Pre-exposure prophylaxis with tixagevimab and cilgavimab (Evusheld) for COVID-19 among 1112 severely immunocompromised patients. (December 2022)

• Record Type: Journal Article
• Authors: Nguyen, Yann; Flahault, Adrien; Chavarot, Nathalie; Melenotte, Cléa; Cheminant, Morgane; Deschamps, Paul; Carlier, Nicolas; Lafont, Emmanuel; Thomas, Marion; Flamarion, Edouard; Lebeaux, David; Charlier, Caroline; Rachline, Anne; Guérin, Corinne; Ratiney, Robert; Touchard, Justine; Péré, Hélène; Rozenberg, Flore; Lanternier, Fanny; Arlet, Jean-Benoît; Avouac, Jérôme; Boussaud, Véronique; Guillemain, Romain; Vignon, Marguerite; Thervet, Eric; Scemla, Anne; Weiss, Laurence; Mouthon, Luc
• Is Part Of: Clinical microbiology and infection. Volume 28:Number 12(2022)
• Page Start: 1654.e1
• Page End: 1654.e4
• Publication Date: 2022-12
• Subjects: Cilgavimab -- COVID-19 -- Immunocompromised -- Monoclonal antibodies -- Preexposure prophylaxis -- SARS-CoV-2 -- Tixagevimab; Medical microbiology -- Periodicals; Diagnostic microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.01
• DOI: 10.1016/j.cmi.2022.07.015
• Languages: English
• ISSNs: 1198-743X

Abstract

Abstract: Objective: Immunocompromised patients have an increased risk of a severe form of COVID-19. The clinical efficacy of the tixagevimab/cilgavimab monoclonal antibody combination as pre-exposure prophylaxis against BA.1 and BA.2 SARS-CoV-2 Omicron sublineages is unknown. We aimed to describe the incidence and outcomes of COVID-19 among immunocompromised patients receiving tixagevimab/cilgavimab as preexposure prophylaxis during the Omicron wave in France. Methods: This was an observational multicentre cohort study of immunocompromised patients receiving tixagevimab/cilgavimab as preexposure prophylaxis between December 28, 2021 and March 31, 2022. Patients received tixagevimab/cilgavimab 150/150 mg intramuscularly if they had impaired vaccine response and a high risk of severe form of COVID-19. Results: Tixagevimab/cilgavimab was administered to 1112 immunocompromised patients. After a median (range) follow-up of 63 (49–73) days, COVID-19 was confirmed in 49/1112 (4.4%) ≥5 days after treatment. During the study period, mean weekly incidence rate was 1669 in 100 000 inhabitants in Ile-de-France and 530 in 100 000 among patients who received tixagevimab/cilgavimab prophylaxis. Among infected patients, 43/49 (88%) had a mild-to-moderate form and 6/49 (12%) had a moderate-to-severe form of COVID-19. Patients with moderate-to-severe illnesses were less likely to have received early therapies than patients with mild forms (53.5% vs. 16.7% respectively) and 2/49 (4%) patients died from COVID-19. Discussion: Our study reported a low rate of infections and severe illnesses among immunocompromised patients treated with tixagevimab/cilgavimab. A global preventive strategy including vaccines, preexposure prophylaxis with monoclonal antibodies, and early therapies might be effective to prevent severe forms of COVID-19 among severely immunocompromised patients.