Outcomes of Anti-Spike Monoclonal Antibody Therapy in Pregnant Women with Mild to Moderate COVID-19

Abstract

ObjectiveTo evaluate the efficacy and safety of anti-spike monoclonal antibodies (MAb) in the treatment of mild to moderate COVID-19 in high-risk patients who are pregnant.MethodsThe database of patients treated with monoclonal antibodies in the Mayo Clinic Midwest region was reviewed for patients who were pregnant at the time of infusion. Manual chart review was performed to collect demographic details as well as COVID course for both the mother and the infant if delivered. The data are presented using descriptive methods.ResultsWe identified fifty-one pregnant patients with mild to moderate COVID-19 who were treated with MAb (4 with bamlanivimab monotherapy, 3 with bamlanivimab-etesevimab combination, and 44 with the casirivimab-imdevimab combination). No adverse effects were reported, and no patient required COVID-19 related hospitalization. Twenty-nine patients delivered healthy babies, there was one case of intrauterine fetal demise secondary to a congenital Ebstein anomaly (not related to MAb treatment), and twenty-one were uncomplicated pregnancies.ConclusionMAb infusions were well tolerated in pregnant patients considered at high risk for COVID-19 complications, with no observed adverse effects to mother or fetus. Although preliminary data suggest MAb therapy in pregnancy is safe, further research is recommended to fully assess safety and efficacy in pregnancy.TEACHING POINTSAnti-spike monoclonal antibody therapy is well tolerated in high-risk pregnant patients with mild to moderate COVID-19No adverse effects of anti-spike monoclonal antibody administration were observed in either the mother or fetus.

Sotrovimab Use for COVID-19 Infection in Pregnant Kidney Transplant Recipient

“…3 Thilagar et al (preprint) reported outcomes of 51 pregnant patients treated with antispike mAbs for COVID-19 infection. The mean maternal age was 31.1 y and mean gestational age was 180.1 d. No fetomaternal complications were reported and 29 patients had healthy babies 4 (Table 1).…”