ED visits, and mortality within 28 days of the positive COVID-19 test. Results A total of 2780 patients were evaluated for inclusion using electronic chart review via Cerner. Of the 1612 patients who met inclusion criteria, 568 received an mAb infusion (mAb group) and 1044 did not (non-mAb group). Baseline characteristics were similar between the 2 groups. Of the patients in the mAb group, 34 (6%) were hospitalized versus 397 (38%) in the non-mAb group. Patients with ED visits included 111 (20%) and 672 (64%) in the mAb and non-mAb groups, respectively. Finally, 5 patients in the mAb group experienced mortality (0.9%) versus 83 (8%) in the non-mAb group. Each endpoint achieved statistical significance with a P value of <0.0001. Conclusion Monoclonal antibody infusions are effective in preventing hospitalization, ED visits, and mortality in high-risk patients with mild-to-moderate COVID-19.
Collapse
Affiliation(s)
- Ashlee N. Milam
- Harrison School of Pharmacy, Auburn
University, Auburn, AL, USA
| | - Diana T. Doan
- Harrison School of Pharmacy, Auburn
University, Auburn, AL, USA
| | | | | |
Collapse
|
21
|
Mazzotta V, Cozzi-Lepri A, Colavita F, Lanini S, Rosati S, Lalle E, Mastrorosa I, Cimaglia C, Vergori A, Bevilacqua N, Lapa D, Mariano A, Bettini A, Agrati C, Piselli P, Girardi E, Castilletti C, Garbuglia AR, Vaia F, Nicastri E, Antinori A. Emulation of a Target Trial From Observational Data to Compare Effectiveness of Casirivimab/Imdevimab and Bamlanivimab/Etesevimab for Early Treatment of Non-Hospitalized Patients With COVID-19. Front Immunol 2022; 13:868020. [PMID: 35514955 PMCID: PMC9066636 DOI: 10.3389/fimmu.2022.868020] [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] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/24/2022] [Indexed: 11/22/2022] Open
Abstract
Objectives Comparative analysis between different monoclonal antibodies (mAbs) against SARS-CoV-2 are lacking. We present an emulation trial from observational data to compare effectiveness of Bamlanivimab/Etesevimab (BAM/ETE) and Casirivimab/Imdevimab (CAS/IMD) in outpatients with early mild-to-moderate COVID-19 in a real-world scenario of variants of concern (VoCs) from Alpha to Delta. Methods Allocation to treatment was subject to mAbs availability, and the measured factors were not used to determine which combination to use. Patients were followed through day 30. Viral load was measured by cycle threshold (CT) on D1 (baseline) and D7.Primary outcome was time to COVID-19-related hospitalization or death from any cause over days 0-30. Weighted pooled logistic regression and marginal structural Cox model by inverse probability weights were used to compare BAM/ETE vs. CAS/IMD. ANCOVA was used to compare mean D7 CT values by intervention. Models were adjusted for calendar month, MASS score and VoCs. We evaluated effect measure modification by VoCs, vaccination, D1 CT levels and enrolment period. Results COVID19-related hospitalization or death from any cause occurred in 15 of 237 patients in the BAM/ETE group (6.3%) and in 4 of 196 patients in the CAS/IMD group (2.0%) (relative risk reduction [1 minus the relative risk] 72%; p=0.024). Subset analysis carried no evidence that the effect of the intervention was different across stratification factors. There was no evidence in viral load reduction from baseline through day 7 across the two groups (+0.17, 95% -1.41;+1.74, p=0.83). Among patients who experienced primary outcome, none showed a negative RT-PCR test in nasopharyngeal swab (p=0.009) and 82.4% showed still high viral load (p<0.001) on D7. Conclusions In a pre-Omicron epidemiologic scenario, CAS/IMD reduced risk of clinical progression of COVID-19 compared to BAM/ETE. This effect was not associated with a concomitant difference in virological response.
