Resistance mutations in SARS-CoV-2 omicron variant in patients treated with sotrovimab

Genotypic and predicted phenotypic analysis of SARS-COV-2 Omicron subvariants in immunocompromised patients with COVID-19 following tixagevimab-cilgavimab prophylaxis

“…In 2022, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron became the leading variant causing coronavirus disease 2019 (COVID-19) worldwide [1] . This variant, divided into 5 subvariant lineages (BA.1/BA.2/BA.3/BA.4/BA.5), harbors numerous mutations in the spike protein (S) that enhance transmissibility and enable escape from antibody neutralization [ 1 , 2 ].…”

Sotrovimab to prevent severe COVID-19 in high-risk patients infected with Omicron BA.2

“…Targeting a single epitope, and used as a monotherapy, the risk of developing resistance mutations of SARS-CoV-2 in Sotrovimab-treated patients is of major concern. Mutations in the spike protein at positions 337 or 340 were shown in patients infected with the Delta ( 7 ) and the Omicron lineages ( 8 ). A recent report demonstrated across a routine genomic surveillance that these mutations occurred in 24 (0.13%) of 18,882 omicron BA.1 lineages and in one (0.02%) of 4025 omicron BA.2 lineages, affecting mostly immunocompromised patients with persistent SARS-CoV-2 excretion ( 9 ).…”

Sotrovimab for treatment of COVID-19 infections

“…These patients had spike protein mutations at position 337 or 340, with an associated reduction in susceptibility [14]. This development of treatment resistant SARS-CoV-2 variants was also identified in a similar study from Toulouse University Hospital [15]. Thus, consideration should be given to ensure confirmed viral clearance after treatment to avoid these patients becoming a source of new variants.…”