Monoclonal antibody therapy improves severity and mortality of COVID-19 in organ transplant recipients: A meta-analysis

Yang, Mingyang; Li, Anthony; Wang, Yushu; Tran, Carolyn; Zhao, Siyi; Ao, Guangyu

doi:10.1016/j.jinf.2022.06.027

Cited by 12 publications

(6 citation statements)

References 9 publications

(3 reference statements)

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“…Another important finding from our study was that mAb administration to OTRs with COVID-19 was associated with better survival ( Table 3 ), in agreement with the results of a recent meta-analysis [ 35 ]. Vaccinated patients received mAbs more frequently; however, the difference was not statistically significant ( Table 2 ) and is unlikely to have contributed to the independent benefits observed with vaccination ( Table 3 ).…”

Section: Discussionsupporting

confidence: 91%

“…Regardless, mAbs remain our first-line outpatient treatment for OTRs with COVID-19, as they have been shown to decrease the risk of hospitalization [ 27 ] and emergency room visit and death [ 35 ]. Nirmatrelvir/ritonavir (Paxlovid), although at least as effective as mAbs, inhibits irreversibly the catabolism of calcineurin and mTOR inhibitors, which are the backbone of maintenance immunosuppression among OTRs.…”

Section: Discussionmentioning

confidence: 99%

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mRNA Vaccination Decreases COVID-19-Associated Morbidity and Mortality Among Organ Transplant Recipients: A Contemporary Cohort Study

Lerner

Arvanitis

Vieira

et al. 2022

Open Forum Infectious Diseases

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Background Organ transplant recipients (OTR) are less protected from vaccination than immunocompetent hosts. Additional vaccine doses have shown increased immunogenicity. Few studies assessed their clinical efficacy, particularly against Omicron variants, since most included patients from earlier phases of the pandemic, with higher base mortality rates. Methods We studied adult OTR who had COVID-19 between 12/15/21 and 5/25/22. We compared clinical outcomes between those who had received 2 or ≥3 doses of an mRNA vaccine and concurrent unvaccinated controls. Results Among 103 OTR, vaccination was associated with lower 90-day mortality (unvaccinated vs. 2 vs. ≥3 doses: 25% vs. 7% vs. 3%, P = 0.003), hospital (unvaccinated vs. 2 vs. ≥3 doses: 56% vs. 37% vs. 27%, P = 0.018) or ICU (unvaccinated vs. 2 vs. ≥3 doses: 25% vs. 15% vs. 3%, P = 0.001) admission rates, and peak O2 requirements (ordinal scale Kendall’s tau b=-0.309 [lower scores, i.e., O2 requirements with more vaccine doses], P = 0.003). Age (>60 years adjusted hazard ratio [aHR] 7.73, P = 0.016), administration of anti-spike monoclonal antibody (aHR 0.17, P = 0.042) and vaccination, especially with ≥3 doses (aHR 0.105, P = 0.01), were independently associated with 90-day mortality. Black (P = 0.021) or Hispanic (P = 0.016) OTR were underrepresented among the vaccinated, especially in the ≥3 dose group. Conclusions Despite lower mRNA vaccine efficacy in OTR and against Omicron variants, vaccination protects this vulnerable patient population from severe COVID-19 and death. Ethnic and racial disparities in healthcare have been exacerbated by the COVID-19 pandemic and warrant better community outreach efforts.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

mRNA Vaccination Decreases COVID-19-Associated Morbidity and Mortality Among Organ Transplant Recipients: A Contemporary Cohort Study

Lerner

Arvanitis

Vieira

et al. 2022

Open Forum Infectious Diseases

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“…In this journal, Yang and colleagues recently reviewed effectiveness of monoclonal antibody therapy in organ transplant recipients with COVID-19 1 . Pre-exposure prophylaxis (PrEP) of COVID-19 is essential for immunocompromised patients who do not respond to SARS-CoV-2 vaccines.…”

Section: To the Editormentioning

confidence: 99%

Low serum neutralization of Omicron variants a month after AZD7442 prophylaxis initiation

Lamballerie

Martin‐Blondel

Dupont

et al. 2023

Journal of Infection

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“…Терапия mAbs у этих пациентов была сопряжена с достоверно более низкой летальностью (3% в группе 1 против 19,7% в группе 2). Полученные данные согласуются с результатами недавно опубликованного метаанализа, включавшего 8 рет ро спектив ных исследований [37]. При сравнении групп больных mAbs+ (n = 313) и mAbs-(n = 617) оказалось, что лечение нейтрализующими антителами ассоциировалось как со снижением риска развития тяжелого течения болезни (OP = 0,19, 95% ДИ: 0,08 до 0,42, p < 0,0001), так и смертности от COVID-19 (OP = 0,16, 95% ДИ: 0,06 до 0,45, p = 0,0005).…”

Section: параметрыunclassified

Experience in the use of neutralizing monoclonal antibodies in kidney transplant recipients with COVID-19

Kim

Lysenko

Frolova

et al. 2023

RJTAO

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Therapy with neutralizing monoclonal antibodies (mAbs) is particularly relevant during COVID-19 outbreaks in patients at high risk of severe disease, including kidney transplant recipients (KTRs).Objective: to evaluate the efficacy and safety of neutralizing mAbs in KTRs with mild to moderate COVID-19.Materials and methods. The retrospective study included 99 KTRs who received inpatient treatment for COVID-19 between September 1 and December 31, 2021. Patients were 52.0 ± 11.5 years old (M, 47.5%). Bamlanivimab/etesevimab combination drug at a dose of 700/1400 mg was used as mAbs. To evaluate the efficacy of mAbs therapy, two groups of patients were identified. Group 1 consisted of 33 KTRs who received mAbs as one of the therapy components, while group 2 consisted of 66 patients who received no mAbs. Discharge from the hospital or death was considered as the endpoint of follow-up.Results. In group 1, after the use of mAb, progression of pulmonary process was observed less frequently than in the control group with CT1-2 transformation to CT3-4 (9.1% vs. 30.3%, respectively, p < 0.01). Group 1 KTRs differed significantly from group 2 - lower need for ICU and ventilator care (6.1% vs. 27.3% and 3% vs. 19.8%, respectively). The groups were comparable by sex, age, body mass index, Charlson Comorbidity Index (CCI) and time after kidney transplant (KTx) at the onset of the disease and by rnseline blood biochemistry parameter values at the time of hospitalization. Only C-reactive protein (CRP) and fibrinogen values were higher in the non-mAbs patients who were hospitalized later in the course of the disease (7.7 ± 3.2 days versus 4.6 ± 1.6 days in group 1, p < 0 .001). The frequency of prescription of other therapies did not differ between the compared groups. Use of mAbs significantly reduced mortality from 19.7% in KTRs in group 2 to 3% in group 1 without adverse effect on graft function. Conclusion. The use of mAbs therapy in the early stages of COVID-19 in KTRs is safe, it prevents severe COVID-19, and reduces the incidence of adverse outcomes.

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Monoclonal antibody therapy improves severity and mortality of COVID-19 in organ transplant recipients: A meta-analysis

Cited by 12 publications

References 9 publications

mRNA Vaccination Decreases COVID-19-Associated Morbidity and Mortality Among Organ Transplant Recipients: A Contemporary Cohort Study

mRNA Vaccination Decreases COVID-19-Associated Morbidity and Mortality Among Organ Transplant Recipients: A Contemporary Cohort Study

Low serum neutralization of Omicron variants a month after AZD7442 prophylaxis initiation

Experience in the use of neutralizing monoclonal antibodies in kidney transplant recipients with COVID-19

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