Collapse
Affiliation(s)
- Valentina Mazzotta
- Clinical and Infectious Diseases Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani Istituiti di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London (UCL), London, United Kingdom
| | - Francesca Colavita
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani Istituiti di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Simone Lanini
- Clinical and Infectious Diseases Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani Istituiti di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Silvia Rosati
- Clinical and Infectious Diseases Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani Istituiti di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Eleonora Lalle
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani Istituiti di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Ilaria Mastrorosa
- Clinical and Infectious Diseases Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani Istituiti di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Claudia Cimaglia
- Clinical Epidemiology, National Institute for Infectious Diseases Lazzaro Spallanzani Istituiti di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Alessandra Vergori
- Clinical and Infectious Diseases Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani Istituiti di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Nazario Bevilacqua
- Clinical and Infectious Diseases Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani Istituiti di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Daniele Lapa
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani Istituiti di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Andrea Mariano
- Clinical and Infectious Diseases Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani Istituiti di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Aurora Bettini
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani Istituiti di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Chiara Agrati
- Laboratory of Cellular Immunology and Pharmacology, National Institute for Infectious Diseases Lazzaro Spallanzani Istituiti di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Pierluca Piselli
- Clinical Epidemiology, National Institute for Infectious Diseases Lazzaro Spallanzani Istituiti di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Enrico Girardi
- Scientific Direction, National Institute for Infectious Diseases Lazzaro Spallanzani Istituiti di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Concetta Castilletti
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani Istituiti di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Anna Rosa Garbuglia
- Laboratory of Virology, National Institute for Infectious Diseases Lazzaro Spallanzani Istituiti di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Francesco Vaia
- Health Direction, National Institute for Infectious Diseases Lazzaro Spallanzani Istituiti di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Emanuele Nicastri
- Clinical and Infectious Diseases Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani Istituiti di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| | - Andrea Antinori
- Clinical and Infectious Diseases Research Department, National Institute for Infectious Diseases Lazzaro Spallanzani Istituiti di Ricovero e Cura a Carattere Scientifico (IRCCS), Roma, Italy
| |
Collapse
|
22
|
Tuccori M, Convertino I, Ferraro S, Cappello E, Valdiserra G, de Luca G, Franchini M, Focosi D. Preclinical discovery and development of the casirivimab + imdevimab cocktail for the treatment of novel coronavirus infection: the rise and fall. Expert Opin Drug Discov 2022; 17:531-546. [PMID: 35361043 DOI: 10.1080/17460441.2022.2058486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The ongoing COVID19 pandemic represents an unprecedented opportunity to test the feasibility of monoclonal antibody (mAb) therapies against respiratory viruses. While many hurdles were easily predictable (e.g. time to develop, scalability, and economic sustainability), mAb cocktails (i.e. the combination of two mAbs) were finally deployed in 2021, one year after the beginning of the pandemic. Of them, the REGN-COV-2 cocktail was likely the most successful experience and contributed at saving lives at the time of the wave sustained by the Delta variant of concern (VOC). AREAS COVERED Herein, the authors review the preclinical and clinical history of the casirivimab + imdevimab cocktail for the treatment of novel coronavirus infection. The authors furthermore provide the reader with their perspectives on this cocktail including its current place in the treatment armamentarium. EXPERT OPINION Unfortunately, results from clinical trials highlighted a very limited efficacy in inpatients; furthermore, the current evidence with regards to its lack of effectiveness against the current dominant VOC (omicron) suggests a very limited use of these drugs in the future. In the authors' opinion, this story reminds us of the limitations of mAb therapies in pandemic settings, and of the inferiority of monoclonal versus polyclonal antibody-based therapeutics in such scenarios.
Collapse
Affiliation(s)
- Marco Tuccori
- Unit of Pharmacology and Pharmacovigilance - Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Unit of Adverse Drug Reactions Monitoring, Pisa University Hospital, Pisa, Italy
| | - Irma Convertino
- Unit of Pharmacology and Pharmacovigilance - Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Ferraro
- Unit of Pharmacology and Pharmacovigilance - Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Emiliano Cappello
- Unit of Pharmacology and Pharmacovigilance - Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia Valdiserra
- Unit of Pharmacology and Pharmacovigilance - Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia de Luca
- Unit of Pharmacology and Pharmacovigilance - Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Massimo Franchini
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital Azienda Socio Sanitaria Territoriale of Mantova, Mantova, Italy.,Tuscany Blood Bank, Pisa University HospitalNorth-Western, Pisa, Italy
| | | |
Collapse
|
23
|
Early administration of Anti-SARS-CoV-2 Monoclonal Antibodies prevents severe Covid-19 in Kidney Transplant Patients. Kidney Int Rep 2022; 7:1241-1247. [PMID: 35372734 PMCID: PMC8957354 DOI: 10.1016/j.ekir.2022.03.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction Kidney transplant recipients (KTRs) are prone to develop severe COVID-19 and are less well protected by vaccine than immunocompetent subjects. Thus, the use of neutralizing anti–SARS-CoV-2 monoclonal antibody (MoAb) to confer a passive immunity appears attractive in KTRs. Methods We performed a French nationwide study to compare COVID-19–related hospitalization, 30-day admission to intensive care unit (ICU), and 30-day death between KTRs who received an early infusion of MoAb (MoAb group) and KTRs who did not (control group). Controls were identified from the COVID-SFT registry (NCT04360707) using a propensity score matching with the following covariates: age, sex, delay between transplantation and infection, induction and maintenance immunosuppressive therapy, initial symptoms, and comorbidities. Results A total of 80 KTRs received MoAb between February 2021 and June 2021. They were matched to 155 controls. COVID-19–related hospitalization, 30-day admission to ICU, and 30-day death were less frequently observed in the MoAb group (35.0% vs. 49.7%, P = 0.032; 2.5% vs. 15.5%, P = 0.002; 1.25% vs. 11.6%, P = 0.005, respectively). No patient required mechanical ventilation in the MoAb group. The number of patients to treat to prevent 1 death was 9.7. Conclusion The early use of MoAb in KTRs with a mild form of COVID-19 largely improved outcomes in KTRs.
