Bierle: Monoclonal Antibody Treatment of Breakthrough COVID-19 in Fully Vaccinated Individuals with High-Risk Comorbidities

Monoclonal Antibody Treatment of Breakthrough COVID-19 in Fully Vaccinated Individuals with High-Risk Comorbidities

Bierle et al., The Journal of Infectious Diseases, doi:10.1093/infdis/jiab570 (date from earlier preprint)

20 Oct 2021 Source PDF Share Tweet

Retrospective 1,395 vaccinated COVID-19 cases, showing significantly lower hospitalization and oxygen supplementation with monoclonal antibody treatment, primarily casirivimab-imdevimab. Hospitalization was significantly associated with comorbidities.

Efficacy is variant dependent. In Vitro research suggests a lack of efficacy for omicron [Liu, Sheward, Tatham, VanBlargan].

1. Liu et al., bioRxiv, doi:10.1101/2021.12.14.472719, Striking Antibody Evasion Manifested by the Omicron Variant of SARS-CoV-2, https://www.biorxiv.org/content/10.1101/2021.12.14.472719.

2. Sheward et al., bioRxiv, doi:10.1101/2021.12.19.473354, Variable loss of antibody potency against SARS-CoV-2 B.1.1.529 (Omicron), https://www.biorxiv.org/content/10.1101/2021.12.19.473354.

3. Tatham et al., bioRxiv, doi:10.1101/2022.01.23.477397, Lack of Ronapreve (REGN-CoV; casirivimab and imdevimab) virological efficacy against the SARS-CoV 2 Omicron variant (B.1.1.529) in K18-hACE2 mice, https://www.biorxiv.org/content/10.1101/2022.01.23.477397.

4. VanBlargan et al., bioRxiv, doi:10.1101/2021.12.15.472828, An infectious SARS-CoV-2 B.1.1.529 Omicron virus escapes neutralization by several therapeutic monoclonal antibodies, https://www.biorxiv.org/content/10.1101/2021.12.15.472828v1.

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risk of ICU admission, 88.9% lower, RR 0.11, p = 0.16, treatment 0 of 527 (0.0%), control 5 of 868 (0.6%), NNT 174, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm).

risk of oxygen therapy, 85.3% lower, RR 0.15, p < 0.001, treatment 5 of 527 (0.9%), control 56 of 868 (6.5%), NNT 18, odds ratio converted to relative risk.

risk of hospitalization, 75.3% lower, RR 0.25, p < 0.001, treatment 14 of 527 (2.7%), control 93 of 868 (10.7%), NNT 12, odds ratio converted to relative risk.

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates

This study is excluded in meta analysis: patients were treated with different medications, results specific to each medication were not reported.

Conflicts of interest: research funding from the drug patent holder.

Bierle et al., 20 Oct 2021, retrospective, USA, peer-reviewed, 7 authors, average treatment delay 5.0 days.

Contact: razonable.raymund@mayo.edu.

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