Targeted SARS-CoV-2 treatment is associated with decreased mortality in immunocompromised patients with COVID-19

Abstract

Background Little is known about targeted (antiviral or monoclonal antibody) anti-SARS-CoV-2 treatment in immunocompromised patients with COVID-19. Objectives To assess the real-life efficacy and tolerance of targeted treatment of COVID-19 in immunocompromised patients. Patients and methods Single-centre retrospective case series of immunocompromised patients with COVID-19 between December 2021 and March 2022. We recorded all cases of COVID-19 among immunocompromised patients treatment between 20 December 2021 and 15 March 2022. Choice of treatment was left to the physician’s decision, according to internal treatment protocol, treatment availability and circulating variants. Main outcome was death from COVID-19 after no treatment or targeted treatment. Results Sixty-seven immunocompromised patients [38 male; median (IQR) age, 53 (43–63) years], with a median (IQR) follow-up of 60 (47–80) days. Ten patients did not receive any targeted treatment. Targeted treatment consisted of IV curative remdesivir (n = 22), sotrovimab (n = 16), tixagevimab/cilgavimab (n = 13) and casirivimab/imdevimab (n = 1). Ten patients (15%) presented severe COVID-19 and 2 (3%) died from Omicron COVID-19. Comparing patients who received targeted anti-SARS-CoV-2 treatment and no prophylaxis, (n = 42; 81%) with those who did not (n = 10; 19%), death rate was significantly lower in treated patients [n = 0 (0%) versus n = 2 (20%); P = 0.034]. No severe adverse events were reported among treated patients. Among 15 patients who received tixagevimab/cilgavimab as pre-exposure prophylaxis, 6 received an additional curative treatment and none died from COVID-19. Conclusions Our results suggest that targeted COVID-19 treatment, including direct antivirals or monoclonal antibodies, is safe and efficient and could be proposed in high-risk immunocompromised patients.

Efficacy and Safety of Tixagevimab/Cilgavimab to Prevent COVID-19 (Pre-Exposure Prophylaxis): A Systematic Review and Meta-Analysis

“…The full texts of the 76 remaining articles were reviewed, and 46 irrelevant articles were excluded (reasons: study with in vitro activity of TGM/CGM to prevent SARS-CoV-2 variants = 13, study with no relevant data = 13, review = 12, study with in silico activity of TGM/CGM to prevent SARS-CoV-2 variants = 4, study with no extractable data = 3, and editorial and commentary = 1). As a result, we identified 30 studies (total participants = 27,932) that met our inclusion criteria and were included in the systematic review and meta-analysis [ 6 , 9 , 10 , 11 , 12 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. The PRISMA chart for the studies included is displayed in Figure 2 .…”

“…Among these, two articles were in preprint versions [ 26 , 35 ]. Most of the studies were cohorts ( n = 23) [ 6 , 10 , 11 , 12 , 20 , 21 , 22 , 23 , 26 , 27 , 30 , 31 , 33 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ], however, there were one case report [ 24 ] and five case series studies [ 25 , 28 , 29 , 32 , 34 ]. These studies were conducted in United States ( n = 14), France ( n = 11), Israel ( n = 2), Germany ( n = 1), and Austria ( n = 1).…”

“…Only one study was conducted within several countries ( n = 1) [ 9 ]. The majority of the studies were single center [ 6 , 11 , 12 , 23 , 24 , 25 , 26 , 28 , 29 , 31 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 41 , 42 , 44 ], and only ten studies were multicenter [ 9 , 10 , 20 , 21 , 22 , 27 , 30 , 35 , 40 , 43 ]. Studies randomly assigned participants into a TGM/CGM therapy versus a placebo [ 9 , 10 , 12 , 35 ], a combination of casirivimab/imdevimab (CRM/IDM) [ 11 , 21 , 37 ], or no treatment (no mAbs) [ 11 , 25 , 27 , 29 , 31 , 37 , 40 ].…”

“…The majority of the studies were single center [ 6 , 11 , 12 , 23 , 24 , 25 , 26 , 28 , 29 , 31 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 41 , 42 , 44 ], and only ten studies were multicenter [ 9 , 10 , 20 , 21 , 22 , 27 , 30 , 35 , 40 , 43 ]. Studies randomly assigned participants into a TGM/CGM therapy versus a placebo [ 9 , 10 , 12 , 35 ], a combination of casirivimab/imdevimab (CRM/IDM) [ 11 , 21 , 37 ], or no treatment (no mAbs) [ 11 , 25 , 27 , 29 , 31 , 37 , 40 ]. Few studies utilized a pre–post design (baseline) [ 6 , 23 , 26 , 36 ] and only one study utilized the design of randomized double-blind controlled trial [ 9 ].…”

“…There was a slightly higher male percentage in patients who received TGM/CGM as PrEP against COVID-19 ( n = 5590/8903, 62.8%). Participants were immunocompromised ( n = 18,611) [ 22 , 25 , 27 , 29 , 30 , 32 , 35 , 39 , 40 , 44 ], high-risk patients for severe COVID-19 (obesity (BMI ≥ 30), hypertension, smoking, diabetes, asthma, chronic heart or kidney or liver diseases, or receipt of immunosuppressive therapy) ( n = 8621) [ 9 , 30 , 35 , 44 ], solid organ transplant recipients (kidney, liver, lung, and multiorgan) ( n = 3111) [ 6 , 10 , 11 , 12 , 20 , 21 , 26 , 28 , 30 , 38 , 42 , 44 ], hematologic malignancy patients ( n = 1320) [ 30 , 31 , 32 , 33 , 37 , 38 , 44 ], inborn error of immunity and immune-mediated inflammatory diseases patients ( n = 445) [ 30 , 38 , 43 ], B-cell malignancy patients ( n = 251) [ 41 ], autoimmune disease patients ( n = 229) [ 25 , 32 , 38 , 44 ], multiple sclerosis patients ( n = 45) [ 23 , 34 , 38 ...…”