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Buonomo AR, Filippo ID, Esposito N, Saccone G, Nobile M, Viceconte G, Villari R, Carlo CD, Bifulco G, Gentile I. Outpatient Use of Monoclonal Antibodies Casirivimab and Imdevimab in Pregnancy for Mild-to-Moderate Coronavirus Disease 2019. Am J Perinatol 2024; 41:365-367. [PMID: 37072016 DOI: 10.1055/s-0042-1753488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
OBJECTIVE The aim of this study was to report the use casirivimab/imdevimab therapy in pregnant women with moderate coronavirus disease 2019 (COVID-19). STUDY DESIGN We report 12 cases of unvaccinated pregnant patients with mild-to-moderate COVID-19 treated with casirivimab/imdevimab. RESULTS Twelve unvaccinated pregnant patients with mild-to-moderate COVID-19 received casirivimab/imdevimab at the dose of 1200/1200 mg by intravenous infusion over 60 minutes. All women were managed outpatient. None experienced severe adverse drug reaction and none progressed to severe disease. CONCLUSION Casirivimab/imdevimab should be considered for outpatient treatment of unvaccinated pregnant women with mild-to-moderate COVID-19 to decrease the risk of severe disease. KEY POINTS · Casirivimab/imdevimab is not well studied in pregnant women.. · Casirivimab/imdevimab in pregnant women with mild-to-moderate COVID-19 decreases the risk of severe disease.. · Casirivimab/imdevimab in pregnant women with mild-to-moderate COVID-19 is well tolerated..
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Affiliation(s)
- Antonio Riccardo Buonomo
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit University "Federico II," - Naples, Italy
| | - Isabella Di Filippo
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit University "Federico II," - Naples, Italy
| | - Nunzia Esposito
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit University "Federico II," - Naples, Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, - Naples, Italy
| | - Mariano Nobile
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit University "Federico II," - Naples, Italy
| | - Giulio Viceconte
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit University "Federico II," - Naples, Italy
| | - Riccardo Villari
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, - Naples, Italy
| | - Costantino Di Carlo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, - Naples, Italy
| | - Giuseppe Bifulco
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, - Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit University "Federico II," - Naples, Italy
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Moriello NS, Buonomo AR, Scotto R, Pinchera B, Sarno M, Fusco L, Viceconte G, Iuliano A, Zappulo E, Foggia M, Villari R, Gentile I. Casirivimab/imdevimab + remdesivir in hospitalized patients with severe Covid-19: A single centre experience. Heliyon 2023; 9:e13126. [PMID: 36713627 DOI: 10.1016/j.heliyon.2023.e13126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 12/07/2022] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
Since 2020, COVID-19 pandemic has spread worldwide causing a huge number of cases and casualties. Among direct anti SARS-CoV-2 agents available for the treatment of COVID-19, only remdesivir and casirivimab/imdevimab have been approved for severe disease. As they act at different levels in blocking viral replication, it is theoretically possible to combine them. In this case series we describe tolerability, safety and effectiveness in a small group of 14 patients of the combination of casirivimab/imdevimab monoclonal antibodies with the polymerase inhibitor remdesivir for the treatment of severe COVID-19. We conducted a retrospective study among consecutive patients admitted to the Infectious Disease ward of the University of Naples (Italy) Hospital for COVID-19 that received the combination of casirivimab/imdevimab and remdesivir for the treatment of severe COVID-19 from the August 1, 2021 to the November 30, 2021. During the study period, 78 patients were admitted for severe COVID-19. Fourteen patients (18%) received the combination casirivimab/imdevimab and remdesivir. They were five males and nine females with a median age of 54 years. Eight patients had significant comorbidities; three patients were in the immediate post-partum period. No adverse drug reaction was observed. All patients except one improved clinical condition and respiratory parameters within seven days following the therapy. All patients were discharged in good conditions.
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Riccardo BA, Gabriele S, Nunzia E, Isabella DF, Biagio P, Maria F, Emanuela Z, Agnese G, Nicola SM, Giulio V, Riccardo S, Giuseppe B, Ivan G. Casirivimab and Imdevimab for Pregnant Women Hospitalized for Severe Coronavirus Disease 2019. Am J Perinatol 2022. [PMID: 35973799 DOI: 10.1055/a-1925-2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Our objective was to evaluate the safety and efficacy of casirivimab/imdevimab therapy in pregnant women with severe coronavirus disease 2019 (COVID-19) requiring oxygen therapy. STUDY DESIGN This was a prospective case series study aimed to evaluate the safety and efficacy of casirivimab/imdevimab therapy in unvaccinated pregnant women with severe COVID-19. Inclusion criteria were severe acute respiratory syndrome coronavirus 2 infection documented with polymerase chain reaction, pregnancy, severe COVID-19 requiring oxygen therapy, duration of symptoms of 10 days or less, and able to provide informed consent. Vaccinated women and those with mild-to-moderate disease were excluded from the study. Included patients received casirivimab and imdevimab as a single intravenous dose of 4,000/4,000 mg. Women were also treated with low molecular weight heparin, steroids, and antibiotics, if necessary. The primary outcome was maternal death. Secondary outcomes were the rate of adverse events during infusion or within 72 hours and the rate of abortion. RESULTS Thirteen hospitalized unvaccinated pregnant women with severe COVID-19 requiring oxygen and treated with casirivimab/imdevimab were included in the study. We observed no maternal death, and no patients required intubation or admission to the intensive care unit. No abortion or fetal loss was recorded. Nine pregnancies were still ongoing, and there were three cesarean deliveries and one vaginal delivery. Two were preterm deliveries (at 31 and 34 weeks), and two were term deliveries. CONCLUSION Casirivimab/imdevimab therapy may be considered as a therapy in unvaccinated pregnant women with severe COVID-19.
