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

Klein, Elizabeth J.; Hardesty, Anna; Vieira, Kendra; Farmakiotis, Dimitrios

doi:10.1111/ajt.16843

Cited by 35 publications

(44 citation statements)

References 20 publications

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“…The finding of mAb treatment disparities is consistent with previous studies. A single-center study of kidney transplant patients found that Black and Hispanic patients infected with SARS-CoV-2 were less likely to receive mAb and more likely to be hospitalized (5). The current study did not identify the underlying causes for the observed disparities.…”

Section: Discussioncontrasting

confidence: 58%

Racial and Ethnic Disparities in Receipt of Medications for Treatment of COVID-19 — United States, March 2020–August 2021

Wiltz¹,

Feehan²,

Molinari³

et al. 2022

MMWR Morb. Mortal. Wkly. Rep.

105

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On January 14, 2022, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr).The COVID-19 pandemic has magnified longstanding health care and social inequities, resulting in disproportionately high COVID-19-associated illness and death among members of racial and ethnic minority groups (1). Equitable use of effective medications (2) could reduce disparities in these severe outcomes (3). Monoclonal antibody (mAb) therapies against SARS-CoV-2, the virus that causes COVID-19, initially received Emergency Use Authorization (EUA) from the Food and Drug Administration (FDA) in November 2020. mAbs are typically administered in an outpatient setting via intravenous infusion or subcutaneous injection and can prevent progression of COVID-19 if given after a positive SARS-CoV-2 test result or for postexposure prophylaxis in patients at high risk for severe illness. † Dexamethasone, a commonly used steroid, and remdesivir, an antiviral drug that received EUA from FDA in May 2020, are used in inpatient settings and help prevent COVID-19 progression § (2). No large-scale studies have yet examined the use of mAb by race and ethnicity. Using COVID-19 patient electronic health record data from 41 U.S. health care systems that participated in the PCORnet, the National Patient-Centered Clinical Research Network, ¶ this study assessed receipt of medications for COVID-19 treatment by race (White, Black, Asian, and Other races [including American Indian or Alaska Native, Native Hawaiian or Other * These authors contributed equally to this report. † Fact sheets for healthcare providers for FDA emergency use authorization are available from https://www.fda.gov/media/145611/download for REGEN-COV (casirivimab and imdevimab) and https://www.fda.gov/ media/145802/download for bamlanivimab and etesevimab. The SARS-CoV-2 B.1.1.529 (Omicron) variant is not neutralized by bamlanivimab and etesevimab or casirivimab and imdevimab, the mAb-based COVID-19 treatments that were most frequently prescribed before the emergence of Omicron. § https://www.covid19treatmentguidelines.nih.gov/management/ clinical-management/ ¶ PCORnet is a national network-of-networks developed to conduct patientcentered outcomes research. The PCORnet infrastructure supports large-scale studies using its distributed data network.

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Section: Discussioncontrasting

confidence: 58%

Racial and Ethnic Disparities in Receipt of Medications for Treatment of COVID-19 — United States, March 2020–August 2021

Wiltz¹,

Feehan²,

Molinari³

et al. 2022

MMWR Morb. Mortal. Wkly. Rep.

105

View full text Add to dashboard Cite

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“…This data confirms that timely and early administration of monoclonal antibodies is associated with a significantly lower risk of hospitalization. The providers should be aware of and address any possible disparities involving underrepresented populations when providing these potentially lifesaving options [35,42].…”

Section: Anti-sars-cov-2 Monoclonal Antibody In Solid Organ Transplan...mentioning

confidence: 99%

COVID-19 and Solid Organ Transplantation: Role of Anti-SARS-CoV-2 Monoclonal Antibodies

Dhand

Razonable

2022

Curr Transpl Rep

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Purpose of Review Solid organ transplant recipients (SOTRs) are ideal candidates for early treatment or prevention of coronavirus disease 2019 (COVID-19) using anti-SARS-CoV-2 monoclonal antibodies because of multiple underlying medical conditions, chronic immune-suppression, sub-optimal immunogenic response to vaccination, and evolving epidemiological risks. In this article, we review pertinent challenges regarding the management of COVID-19 in SOTRs, describe the role of active and passive immunity in the treatment and prevention of COVID-19, and review real-world data regarding the use of anti-SARS-CoV-2 monoclonal antibodies in SOTRs. Recent Findings The use of an anti-SARS-CoV-2 monoclonal antibody in high-risk solid organ transplant recipients is associated with a reduction in the risk of hospitalization, need for intensive care, and death related to COVID-19. Overall, the early experiences from a diverse population of solid organ transplant recipients who were treated with anti-spike monoclonal antibodies are encouraging with no reported acute graft injury, severe adverse events, or deaths related to COVID-19. Summary Anti-SARS-CoV-2 antibodies are currently authorized for treatment of mild-moderate COVID-19 and post-exposure prophylaxis, including in SOTRs. Potential future uses include pre-exposure prophylaxis in certain high-risk persons and synergistic use along with emerging oral treatment options. Successful timely administration of anti-SARS-CoV-2 monoclonal antibodies requires a multidisciplinary team approach, effective communication between patients and providers, awareness of circulating viral variants, acknowledgement of various biases affecting treatment, and close monitoring for efficacy and tolerability.

