Differential efficacy and safety of anti-SARS-CoV-2 antibody therapies for the management of COVID-19: a systematic review and network meta-analysis

Abstract

Purpose To assess and compare the relative efficacy and safety of anti-SARS-CoV-2 antibody regimens for COVID-19. Methods This systematic review and random-effects network meta-analysis was conducted according to PRISMA-NMA. Literature searches were conducted across MEDLINE, EMBASE, PubMed, Web of Science, CENTRAL, and CNKI up to February 20th, 2022. Interventions were ranked using P scores. Results Fifty-five RCTs ( N = 45,005) were included in the review. Bamlanivimab + etesevimab (OR 0.13, 95% CI 0.02–0.77) was associated with a significant reduction in mortality compared to standard of care/placebo. Casirivimab + imdevimab reduced mortality (OR 0.67, 95% CI 0.50–0.91) in baseline seronegative patients only. Four different regimens led to a significant decrease in the incidence of hospitalization compared to standard of care/placebo with sotrovimab ranking first in terms of efficacy (OR 0.20, 95% CI 0.08–0.48). No treatment improved incidence of mechanical ventilation, duration of hospital/ICU stay, and time to viral clearance. Convalescent plasma and anti-COVID IVIg both led to a significant increase in adverse events compared to standard of care/placebo, but no treatment increased the odds of serious adverse events. Conclusion Anti-SARS-CoV-2 mAbs are safe, and could be effective in improving mortality and incidence of hospitalization. Convalescent plasma and anti-COVID IVIg were not efficacious and could increase odds of adverse events. Future trials should further examine the effect of baseline seronegativity, disease severity, patient risk factors, and SARS-CoV-2 strain variation on the efficacy of these regimes. Registration PROSPERO-CRD42021289903. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-022-01825-8.

Efficacy of tocilizumab in the treatment of COVID‐19: An umbrella review

“…In comparison, Deng et al. found no significant differences in the incidence of mechanical ventilation, ICU admission, and duration of ICU hospitalisation in COVID‐19 patients treated with anti‐SARS‐CoV‐2 antibodies (e.g., monoclonal antibodies and intravenous immunoglobulins) and those in the control group 146 . Furthermore, research by Yu et al.…”

“…found no significant differences in the incidence of mechanical ventilation, ICU admission, and duration of ICU hospitalisation in COVID‐19 patients treated with anti‐SARS‐CoV‐2 antibodies (e.g., monoclonal antibodies and intravenous immunoglobulins) and those in the control group. 146 Furthermore, research by Yu et al. found that sarilumab was not significantly associated with a reduced risk of invasive mechanical ventilation (RR 1.15; 95%CI, 0.38–3.51), whereas tocilizumab reduced the risk by 21% (RR 0.79; 95%CI, 0.71–0.88).…”

“… 145 A network meta‐analysis on the efficacy of anti‐severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) antibodies for treating COVID‐19 revealed that bamlanivimab + etesevimab decreased mortality by 87% (95%CI, 0.02–0.77). 146 The differences in the mortality outcomes between the numerous strategies for treating COVID‐19 could be due to differences in the inclusion criteria between the studies and features of the eligible populations, such as the prevalence of various underlying diseases and previous infection with SARS‐CoV‐2. However, comparing our results with the previously published studies shows that tocilizumab appears to be one of the most effective therapies for reducing COVID‐19 mortality.…”

“…Another umbrella review, on the efficacy of hydroxychloroquine or chloroquine in patients with COVID‐19, showed there was a lack of consistency in the clinical efficacy reported by the included articles 145 . A network meta‐analysis on the efficacy of anti‐severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) antibodies for treating COVID‐19 revealed that bamlanivimab + etesevimab decreased mortality by 87% (95%CI, 0.02–0.77) 146 . The differences in the mortality outcomes between the numerous strategies for treating COVID‐19 could be due to differences in the inclusion criteria between the studies and features of the eligible populations, such as the prevalence of various underlying diseases and previous infection with SARS‐CoV‐2.…”

Real-life data on monoclonal antibodies and antiviral drugs in Italian inborn errors of immunity patients during COVID-19 pandemic

“…The low rate of adverse effects observed in our cohort, after mabs and antivirals administration, is in line with data from literature showing - in a real-world evaluation - 1.2% monoclonal antibody infusion-associated adverse events, with 0.3% only considered as severe ( 59 ). In a recent meta-analysis, all mabs demonstrated good safety profiles with no significant increase in adverse events although Casirivimab + imdevimab and sotrovimab were associated with significant reductions in the odds of serious adverse events, with sotrovimab ranking first and casirivimab + imdevimab ranking second in terms of safety ( 60 ). The available evidence of AE is scant regarding antivirals, especially those for at-home therapy, but an incidence comparable with the placebo arm has been reported ( 61 ).…”