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Affiliation(s)
- Buonomo A Riccardo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II Naples, Naples, Italy
| | - Saccone Gabriele
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Esposito Nunzia
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Di Filippo Isabella
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II Naples, Naples, Italy
| | - Pinchera Biagio
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II Naples, Naples, Italy
| | - Foggia Maria
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II Naples, Naples, Italy
| | - Zappulo Emanuela
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II Naples, Naples, Italy
| | - Giaccone Agnese
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II Naples, Naples, Italy
| | - Schiano M Nicola
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II Naples, Naples, Italy
| | - Viceconte Giulio
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II Naples, Naples, Italy
| | - Scotto Riccardo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II Naples, Naples, Italy
| | - Bifulco Giuseppe
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Gentile Ivan
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II Naples, Naples, Italy
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Buonomo AR, Esposito N, Di Filippo I, Saccone G, Pinchera B, Scotto R, Bifulco G, Gentile I. Safety and efficacy of monoclonal antibodies anti SARS-CoV-2 in pregnancy. Expert Opin Drug Saf 2022; 21:1137-1141. [PMID: 36082789 DOI: 10.1080/14740338.2022.2122436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND SARS CoV-2 infection in pregnant women has become an urgent medical concern since it has been demonstrated a high rate of severe course of COVID-19, with evidence of increased mortality and peri-partum complications, especially when the infect.
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Affiliation(s)
- Antonio Riccardo Buonomo
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University "Federico II" - Naples Italy
| | - Nunzia Esposito
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University "Federico II" - Naples Italy
| | - Isabella Di Filippo
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University "Federico II" - Naples Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Science and Dentistry, School of Medicine, University of Naples Federico II - Naples Italy
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University "Federico II" - Naples Italy
| | - Riccardo Scotto
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University "Federico II" - Naples Italy
| | - Giuseppe Bifulco
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University "Federico II" - Naples Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Infectious Diseases Unit, University "Federico II" - Naples Italy
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Villamarín M, Márquez-Algaba E, Esperalba J, Perelló M, Los Arcos I, Campany D, Moreso F, Len O. Preliminary Clinical Experience of Molnupiravir to Prevent Progression of COVID-19 in Kidney Transplant Recipients. Transplantation 2022:TP. [PMID: 35915545 DOI: 10.1097/TP.0000000000004306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recently, different therapeutic lines have been tried in the initial stage of the disease of COVID-19, including remdesivir and molnupiravir. There is scarce evidence on the efficacy and safety of molnupiravir in kidney transplant recipients (KTRs). METHODS ingle-center prospective cohort study' all adult KTRs diagnosed with COVID-19 and treated with molnupiravir or remdesivir from January to April 2022 were included. RESULTS Nine KTRs with SARS-CoV-2 (Omicron variant) infection and mild symptoms received molnupiravir in an outpatient basis and were compared with a cohort of similar patients treated with remdesivir (n = 7). Three patients in the molnupiravir cohort were in the early posttransplant period and received a basiliximab (n = 2) or antithymocite globulin-based induction (n = 1). One of the patients had been treated with methylprednisolone bolus and antithymocite globulin for an episode of acute rejection in the previous months. They were all vaccinated with mRNA vaccines' and all but 1 had serological response. Only one of the patients experienced clinical worsening despite molnupiravir treatment and developed pneumonia requiring hospital admission. None of the patients suffered adverse effects attributed to molnupiravir' and no adjustment of tacrolimus dose was needed. None of the patients treated with remdesivir progressed in COVID-19 severity. CONCLUSIONS Our study suggests that KTRs with SARS-CoV-2 infection under treatment with molnupiravir have a good clinical evolution with a probable lower risk for hospitalization and no adverse effects. At the renal level, molnupiravir was well tolerated, with no evidence of nephrotoxicity secondary to the drug nor interactions with the immunosuppressive therapy.