Collapse
|
24
|
Sobolewski KA, Smoke SM, Brophy A, Vassallo AV, Chen B, Hilden P, Patterson R, Pittiglio M, Raja K, Handler E, Freer C. Real world evaluation of the impact of two Anti-SARS-CoV-2 monoclonal antibody regimens on COVID-19 hospitalizations in older adults. J Med Virol 2022; 94:2493-2499. [PMID: 35199356 PMCID: PMC9088460 DOI: 10.1002/jmv.27668] [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: 11/11/2021] [Revised: 01/14/2022] [Accepted: 02/20/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Evidence from clinical trials suggest anti-SARS-CoV-2 monoclonal antibodies (mABs) may reduce COVID-19-related hospitalizations. The purpose of this study was to assess the real world impact of mAB administration on COVID-19 hospitalization among patients 65 years or older. METHODS This was a retrospective, propensity-matched cohort study that included patients aged 65 years and older who presented to the emergency department (ED) within ten days of symptom onset of mild to moderate COVID-19 infection. Outcomes were compared between those who did and did not receive mAB therapy. The primary endpoint was the rate of hospitalization for COVID-19 within 30 days of index ED visit. RESULTS A total of 137 patients receiving mABs were matched to 137 controls. Hospitalization occurred in 2.9% of mAB-treated patients compared to 14.6% of patients of the standard of care (SOC) arm (OR 0.20, [95% CI 0.07-0.59]). There were zero intubations and zero deaths compared to three (2.2%) and two (1.5%) in the SOC group. Among the 223 patients receiving mAB in the overall cohort, adverse drug events occurred in 10 (4.5%). CONCLUSIONS Treatment with mAB therapy for mild to moderate COVID-19 was associated with a substantially reduced risk of hospitalization among patients at least 65 years of age. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Kristine A Sobolewski
- Pharmacy Department, Saint Barnabas Medical Center, 94 Old Short Hills Rd, Livingston, NJ, 07039
| | - Steven M Smoke
- Pharmacy Department, Saint Barnabas Medical Center, 94 Old Short Hills Rd, Livingston, NJ, 07039
| | - Alison Brophy
- Pharmacy Department, Saint Barnabas Medical Center, 94 Old Short Hills Rd, Livingston, NJ, 07039
| | - Andrew V Vassallo
- Department of Pharmacy, Community Medical Center, 99 W Rt 37, Toms River, NJ, 08757
| | - Brandon Chen
- Pharmacy Department, Clara Maass Medical Center, 1 Clara Maass Drive, Belleville, NJ, 07109
| | - Patrick Hilden
- Biostatistics Department, Saint Barnabas Medical Center, 94 Old Short Hills Rd, Livingston, NJ, 07039
| | - Rebecca Patterson
- Department of Pharmacy, Community Medical Center, 99 W Rt 37, Toms River, NJ, 08757
| | - Marina Pittiglio
- Department of Pharmacy, Community Medical Center, 99 W Rt 37, Toms River, NJ, 08757
| | - Karan Raja
- Pharmacy Department, Clara Maass Medical Center, 1 Clara Maass Drive, Belleville, NJ, 07109
| | - Eric Handler
- Emergency Department, Saint Barnabas Medical Center, 94 Old Short Hills Rd, Livingston, NJ, 07039
| | - Christopher Freer
- Emergency and Hospitalist Medicine Service Line, RWJBarnabas Health, 95 Old Short Hills Road, West Orange, NJ, 07052
| |
Collapse
|
25
|
Bavaro DF, Diella L, Solimando AG, Cicco S, Buonamico E, Stasi C, Ciannarella M, Marrone M, Carpagnano F, Resta O, Carpagnano GE, Palmieri VO, Vacca A, Dell'Aera M, Dell'Erba A, Migliore G, Aricò M, Saracino A. Bamlanivimab and Etesevimab administered in an outpatient setting for SARS-CoV-2 infection. Pathog Glob Health 2022; 116:297-304. [PMID: 35138229 PMCID: PMC8862158 DOI: 10.1080/20477724.2021.2024030] [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] [Indexed: 10/26/2022] Open
Abstract
The early administration of anti-SARS-CoV-2 monoclonal antibodies (mAb) could decrease the risk of severe disease and the need of inpatients care. Herein, our clinical experience with Bamlanivimab/Etesevimab for the treatment of early SARS-CoV-2 infection through an outpatient service was described. Patients with confirmed COVID-19 were selected by General Practitioners (GPs) if eligible to mAb administration, according to manufacturer and AIFA (Agenzia-Italiana-del-Farmaco) criteria. If suitability was confirmed by the Multidisciplinary Team, the patient was evaluated within the next 48-72 hours. Then, all patients underwent a medical evaluation, followed by mAb infusion or hospitalization if the medical condition had worsened. Overall, from March 29th to June 4th, 2021, 106 patients with confirmed COVID-19 were identified by GPs; 26 were considered not eligible and then excluded, while 9 refused treatment. Among the 71 remaining, 6 were not treated because of worsening of symptoms soon after selection. Finally, 65 received mAb therapy. All treated patients survived. However, 2/65 developed adverse events (allergic reaction and atrial fibrillation, respectively) and 6/65 needed hospitalization. By performing univariate logistic regression analysis, diabetes was the only risk factor for hospitalization after mAb administration [aOR = 9.34, 95%CI = 1.31-66.49, p= .026]. Importantly, subjects who worsened awaiting mAb were more frequently obese (OR = 16.66, 95%CI = 1.80-153.9, p= .013) and received home corticosteroid therapy for COVID-19 (OR = 14.11, 95%CI = 1.53-129.6, p= .019). Establishing a network among GPs and COVID units could be an effective strategy to provide mAb treatment to patients with early SARS-CoV-2 infection to reduce hospitalizations and pressure on healthcare systems.
