Sotrovimab for Treatment of COVID-19 in Solid Organ Transplant Recipients

Dhand, Abhay; Okumura, Kenji; Wolfe, Kevin; Lobo, Stephen; Nog, Rajat; Keller, Marina; Bodin, Roxana; Singh, Neil; Levine, Avi; Nabors, Christopher

doi:10.1097/tp.0000000000004136

Cited by 16 publications

(18 citation statements)

References 2 publications

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“…Case series describing outcomes of SOTR treated with either sotrovimab or NR have been published, though they are limited by small sample sizes and do not include comparator populations. 6 , 7 , 8 …”

Section: Introductionmentioning

confidence: 99%

“…As such, it is not yet known if these agents are safe or effective in this particularly at‐risk population. Case series describing outcomes of SOTR treated with either sotrovimab or NR have been published, though they are limited by small sample sizes and do not include comparator populations 6–8 …”

Section: Introductionmentioning

confidence: 99%

“…published, though they are limited by small sample sizes and do not include comparator populations. [6][7][8] The objective of this analysis was to evaluate outcomes in a heterogeneous population of outpatient SOTR infected with COVID-19 during an Omicron BA.1-dominated period in New York City who received either NR or sotrovimab, compared to those who received no SARS-CoV-2 specific treatment.…”

mentioning

confidence: 99%

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COVID-19 therapeutics and outcomes among solid organ transplant recipients during the Omicron BA.1 era

Hedvat

Lange

Salerno

et al. 2022

American Journal of Transplantation

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Treatment outcomes associated with the use of novel COVID‐19 therapeutics in solid organ transplant recipients (SOTR) are not well described in the literature. The objective of this analysis was to characterize 30‐day hospitalization and other key secondary endpoints experienced by outpatient SOTR with mild–moderate COVID‐19 treated with nirmatrelvir/ritonavir (NR), sotrovimab, or no SARS‐CoV‐2 specific treatment. This IRB‐approved, retrospective study included 154 SOTR with a documented positive SARS‐CoV‐2 infection between December 16, 2021 and January 19, 2022 (a predominant Omicron BA.1 period in New York City). Patients who received NR ( N = 28) or sotrovimab ( N = 51) experienced a lower rate of 30‐day hospitalization or death as compared to those who received no specific treatment ( N = 75) ( p = .009). A total of three deaths occurred, all among patients who initially received no specific treatment prior to hospitalization. These results suggest a role for SARS‐CoV‐2 specific agents in the treatment of SOTR with COVID‐19, and that there does not appear to be any difference in effectiveness when comparing NR versus sotrovimab.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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COVID-19 therapeutics and outcomes among solid organ transplant recipients during the Omicron BA.1 era

Hedvat

Lange

Salerno

et al. 2022

American Journal of Transplantation

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“…Sotrovimab and remdesivir have been reported to significantly reduce mortality due to COVID‐19, and have no apparent nephrotoxic effects on renal transplant patients. 17 , 18 However, sufficient evidence has not yet been accumulated regarding steroid pulse therapy for COVID‐19 in renal transplant recipients. In a retrospective cohort study, treatment with methylprednisolone was shown to reduce the risk of death in patients with acute respiratory distress syndrome.…”

Section: Discussionmentioning

confidence: 99%

Rapid deterioration of renal function following coronavirus disease 2019 in a renal transplant recipient

et al. 2022

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Introduction The coronavirus disease 2019 pandemic emerged in December 2019. Renal transplant recipients receiving chronic immunosuppression are considered to be at a high risk of infection. Aside from upper respiratory tract symptoms, coronavirus disease 2019 has also been reported to cause acute kidney injury in 20–50% of infected cases. Case presentation A 62‐year‐old male renal transplant recipient presented with high fever, diarrhea, and cough, concurrent with rapid deterioration of graft function. The patient tested positive for coronavirus disease 2019. The pathological findings of the graft biopsy revealed diffuse flattening of tubular epithelial cells and extensive loss of the brush border in proximal tubular cells. Mycophenolate mofetil was discontinued and sotrovimab, remdesivir, intravenous immunoglobulin, and intravenous methylprednisolone were administered, resulting in gradual improvements in clinical symptoms and renal function. Conclusion We describe a case of a coronavirus disease 2019‐infected kidney transplant recipient who developed severe acute kidney injury caused by severe acute tubular necrosis.

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“…Previously, convalescent plasma infusion was undertaken to provide passive immunity. There are different monoclonal anti-spike antibody formulations available for post exposure prophylaxis and are used depending on the type of COVID 19 variants ( 55 ). They can be used in combination with anti-viral medications: remdesivir, molnupiravir or nirmatrelvir/ritonavir, reducing COVID-19-related morbidity and mortality in SOTR ( 56 , 57 ).…”

Section: Pre and Post Exposure Prophylaxismentioning

confidence: 99%

COVID-19 in kidney transplantation-implications for immunosuppression and vaccination

2022

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COVID-19 pandemic continues to challenge the transplant community, given increased morbidity and mortality associated with the disease and poor response to prevention measures such as vaccination. Transplant recipients have a diminished response to both mRNA and vector-based vaccines compared to dialysis and the general population. The currently available assays to measure response to vaccination includes commercially available antibody assays for anti-Spike Ab, or anti- Receptor Binding Domain Ab. Positive antibody testing on the assays does not always correlate with neutralizing antibodies unless the antibody levels are high. Vaccinations help with boosting polyfunctional CD4+ T cell response, which continues to improve with subsequent booster doses. Ongoing efforts to improve vaccine response by using additional booster doses and heterologous vaccine combinations are underway. There is improved antibody response in moderate responders; however, the ones with poor response to initial vaccination doses, continue to have a poor response to sequential boosters. Factors associated with poor vaccine response include diabetes, older age, specific immunosuppressants such as belatacept, and high dose mycophenolate. In poor responders, a decrease in immunosuppression can increase response to vaccination. COVID infection or vaccination has not been associated with an increased risk of rejection. Pre- and Post-exposure monoclonal antibodies are available to provide further protection against COVID infection, especially in poor vaccine responders. However, the efficacy is challenged by the emergence of new viral strains. A recently approved bivalent vaccine offers better protection against the Omicron variant.

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Sotrovimab for Treatment of COVID-19 in Solid Organ Transplant Recipients

Cited by 16 publications

References 2 publications

COVID-19 therapeutics and outcomes among solid organ transplant recipients during the Omicron BA.1 era

COVID-19 therapeutics and outcomes among solid organ transplant recipients during the Omicron BA.1 era

Rapid deterioration of renal function following coronavirus disease 2019 in a renal transplant recipient

COVID-19 in kidney transplantation-implications for immunosuppression and vaccination

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