Monoclonal antibody therapy improves severity and mortality of COVID-19 in organ transplant recipients: A meta-analysis

Yang, Mingyang; Li, Anthony; Wang, Yushu; Tran, Carolyn; Zhao, Siyi; Ao, Guangyu

doi:10.1016/j.jinf.2022.06.027

Cited by 14 publications

(7 citation statements)

References 9 publications

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“…Another important finding from our study was that mAb administration to OTRs with COVID-19 was associated with better survival ( Table 3 ), in agreement with the results of a recent meta-analysis [ 35 ]. Vaccinated patients received mAbs more frequently; however, the difference was not statistically significant ( Table 2 ) and is unlikely to have contributed to the independent benefits observed with vaccination ( Table 3 ).…”

Section: Discussionsupporting

confidence: 91%

“…Regardless, mAbs remain our first-line outpatient treatment for OTRs with COVID-19, as they have been shown to decrease the risk of hospitalization [ 27 ] and emergency room visit and death [ 35 ]. Nirmatrelvir/ritonavir (Paxlovid), although at least as effective as mAbs, inhibits irreversibly the catabolism of calcineurin and mTOR inhibitors, which are the backbone of maintenance immunosuppression among OTRs.…”

Section: Discussionmentioning

confidence: 99%

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mRNA Vaccination Decreases COVID-19-Associated Morbidity and Mortality Among Organ Transplant Recipients: A Contemporary Cohort Study

Lerner

Arvanitis

Vieira

et al. 2022

Open Forum Infectious Diseases

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Background Organ transplant recipients (OTR) are less protected from vaccination than immunocompetent hosts. Additional vaccine doses have shown increased immunogenicity. Few studies assessed their clinical efficacy, particularly against Omicron variants, since most included patients from earlier phases of the pandemic, with higher base mortality rates. Methods We studied adult OTR who had COVID-19 between 12/15/21 and 5/25/22. We compared clinical outcomes between those who had received 2 or ≥3 doses of an mRNA vaccine and concurrent unvaccinated controls. Results Among 103 OTR, vaccination was associated with lower 90-day mortality (unvaccinated vs. 2 vs. ≥3 doses: 25% vs. 7% vs. 3%, P = 0.003), hospital (unvaccinated vs. 2 vs. ≥3 doses: 56% vs. 37% vs. 27%, P = 0.018) or ICU (unvaccinated vs. 2 vs. ≥3 doses: 25% vs. 15% vs. 3%, P = 0.001) admission rates, and peak O2 requirements (ordinal scale Kendall’s tau b=-0.309 [lower scores, i.e., O2 requirements with more vaccine doses], P = 0.003). Age (>60 years adjusted hazard ratio [aHR] 7.73, P = 0.016), administration of anti-spike monoclonal antibody (aHR 0.17, P = 0.042) and vaccination, especially with ≥3 doses (aHR 0.105, P = 0.01), were independently associated with 90-day mortality. Black (P = 0.021) or Hispanic (P = 0.016) OTR were underrepresented among the vaccinated, especially in the ≥3 dose group. Conclusions Despite lower mRNA vaccine efficacy in OTR and against Omicron variants, vaccination protects this vulnerable patient population from severe COVID-19 and death. Ethnic and racial disparities in healthcare have been exacerbated by the COVID-19 pandemic and warrant better community outreach efforts.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

mRNA Vaccination Decreases COVID-19-Associated Morbidity and Mortality Among Organ Transplant Recipients: A Contemporary Cohort Study

Lerner

Arvanitis

Vieira

et al. 2022

Open Forum Infectious Diseases

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“…Our prior meta-analysis of 27,429 cases also suggested that sotrovimab could effectively lower the mortality rate in patients with COVID-19 [ 23 ]. Generally, mAbs have been demonstrated effective in reducing COVID-19–associated deaths [ 24 ]. This decrease in mortality rate could be attributed to the role of sotrovimab in counteracting the progression to severe disease.…”

Section: Discussionmentioning

confidence: 99%

Sotrovimab in solid organ transplant recipients with COVID-19: a systematic review and meta-analysis

Amani,

Shabestan,

Rajabkhah

et al. 2023

Korean J Transplant

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Background Despite widespread implementation of vaccination against coronavirus disease 2019 (COVID-19), solid organ transplant recipients (SOTRs) can remain particularly vulnerable to this disease. The present study was conducted to investigate the efficacy and safety of sotrovimab in the treatment of SOTRs with COVID-19. Methods A search was performed of PubMed, Cochrane Library, Web of Science, medRxiv, and Google Scholar to gather relevant evidence through July 25, 2023. The quality of the included studies was assessed using the risk of bias tool. Comprehensive Meta-Analysis software (ver. 3.0, Biostat) was employed for data analysis. Results Ten studies, involving a total of 1,569 patients, were included. The meta-analysis revealed significant differences between the patients administered sotrovimab and those treated with the standard of care. These differences were observed in mortality rate (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.03–0.67), hospitalization rate (OR, 0.35; 95% CI, 0.21–0.57), intensive care unit (ICU) admission rate (OR, 0.16; 95% CI, 0.04–0.62), the need for supplemental oxygen therapy (OR, 0.22; 95% CI, 0.09–0.51), and the need for mechanical ventilation (OR, 0.09; 95% CI, 0.01–0.70). However, no significant difference was observed between sotrovimab and other treatments regarding the rates of hospitalization or ICU admission (P>0.05). Regarding safety, sotrovimab was associated with a lower rate of adverse events compared to the absence of sotrovimab (OR, 0.15; 95% CI, 0.02–0.86). Conclusions These results suggest that sotrovimab may improve efficacy outcomes among SOTRs with COVID-19. Nevertheless, additional high-quality trials are necessary to confirm these findings.

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“…In this journal, Yang and colleagues recently reviewed effectiveness of monoclonal antibody therapy in organ transplant recipients with COVID-19 1 . Pre-exposure prophylaxis (PrEP) of COVID-19 is essential for immunocompromised patients who do not respond to SARS-CoV-2 vaccines.…”

Section: To the Editormentioning

confidence: 99%

Low serum neutralization of Omicron variants a month after AZD7442 prophylaxis initiation

Lamballerie

Martin‐Blondel

Dupont

et al. 2023

Journal of Infection

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Monoclonal antibody therapy improves severity and mortality of COVID-19 in organ transplant recipients: A meta-analysis

Cited by 14 publications

References 9 publications

mRNA Vaccination Decreases COVID-19-Associated Morbidity and Mortality Among Organ Transplant Recipients: A Contemporary Cohort Study

mRNA Vaccination Decreases COVID-19-Associated Morbidity and Mortality Among Organ Transplant Recipients: A Contemporary Cohort Study

Sotrovimab in solid organ transplant recipients with COVID-19: a systematic review and meta-analysis

Low serum neutralization of Omicron variants a month after AZD7442 prophylaxis initiation

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