Collapse
Affiliation(s)
- D F Bavaro
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - L Diella
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - A G Solimando
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine 'G. Baccelli' University Hospital Policlinico, Bari, Italy
| | - S Cicco
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine 'G. Baccelli' University Hospital Policlinico, Bari, Italy
| | - E Buonamico
- Department of Basic Medical Science, Institute of Respiratory Disease, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - C Stasi
- Clinica Medica 'A. Murri', Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - M Ciannarella
- Clinica Medica 'A. Murri', Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - M Marrone
- Interdisciplinary Department of Medicine, University of Bari - Section of Legal Medicine, Bari General Hospital, Bari, Italy
| | - F Carpagnano
- Section of Health Management, Policlinico Hospital, Bari, Italy
| | - O Resta
- Department of Basic Medical Science, Institute of Respiratory Disease, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - G E Carpagnano
- Department of Basic Medical Science, Institute of Respiratory Disease, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - V O Palmieri
- Clinica Medica 'A. Murri', Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - A Vacca
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine 'G. Baccelli' University Hospital Policlinico, Bari, Italy
| | - M Dell'Aera
- Hospital Pharmacy, Direttore Farmacia Ospedaliera Aou Policlinico Di Bari, Bari, Italy
| | - A Dell'Erba
- Interdisciplinary Department of Medicine, University of Bari - Section of Legal Medicine, Bari General Hospital, Bari, Italy
| | - G Migliore
- General Direction, Policlinico Hospital, Bari, Italy
| | - M Aricò
- Strategic Direction, Policlinico Hospital, Bari, Italy
| | - A Saracino
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| |
Collapse
|
26
|
Implementation of SARS-CoV-2 Monoclonal Antibody Infusion Sites at Three Medical Centers in the United States: Strengths and Challenges Assessment to Inform COVID-19 Pandemic and Future Public Health Emergency Use. Disaster Med Public Health Prep 2022; 17:e112. [PMID: 35027098 PMCID: PMC9002153 DOI: 10.1017/dmp.2022.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Monoclonal antibody therapeutics to treat coronavirus disease (COVID-19) have been authorized by the US Food and Drug Administration under Emergency Use Authorization (EUA). Many barriers exist when deploying a novel therapeutic during an ongoing pandemic, and it is critical to assess the needs of incorporating monoclonal antibody infusions into pandemic response activities. We examined the monoclonal antibody infusion site process during the COVID-19 pandemic and conducted a descriptive analysis using data from 3 sites at medical centers in the United States supported by the National Disaster Medical System. Monoclonal antibody implementation success factors included engagement with local medical providers, therapy batch preparation, placing the infusion center in proximity to emergency services, and creating procedures resilient to EUA changes. Infusion process challenges included confirming patient severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity, strained staff, scheduling, and pharmacy coordination. Infusion sites are effective when integrated into pre-existing pandemic response ecosystems and can be implemented with limited staff and physical resources.
Collapse
|
27
|
Vijayan T. Raining in Los Angeles. BMJ 2022; 376:o113. [PMID: 35031589 DOI: 10.1136/bmj.o113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Tara Vijayan
- Division of Infectious Diseases, University of California, Los Angeles
| |
Collapse
|
28
|
Wynia MK, Beaty LE, Bennett TD, Carlson NE, Davis CB, Kwan BM, Mayer DA, Ong TC, Russell S, Steele J, Stocker HR, Wogu AF, Zane RD, Sokol RJ, Ginde AA. Real World Evidence of Neutralizing Monoclonal Antibodies for Preventing Hospitalization and Mortality in COVID-19 Outpatients. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.01.09.22268963. [PMID: 35043117 PMCID: PMC8764726 DOI: 10.1101/2022.01.09.22268963] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Neutralizing monoclonal antibodies (mAbs) are authorized for early symptomatic COVID-19 patients. Whether mAbs are effective against the SARS-CoV-2 Delta variant, among vaccinated patients, or for prevention of mortality remains unknown. OBJECTIVE To evaluate the effectiveness of mAb treatment in preventing progression to severe disease during the Delta phase of the pandemic and based on key baseline risk factors. DESIGN SETTING AND PATIENTS Observational cohort study of non-hospitalized adult patients with SARS-CoV-2 infection from November 2020-October 2021, using electronic health records from a statewide health system plus state-level vaccine and mortality data. Using propensity matching, we selected approximately 2.5 patients not receiving mAbs for each patient who received mAbs. EXPOSURE Neutralizing mAb treatment under emergency use authorization. MAIN OUTCOMES The primary outcome was 28-day hospitalization; secondary outcomes included mortality and severity of hospitalization. RESULTS Of 36,077 patients with SARS-CoV-2 infection, 2,675 receiving mAbs were matched to 6,677 not receiving mAbs. Compared to mAb-untreated patients, mAb-treated patients had lower all-cause hospitalization (4.0% vs 7.7%; adjusted OR 0.48, 95%CI 0.38-0.60) and all-cause mortality (0.1% vs. 0.9%; adjusted OR 0.11, 95%CI 0.03-0.29) to day 28; differences persisted to day 90. Among hospitalized patients, mAb-treated patients had shorter hospital length of stay (5.8 vs. 8.5 days) and lower risk of mechanical ventilation (4.6% vs. 16.6%). Relative effectiveness was similar in preventing hospitalizations during the Delta variant phase (adjusted OR 0.35, 95%CI 0.25-0.50) and across subgroups. Lower number-needed-to-treat (NNT) to prevent hospitalization were observed for subgroups with higher baseline risk of hospitalization (e.g., multiple comorbidities (NNT=17) and not fully vaccinated (NNT=24) vs. no comorbidities (NNT=88) and fully vaccinated (NNT=81). CONCLUSION Real-world evidence demonstrated mAb effectiveness in reducing hospitalization among COVID-19 outpatients, including during the Delta variant phase, and conferred an overall 89% reduction in 28-day mortality. Early outpatient treatment with mAbs should be prioritized, especially for individuals with highest risk for hospitalization.