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Pinchera B, Buonomo AR, Scotto R, Carrano R, Salemi F, Galluccio F, Guarino M, Viceconte G, Schiano Moriello N, Giaccone A, Gallicchio A, Zappulo E, Villari R, Gentile I. Sotrovimab in Solid Organ Transplant Patients With Early, Mild/Moderate SARS-CoV-2 Infection: A Single-center Experience. Transplantation 2022; 106:e343-e345. [PMID: 35349534 PMCID: PMC9213056 DOI: 10.1097/tp.0000000000004150] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Biagio Pinchera
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II," Naples, Italy
| | - Antonio Riccardo Buonomo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II," Naples, Italy
| | - Riccardo Scotto
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II," Naples, Italy
| | - Rosa Carrano
- Department of Public Health, Section of Nephrology, University of Naples "Federico II," Naples, Italy
| | - Fabrizio Salemi
- Department of Public Health, Section of Nephrology, University of Naples "Federico II," Naples, Italy
| | - Fabiana Galluccio
- Department of Public Health, Section of Nephrology, University of Naples "Federico II," Naples, Italy
| | - Maria Guarino
- Department of Clinical Medicine and Surgery, Gastroenterology and Hepatology Unit, University of Naples "Federico II," Naples, Italy
| | - Giulio Viceconte
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II," Naples, Italy
| | - Nicola Schiano Moriello
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II," Naples, Italy
| | - Agnese Giaccone
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II," Naples, Italy
| | - Antonella Gallicchio
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II," Naples, Italy
| | - Emanuela Zappulo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II," Naples, Italy
| | - Riccardo Villari
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II," Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II," Naples, Italy
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Pilz S, Theiler-Schwetz V, Trummer C, Krause R, Ioannidis JPA. SARS-CoV-2 reinfections: Overview of efficacy and duration of natural and hybrid immunity. Environ Res 2022; 209:112911. [PMID: 35149106 PMCID: PMC8824301 DOI: 10.1016/j.envres.2022.112911] [Citation(s) in RCA: 132] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/04/2022] [Accepted: 02/05/2022] [Indexed: 05/13/2023]
Abstract
Seroprevalence surveys suggest that more than a third and possibly more than half of the global population has been infected with SARS-CoV-2 by early 2022. As large numbers of people continue to be infected, the efficacy and duration of natural immunity in terms of protection against SARS-CoV-2 reinfections and severe disease is of crucial significance for the future. This narrative review provides an overview on epidemiological studies addressing this issue. National surveys covering 2020-2021 documented that a previous SARS-CoV-2 infection is associated with a significantly reduced risk of reinfections with efficacy lasting for at least one year and only relatively moderate waning immunity. Importantly, natural immunity showed roughly similar effect sizes regarding protection against reinfection across different SARS-CoV-2 variants, with the exception of the Omicron variant for which data are just emerging before final conclusions can be drawn. Risk of hospitalizations and deaths was also reduced in SARS-CoV-2 reinfections versus primary infections. Observational studies indicate that natural immunity may offer equal or greater protection against SARS-CoV-2 infections compared to individuals receiving two doses of an mRNA vaccine, but data are not fully consistent. The combination of a previous SARS-CoV-2 infection and a respective vaccination, termed hybrid immunity, seems to confer the greatest protection against SARS-CoV-2 infections, but several knowledge gaps remain regarding this issue. Natural immunity should be considered for public health policy regarding SARS-CoV-2.
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Affiliation(s)
- Stefan Pilz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, 8036, Graz, Austria.
| | - Verena Theiler-Schwetz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, 8036, Graz, Austria
| | - Christian Trummer
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, 8036, Graz, Austria
| | - Robert Krause
- Department of Internal Medicine, Division of Infectious Diseases, Medical University of Graz, 8036, Graz, Austria
| | - John P A Ioannidis
- Departments of Medicine, Epidemiology and Population Health, Biomedical Data Science, and Statistics, Stanford University, Stanford, CA, 94305, USA.
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Manciulli T, Lagi F, Barbiero A, Fognani M, Di Lauria ND, Malcontenti C, Fiorelli C, Spinicci M, Ceccherini V, D’onofrio P, Angileri M, Malentacchi F, Cecchi M, Rossolini GM, Tomaiuolo M, Zammarchi L, Bartoloni A. Implementing Early Phase Treatments for COVID-19 in Outpatient Settings: Challenges at a Tertiary Care Center in Italy and Future Outlooks. Infect Dis Rep 2022; 14:315-20. [PMID: 35645216 PMCID: PMC9149810 DOI: 10.3390/idr14030037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/02/2022] [Accepted: 04/07/2022] [Indexed: 01/27/2023] Open
Abstract
We present a brief commentary illustrating the current COVID-19 outpatient treatment options in Italy. We also report our experience setting up a service dedicated to these patients in the wake of the rise in COVID-19 cases observed in January 2022. We also gathered data on the daily costs faced by our outpatient service, based at a tertiary care center located in Florence, Italy. We present them with some considerations on future outlooks on the use of outpatient treatment in COVID-19.
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Abstract
Ivan Gentile and Nicola Schiano Moriello discuss the potential of monoclonal antibody prophylaxis against COVID-19 infection in immunocompromised patients.
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Affiliation(s)
- Ivan Gentile
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
- * E-mail:
| | - Nicola Schiano Moriello
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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