Update on COVID-19 Therapeutics for Solid Organ Transplant Recipients, Including the Omicron Surge

Abstract

Major changes have occurred in therapeutics for coronavirus-19 (COVID-19) infection over the past 12–18 mo, most notably in early outpatient therapy. In most cases, solid organ transplant recipients were not included in the original clinical trials of these agents, so studies of real-world outcomes have been important in building our understanding of their utility. This review examines what is known about clinical outcomes in solid organ transplant recipients with newer therapies. SARS-CoV-2 monoclonal antibodies for early treatment or prophylaxis have likely prevented many hospitalizations and deaths. In addition, convalescent plasma, the oral drugs nirmatrelvir/ritonavir and molnupiravir, remdesivir for early outpatient treatment, anti-inflammatory therapy, and investigational virus-specific T-cell therapy will be discussed. Finally, the later consequences of COVID-19, such as secondary infections, long COVID symptoms, and persistent active infection, are identified as areas for future research.

Impact of homologous and heterologous boosters in neutralizing antibodies titers against SARS-CoV-2 Omicron in solid-organ transplant recipients

“…Thus, the data provided here highlight the importance of monitoring antibody responses in immunocompromised subjects, which according to our results should be considered when planning vaccination programs in these risk groups. While different strategies such as the use of monoclonal antibodies for early treatment or prophylaxis, convalescent plasma, drugs such as nirmatrelvir/ritonavir, molnupiravir and remdesivir, anti-inflammatory therapy, and virus specific T-cell therapy are being evaluated ( 24 ). we urgently need to find alternative approaches for this specific set of patients.…”

Vaccines and therapeutics for immunocompromised patients with COVID-19

“…Use of nirmatrelvir/ritonavir should be approached with extreme caution in transplant recipients. 39 …”

Diagnosis, treatment protocols, and outcomes of liver transplant recipients infected with COVID-19

“…Since the appearance of the omicron variant in December 2021, most of the previously available MABs have shown drastically reduced activity, except for sotrovimab, which is effective against omicron BA.1 and BA.1.1 subvariants, in addition to previous variants. However, it is less effective against the BA.2 subvariant[ 107 ].…”

“…The FDA has authorized the long-acting combination MABs tixagevimab-cilgavimab (EVUSHELD™) for pre-exposure prophylaxis to prevent COVID-19 in December 2021. In the United States, this agent is the only one to have received an EUA for this use[ 107 ]. Those who are not likely to produce an effective immune response to vaccination may nevertheless benefit from this medication’s protective effects, such as those who are immunocompromised due to a medical condition or immunosuppressive medication, as well as those for whom COVID-19 vaccination is not recommended due to a history of severe adverse reaction to COVID-19 vaccine[ 162 ].…”