Collapse
|
29
|
Gupta S, Sudhindran S, Saraf N, Vijai A, Swaminathan S, Panackel C, Mehta NN, Varghese J, Singh S, Reddy MS, M. Sivaramakrishnan V, Bhangui P, Mohanka R, Asthana S, Rohatgi S. Liver Transplant Society of India Guidelines for Liver Transplant During COVID-19 times. J Clin Exp Hepatol 2022; 12:180-185. [PMID: 34429571 PMCID: PMC8378015 DOI: 10.1016/j.jceh.2021.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/15/2021] [Indexed: 12/12/2022] Open
Abstract
Coronavirus disease-2019 (COVID-19) pandemic has affected liver transplantation in many ways. There is risk of infection to the transplant recipients; and COVID-19 is associated with significant risk of mortality in patients on wait list. The Liver Transplant Society of India (LTSI) has prepared guidelines regarding selection of adult and pediatric patients for liver transplantation, transplant for acute liver failure, use of deceased donor organs, transplant techniques and minimally invasive donor hepatectomy, pre- and postsurgery testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related coronavirus disease 2019 in donors and recipients, role of COVID-19 antibody testing, shifting of recipients from COVID-19 to non-COVID-19 areas after recovery, isolation policy of team members exposed to COVID-19 patients, drug therapy of proven or suspected COVID-19 infection early posttransplant, care of SARS-CoV-2 positive donors and recipients and a separate COVID-19 consent for surgery.
Collapse
Affiliation(s)
| | | | - Neeraj Saraf
- Medanta The Medicity, Gurgaon, India,Address for correspondence: Neeraj Saraf. Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity Hospital, Sector 38, Gurgaon, Delhi (NCR), India.
| | - Anand Vijai
- GEM Hospital and Research Center, Coimbatore, India
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
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.
Collapse
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
| |
Collapse
|
31
|
Xiang HR, He B, Li Y, Cheng X, Zhang QZ, Peng WX. Bamlanivimab plus etesevimab treatment have a better outcome against COVID-19: A meta-analysis. J Med Virol 2021; 94:1893-1905. [PMID: 34936121 DOI: 10.1002/jmv.27542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 01/10/2023]
Abstract
Bamlanivimab is routinely used in the treatment of coronavirus disease 2019 (COVID-19) worldwide. We performed a meta-analysis to investigate the efficacy and safety of bamlanivimab treatment in patients with COVID-19. We searched articles from Web of Science, PubMed, Embase, the Cochrane Library, and medRxiv between January 30, 2020 and August 5, 2021. We selected randomized clinical trials (RCTs) and observational studies with a control group to assess the efficiency of bamlanivimab in treating patients with COVID-19. Our meta-analysis retrieved three RCTs and seven cohort studies including 14 461 patients. Bmlanivimab may help outpatients to prevent hospitalization or emergency department visits (RR 0.41, 95%CI 0.29-0.58), reduce ICU admission (RR 0.47, 95%CI 0.23-0.92), and mortality (RR 0.32, 95%CI 0.13-0.77) from the disease. The combination of bamlanivimab and etesevimab may have a greater potential for positive treatment outcomes. Bamlanivimab has demonstrated clinical efficacy on mild or moderate ill patients with COVID-19 to prevent hospitalization, reduce severity, and mortality from the disease. Combinations of bamlanivimab and etesevimab have a significant relative risk reduction for COVID-related hospitalization or death for patients than the monotherapy 700 mg group. Well-designed clinical trials to identify the clinical and biochemical characteristics in the COVID-19 patients' population that could benefit from bamlanivimab or plus etesevimab are warranted in the future.
Collapse
Affiliation(s)
- Huai-Rong Xiang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bei He
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yun Li
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xuan Cheng
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qi-Zhi Zhang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wen-Xing Peng
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Institute of Clinical Pharmacy, Central South University, Changsha, Hunan, China
| |
Collapse
|
32
|
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.