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“…Accumulating evidence has demonstrated that neutralizing antibody, including casirivimab/imdevimab, bamlanivimab/etsevimab, and sotrovimab, are associated with lesser hospitalization duration and death rate for high-risk patients and SOTRs with mild-to-moderate COVID-19 [5,[14][15][16][17][18][19][20][21][22].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with solid organ transplants, diabetes mellitus, cardiovascular disease, chronic obstructive pulmonary disease, and cancer have a worse prognosis after COVID-19 [3,4]. In particular, solid organ transplant recipients (SOTRs) are at high risk for severe COVID-19 due to comorbidities and immunosuppression [5]. Although the treatment for COVID-19 is limited, various combination therapies are explored, including remdesivir as an anti-viral agent, dexamethasone, tocilizumab, and baricitinib as an anti-in ammation agent [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…Neutralizing mAbs reduce SARS-CoV-2 viral load, hospitalization, and death in patients with diabetes mellitus, cardiovascular disease, various chronic diseases, and immunosuppression [14][15][16]. However, only letters or brief reports have reported the data for COVID-19 in SOTRs in terms of hospitalization, prognosis, and tolerance with [5,17] or without [18][19][20][21][22] neutralizing mAbs therapy, and the studies on the comparison of therapies with and without neutralizing mAbs for COVID-19 in SOTRs are limited. We hypothesized that neutralizing mAbs therapy would be more effective to treat COVID-19 in SOTRs than that without neutralizing mAbs.…”

Section: Introductionmentioning

confidence: 99%

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The Efficacy of Casirivimab/Imdevimab in Solid Organ Transplant Recipients with Mild-To-Moderate COVID-19

Tagaya

Kikuchi

Mitsuda

et al. 2022

Preprint

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Background: Solid organ transplant recipients (SOTRs) are at high risk for severe coronavirus disease 2019 (COVID-19) due to comorbidities and immunosuppression. Moreover, the treatment for COVID-19 is limited. Neutralizing monoclonal antibodies (mAbs) against severe acute respiratory syndrome coronavirus 2 are used for treating mild-to-moderate COVID-19. However, reports comparing the efficacy of COVID-19 treatment with and without neutralizing mAbs in SOTRs are limited. Here, we assessed the efficacy of casirivimab/imdevimab as neutralizing mAbs against mild-to-moderate COVID-19 in SOTRs. Methods: Forty-one patients hospitalized from September 2020 to September 2021 at Tokyo Women’s Medical University Hospital were included. The duration until antifebrile and of hospitalization, requirement of oxygen (O2) ≥ 5 L, and neutralizing antibody levels were compared in SOTRs with COVID-19 who received and those who did not receive casirivimab/imdevimab therapy.Results: Casirivimab/imdevimab therapy correlated with less duration until antifebrile and of hospitalization and non-requirement of O2 ≥ 5 L in SOTRs with COVID-19 [mean days without vs. with casirivimab/imdevimab: 6 vs. 2; P = 0.0002, hazard ratio (HR) = 0.3333, 95% confidence interval (CI) = 0.1763–0.6301; mean days: 15 vs. 8; P < 0.0001, HR = 0.5333, 95% CI = 0.2878–0.9883; P = 0.0377, HR = 0.1502, 95% CI = 0.02511–0.8980, respectively]. Further, casirivimab/imdevimab therapy was associated with early antifebrile after adjusting for sex and age (P = 0.013, HR = 0.412, 95% CI = 0.205–0.826). Although no significant difference was observed in neutralizing antibody levels between patients without and with casirivimab/imdevimab therapy on the day of hospitalization (P = 0.1055), including 13 SOTRs who had received vaccination. Neutralizing antibody levels were higher in patients with casirivimab/imdevimab therapy at 3–5 days after hospitalization including such patients in whom the levels tended to stay lower despite vaccination than in those without casirivimab/imdevimab at 7–9 days after hospitalization (P < 0.0001, mean antibody without vs. with, 414.9 vs. 40000). Conclusion: Casirivimab/imdevimab therapy was effective and increased the neutralizing antibody levels in SOTRs with mild-to-moderate COVID-19. Therefore, casirivimab/imdevimab therapy could contribute to preventing the progression of mild-to-moderate COVID-19 in SOTRs.

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

Cited by 35 publications

References 20 publications

Racial and Ethnic Disparities in Receipt of Medications for Treatment of COVID-19 — United States, March 2020–August 2021

Racial and Ethnic Disparities in Receipt of Medications for Treatment of COVID-19 — United States, March 2020–August 2021

COVID-19 and Solid Organ Transplantation: Role of Anti-SARS-CoV-2 Monoclonal Antibodies

The Efficacy of Casirivimab/Imdevimab in Solid Organ Transplant Recipients with Mild-To-Moderate COVID-19

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