Initial experience of bamlanivimab monotherapy use in solid organ transplant recipients

Abstract

The widespread transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to propagate the coronavirus disease 2019 (COVID-19) pandemic with solid organ transplant (SOT) recipients being an exceptionally vulnerable population for poor outcomes. Treatments for COVID-19 are limited; however, monoclonal antibodies are emerging as a potential therapeutic option to change the trajectory of high-risk patients. This retrospective single center cohort study evaluated the outcomes of SOT recipients with mild to moderate COVID-19 who received bamlanivimab monotherapy. Eighteen SOT recipients (15 kidney, 2 liver, and 1 heart)

Use of anti-spike monoclonal antibodies in kidney transplant recipients with COVID-19: Efficacy, ethnic and racial disparities

“…In summary, we found a strong signal for less hospitalizations or ER visits in KTR who received anti‐spike mAbs, compared to those who did not. Based on our results and those of multiple other studies, 11 , 12 , 13 , 14 , 16 mAbs are an important addition to the antiviral therapeutic armamentarium for immunocompromised patients. Such agents could help improve clinical outcomes and significantly decrease the burden of ER visits and hospital admissions during the ongoing and potential future pandemics.…”

“…Second, this was a single‐center retrospective study, and the number of KTR who received mAb was relatively small, but within range of what has been reported by other investigators. 11 , 13 , 14 , 16 , 17 Fourth, we did not assess the autologous antibody response prior to mAb, neither the virological response, due to lack of standardized assays.…”

Organ transplant patients, COVID‐19, and neutralizing monoclonal antibodies: The glass is half full

“…present the outcomes and tolerability of bamlanivimab for mild to moderate COVID‐19 in SOT recipients. 13 Eighteen adult SOT recipients (15 kidney recipients, two liver recipients, and one heart recipient) were included in this retrospective, observational cohort. The average age was 52 years, and 72% of the patients were male and predominately Caucasian (67%).…”

“…This scenario has been described in a patient with acute myelogenous leukemia who received bamlanivimab and from whom a viral variant with the E484K substitution was subsequently detected. 22 It is unknown if the higher observed hospitalization rate in bamlanivimab‐treated transplant recipients compared to reported hospitalization rates in the monoclonal antibody clinical trials reflects treatment failure because of a resistant infecting variant, emergence of resistance variants after receipt of the monoclonal antibody, or simply because the transplant patients are a “higher acuity population 13 ” with low thresholds for hospitalization when infection is present. Future studies addressing the virology and viral dynamics of SARS‐CoV‐2 in the transplant population are essential for a better understanding of treatment response and outcomes in this population.…”

“…The major drawback of the Kutzler cohort and other SOT cohorts has been the lack of a comparator group. Apart from the small experience by Dhand et al., each of these cohorts has an ED visit or hospitalization rate of 15.1%–22%, 13 , 14 , 15 , 16 but it is unknown how this compares to hospitalization rates for SOT recipients not treated with monoclonal antibodies. Contemporary cohorts of COVID‐19 in SOT recipients have rates of hospitalization much higher than that reported in these small monoclonal antibody cohorts.…”