Collapse
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
| |
Collapse
|
33
|
Choi S, Hwang S, Kwon K. Compassionate Use of GC5131 (Hyperimmunoglobulin) Therapy in Critically Ill Patients Diagnosed with COVID-19: A Case Series and Review of Literature. Viruses 2021; 13:v13091826. [PMID: 34578407 PMCID: PMC8473256 DOI: 10.3390/v13091826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022] Open
Abstract
Presently, the use of convalescent plasma and hyperimmunoglobulin obtained from individuals who have recovered from coronavirus disease 2019 (COVID-19) has proved to potentially provide passive antibody-based immunity, thereby leading to several clinical trials to develop an immune-based COVID-19 treatment. However, the therapeutic efficacy of hyperimmunoglobulin in critically ill patients with COVID-19 remains unknown. On 23 October 2020, we first administered GC5131 in a compassionate-use program to critically ill patients at the Kyungpook National University, Chilgok Hospital, Korea. Since then, five more critically ill patients were treated with GC5131 in this compassionate-use program in our hospital up until 17 December 2020. We retrospectively reviewed the clinical responses of six critically ill patients diagnosed with COVID-19 who received the hyperimmunoglobulin concentrate, GC5131, which was produced by the Green Cross Corporation. After the administration of GC5131, five patients died due to an exacerbation of COVID-19 pneumonia. GC5131 was ineffective when administered to critically ill patients with COVID-19. Nevertheless, we propose that to expect a therapeutic effect from GC5131, it should be administered as early as possible to avoid the excessive inflammatory response phase in patients with severe and advanced COVID-19 infection. This step was difficult to achieve in the real world due to the time required for decision making and the process of the compassionate-use program.
Collapse
Affiliation(s)
- Sunha Choi
- Division of Pulmonary Disease, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 47404, Korea;
| | - Soyoon Hwang
- Division of Infectious Diseases, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 47404, Korea;
| | - Kitae Kwon
- Division of Infectious Diseases, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 47404, Korea;
- Correspondence: ; Tel.: +82-53-200-2616
| |
Collapse
|
34
|
Kreuzberger N, Hirsch C, Chai KL, Tomlinson E, Khosravi Z, Popp M, Neidhardt M, Piechotta V, Salomon S, Valk SJ, Monsef I, Schmaderer C, Wood EM, So-Osman C, Roberts DJ, McQuilten Z, Estcourt LJ, Skoetz N. SARS-CoV-2-neutralising monoclonal antibodies for treatment of COVID-19. Cochrane Database Syst Rev 2021; 9:CD013825. [PMID: 34473343 PMCID: PMC8411904 DOI: 10.1002/14651858.cd013825.pub2] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Monoclonal antibodies (mAbs) are laboratory-produced molecules derived from the B cells of an infected host. They are being investigated as a potential therapy for coronavirus disease 2019 (COVID-19). OBJECTIVES To assess the effectiveness and safety of SARS-CoV-2-neutralising mAbs for treating patients with COVID-19, compared to an active comparator, placebo, or no intervention. To maintain the currency of the evidence, we will use a living systematic review approach. A secondary objective is to track newly developed SARS-CoV-2-targeting mAbs from first tests in humans onwards. SEARCH METHODS: We searched MEDLINE, Embase, the Cochrane COVID-19 Study Register, and three other databases on 17 June 2021. We also checked references, searched citations, and contacted study authors to identify additional studies. Between submission and publication, we conducted a shortened randomised controlled trial (RCT)-only search on 30 July 2021. SELECTION CRITERIA We included studies that evaluated SARS-CoV-2-neutralising mAbs, alone or combined, compared to an active comparator, placebo, or no intervention, to treat people with COVID-19. We excluded studies on prophylactic use of SARS-CoV-2-neutralising mAbs. DATA COLLECTION AND ANALYSIS Two authors independently assessed search results, extracted data, and assessed risk of bias using the Cochrane risk of bias tool (RoB2). Prioritised outcomes were all-cause mortality by days 30 and 60, clinical progression, quality of life, admission to hospital, adverse events (AEs), and serious adverse events (SAEs). We rated the certainty of evidence using GRADE. MAIN RESULTS We identified six RCTs that provided results from 17,495 participants with planned completion dates between July 2021 and December 2031. Target sample sizes varied from 1020 to 10,000 participants. Average age was 42 to 53 years across four studies of non-hospitalised participants, and 61 years in two studies of hospitalised participants. Non-hospitalised individuals with COVID-19 Four studies evaluated single agents bamlanivimab (N = 465), sotrovimab (N = 868), regdanvimab (N = 307), and combinations of bamlanivimab/etesevimab (N = 1035), and casirivimab/imdevimab (N = 799). We did not identify data for mortality at 60 days or quality of life. Our certainty of the evidence is low for all outcomes due to too few