Early COVID‐19 treatment with Sotrovimab in high‐risk Beta‐thalassemia: Real‐life case‐series, state of the art and new perspectives

Abstract

Dear Editor, This report aims to provide a clinical demonstration of the safety and effectiveness of sotrovimab, regarding our experience in using this preventative therapy, with real-world data, which are scarce and sometimes conflicting during the different waves of the pandemic.Neutralizing monoclonal antibodies (mAbs) have been shown to reduce COVID-19 severity in patients with underlying predisposing conditions. mAbs such as sotrovimab, casirivimab/imdevimab and bamlanivimab/etesevimab are effective at reducing the risk of subsequent hospitalization in COVID-19 outpatients and have since received US Food and Drug Administration (FDA) emergency-use authorization for this indication 1,2 (Table 1).Sotrovimab is a pan-sarbecovirus mAb useful to prevent the progression of COVID-19 in high-risk patients. To date, little is known about the efficacy, tolerability and indications of mAbs in thalassaemia patients with COVID-19.The prevalence of SARS-CoV-2 infection among beta (β) thalassaemia seems to be lower than the general population, however, associated comorbidities confer the risk of more severe disease, with a fivefold increase in age-standardized lethality. 3,4 Considering the position statement of the Thalassaemia International Federation (TIF), the highest risk group for severe infectious complications, included thalassaemia patients with splenectomy and one or more severe systemic diseases, underlying comorbidities such as diabetes, cardiac, endocrine, hepatic or respiratory disease, severe iron overload, age more than 50 years and suboptimal haemoglobin pretransfusional level (less of 7 g/dL). 5 We conducted a retrospective cohort study of all adult βthalassaemia patients who acquired SARS-CoV-2 infection in February 2020 up to March 2023. We describe the clinical outcome of 54 β-thalassaemia patients, who were infected by the SARS-CoV-2 virus (Supplementary Video S1). The majority of them (51) have received mRNA vaccines, and only three have not been vaccinated by their own choice.The patients included in this study were diagnosed with SARS-CoV-2 infection diagnosed between February 2020 and March 2023. Sotrovimab was administered to three patients based on clinical features as well as comorbidities and drug-drug interactions, and on the availability of this drug,