Real-world effectiveness of casirivimab plus indevimab in a dedicated ambulatory unit created for patients with early COVID-19 during a massive delta variant wave

Abstract

Only limited real-life data are available on the effects of neutralizing monoclonal antibodies in high-risk patients who have early COVID-19 and do not require supplemental oxygen. We prospectively studied 217 patients infected by the delta variant who received casirivimab plus indevimab in a dedicated ambulatory unit created during our 4th COVID wave. Mean age was 64 years, 94% had at least one comorbidity, and mean duration of symptoms was 2.9 days. Oxygen requirement, hospitalization, and mortality rates were 10, 6, and 2.8%, respectively. These results suggest benefits of early administration of neutralizing antibodies in high-risk patients infected with the delta variant.

Inhalable neutralizing antibodies – promising approach to combating respiratory viral infections

“…Early administration is critical for neutralizing antibody therapy. As reported in many studies, administration before the establishment of inflammation can dramatically enhance the efficacy of neutralization antibodies [14,24,78]. This means that neutralizing antibody treatment should be aimed at outpatients at an early stage of infection, for which DPIs and nasal powder formulations should be appropriate.…”

“…All these injectable products contain monoclonal antibodies that are designed to bind to epitopes of the receptor-binding domain (RBD) of SARS-CoV-2 spike (S) protein, blocking viral entry into host cells [21,22]. Antibody therapeutics demonstrated effectiveness in preventing disease progression of COVID-19 when administered during the early stages of infection [19,23,24]. Unfortunately, due to the emergence of SARS-CoV-2 variants that exhibit multitude of mutations in the S protein, resistance has become a major setback for antibody therapy.…”