events (very serious imprecision). Bamlanivimab compared to placebo No deaths occurred in the study by day 29. There were nine people admitted to hospital by day 29 out of 156 in the placebo group compared with one out of 101 in the group treated with 0.7 g bamlanivimab (risk ratio (RR) 0.17, 95% confidence interval (CI) 0.02 to 1.33), 2 from 107 in the group treated with 2.8 g (RR 0.32, 95% CI 0.07 to 1.47) and 2 from 101 in the group treated with 7.0 g (RR 0.34, 95% CI 0.08 to 1.56). Treatment with 0.7 g, 2.8 g and 7.0 g bamlanivimab may have similar rates of AEs as placebo (RR 0.99, 95% CI 0.66 to 1.50; RR 0.90, 95% CI 0.59 to 1.38; RR 0.81, 95% CI 0.52 to 1.27). The effect on SAEs is uncertain. Clinical progression/improvement of symptoms or development of severe symptoms were not reported. Bamlanivimab/etesevimab compared to placebo There were 10 deaths in the placebo group and none in bamlanivimab/etesevimab group by day 30 (RR 0.05, 95% CI 0.00 to 0.81). Bamlanivimab/etesevimab may decrease hospital admission by day 29 (RR 0.30, 95% CI 0.16 to 0.59), may result in a slight increase in any grade AEs (RR 1.15, 95% CI 0.83 to 1.59) and may increase SAEs (RR 1.40, 95% CI 0.45 to 4.37). Clinical progression/improvement of symptoms or development of severe symptoms were not reported. Casirivimab/imdevimab compared to placebo Casirivimab/imdevimab may reduce hospital admissions or death (2.4 g: RR 0.43, 95% CI 0.08 to 2.19; 8.0 g: RR 0.21, 95% CI 0.02 to 1.79). We are uncertain of the effect on grades 3-4 AEs (2.4 g: RR 0.76, 95% CI 0.17 to 3.37; 8.0 g: RR 0.50, 95% CI 0.09 to 2.73) and SAEs (2.4 g: RR 0.68, 95% CI 0.19 to 2.37; 8.0 g: RR 0.34, 95% CI 0.07 to 1.65). Mortality by day 30 and clinical progression/improvement of symptoms or development of severe symptoms were not reported. Sotrovimab compared to placebo We are uncertain whether sotrovimab has an effect on mortality (RR 0.33, 95% CI 0.01 to 8.18) and invasive mechanical ventilation (IMV) requirement or death (RR 0.14, 95% CI 0.01 to 2.76). Treatment with sotrovimab may reduce the number of participants with oxygen requirement (RR 0.11, 95 % CI 0.02 to 0.45), hospital admission or death by day 30 (RR 0.14, 95% CI 0.04 to 0.48), grades 3-4 AEs (RR 0.26, 95% CI 0.12 to 0.60), SAEs (RR 0.27, 95% CI 0.12 to 0.63) and may have little or no effect on any grade AEs (RR 0.87, 95% CI 0.66 to 1.16). Regdanvimab compared to placebo Treatment with either dose (40 or 80 mg/kg) compared with placebo may decrease hospital admissions or death (RR 0.45, 95% CI 0.14 to 1.42; RR 0.56, 95% CI 0.19 to 1.60, 206 participants), but may increase grades 3-4 AEs (RR 2.62, 95% CI 0.52 to 13.12; RR 2.00, 95% CI 0.37 to 10.70). 80 mg/kg may reduce any grade AEs (RR 0.79, 95% CI 0.52 to 1.22) but 40 mg/kg may have little to no effect (RR 0.96, 95% CI 0.64 to 1.43). There were too few events to allow meaningful judgment for the outcomes mortality by 30 days, IMV requirement, and SAEs. Hospitalised individuals with COVID-19 Two studies evaluating bamlanivimab as a single agent (N = 314) and casirivimab/imdevimab as a combination therapy (N = 9785) were included. Bamlanivimab compared to placebo We are uncertain whether bamlanivimab has an effect on mortality by day 30 (RR 1.39, 95% CI 0.40 to 4.83) and SAEs by day 28 (RR 0.93, 95% CI 0.27 to 3.14). Bamlanivimab may have little to no effect on time to hospital discharge (HR 0.97, 95% CI 0.78 to 1.20) and mortality by day 90 (HR 1.09, 95% CI 0.49 to 2.43). The effect of bamlanivimab on the development of severe symptoms at day 5 (RR 1.17, 95% CI 0.75 to 1.85) is uncertain. Bamlanivimab may increase grades 3-4 AEs at day 28 (RR 1.27, 95% CI 0.81 to 1.98). We assessed the evidence as low certainty for all outcomes due to serious imprecision, and very low certainty for severe symptoms because of additional concerns about indirectness. Casirivimab/imdevimab with usual care compared to usual care alone Treatment with casirivimab/imdevimab compared to usual care probably has little or no effect on mortality by day 30 (RR 0.94, 95% CI 0.87 to 1.02), IMV requirement or death (RR 0.96, 95% CI 0.90 to 1.04), nor alive at hospital discharge by day 30 (RR 1.01, 95% CI 0.98 to 1.04). We assessed the evidence as moderate certainty due to study limitations (lack of blinding). AEs and SAEs were not reported. AUTHORS' CONCLUSIONS: The evidence for each comparison is based on single studies. None of these measured quality of life. Our certainty in the evidence for all non-hospitalised individuals is low, and for hospitalised individuals is very low to moderate. We consider the current evidence insufficient to draw meaningful conclusions regarding treatment with SARS-CoV-2-neutralising mAbs. Further studies and long-term data from the existing studies are needed to confirm or refute these initial findings, and to understand how the emergence of SARS-CoV-2 variants may impact the effectiveness of SARS-CoV-2-neutralising mAbs. Publication of the 36 ongoing studies may resolve uncertainties about the effectiveness and safety of SARS-CoV-2-neutralising mAbs for the treatment of COVID-19 and possible subgroup differences.
Collapse
Affiliation(s)
- Nina Kreuzberger
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Caroline Hirsch
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Khai Li Chai
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Eve Tomlinson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Zahra Khosravi
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Maria Popp
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Miriam Neidhardt
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Vanessa Piechotta
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Susanne Salomon
- Laboratory of Experimental Immunology, Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sarah J Valk
- Jon J van Rood Center for Clinical Transfusion Research, Sanquin/Leiden University Medical Center, Leiden, Netherlands
| | - Ina Monsef
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christoph Schmaderer
- Department of Nephrology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Erica M Wood
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - David J Roberts
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
| | - Zoe McQuilten
- Transfusion Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lise J Estcourt
- Haematology/Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
| | - Nicole Skoetz
- Cochrane Cancer, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| |
Collapse
|
35
|
Sakata T, Brunisholz KD, Andersen C, Davie D, Srivastava R, Webb BJ. The MAb Squad: Delivering Covid-19 Monoclonal Antibody Therapy Across a Large Geographic Region. NEJM CATALYST 2021. [PMCID: PMC8372990 DOI: 10.1056/cat.21.0154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Providing access to anti–severe acute respiratory syndrome coronavirus 2–neutralizing monoclonal antibody (MAb) infusions to ambulatory patients with early-onset Covid-19 poses numerous operational challenges to health care systems. Among these include optimizing efficacy through early identification of high-risk patients, ensuring equitable access to disadvantaged populations and across wide geographic regions, preserving access to infusion services for other populations, maintaining adequate infection control, and managing resource constraints. Intermountain Healthcare shares its experience designing and implementing a novel care delivery pathway for MAb therapy to address these challenges within a large integrated health care system. By describing adaptable and scalable solutions, the authors hope to illustrate the real-world feasibility of implementing these promising therapies in health care systems, large and small, to improve patient outcomes and preserve hospital capacity.
Collapse
Affiliation(s)
- Theadora Sakata
- Urgent Care Service Line, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Kim D. Brunisholz
- Healthcare Delivery Institute, Intermountain Healthcare, Murray, Utah, USA
| | - Curtis Andersen
- Urgent Care Service Line, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Daniel Davie
- Urgent Care Service Line, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Rajendu Srivastava
- Healthcare Delivery Institute, Intermountain Healthcare, Murray, Utah, USA
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Brandon J. Webb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
- Division of Infectious Diseases and Geographic Medicine, Stanford Medicine, Palo Alto, California, USA
| |
Collapse
|
36
|
Nathan R, Shawa I, De La Torre I, Pustizzi JM, Haustrup N, Patel DR, Huhn G. A Narrative Review of the Clinical Practicalities of Bamlanivimab and Etesevimab Antibody Therapies for SARS-CoV-2. Infect Dis Ther 2021; 10:1933-1947. [PMID: 34374951 PMCID: PMC8353431 DOI: 10.1007/s40121-021-00515-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/22/2021] [Indexed: 12/16/2022] Open
Abstract
The severity of coronavirus disease 2019 (COVID-19) ranges from mild to death, with high morbidity and mortality rates reported amongst a vulnerable subset of patients termed high risk. While vaccines remain the primary option for COVID-19 prevention, neutralizing monoclonal antibodies (mAbs), such as bamlanivimab and etesevimab, have been shown to benefit certain subpopulations after exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Unlike vaccine-derived immunity that develops over time, administration of neutralizing mAbs is an immediate and passive immunotherapy, with the potential to reduce disease progression, emergency room visits, hospitalizations, and death. Bamlanivimab alone and together with etesevimab hold emergency use authorizations in several countries globally, with countries increasingly transitioning to the use of bamlanivimab and etesevimab together and other authorized mAbs on the basis of their evolving variant landscape, regulatory authorizations, and access to drugs. The current guidelines for the administration of bamlanivimab alone or together with etesevimab are informed by an iterative process of testing and development. Herein the rationale for these guidelines is provided by sharing the learnings that have been gathered throughout the development process of these mAbs. In addition, this review addresses the most common clinical questions received from health care professionals (HCPs) and patients regarding indicated population, dose, use with other medications and vaccines, duration of protection, and variants in clinical practice. As prevalence of SARS-CoV-2 variants can differ by country and state, prescribing HCPs should consider the prevalence of bamlanivimab and etesevimab resistant variants in their area, where data are available, regarding potential efficacy impact when considering treatment options. Trial Registration: ClinicalTrials.gov identifier: NCT04427501; NCT04411628; NCT04497987; NCT04634409.
Collapse
Affiliation(s)
| | - Imad Shawa
- Franciscan Health, 701E County Line Rd, Ste 101, Greenwood, IN, 46143, USA
| | | | | | | | | | - Gregory Huhn
- The Ruth M. Rothstein CORE Center, Cook County Health and Hospital System, Chicago, IL, USA.
| |
Collapse
|