Dennis M Bierle, Ravindra Ganesh, Sidna Tulledge-Scheitel, Sara N Hanson, Lori L Arndt, Caroline G Wilker, MD Raymund R Razonable
doi:10.1093/infdis/jiab570/6429422
Breakthrough COVID-19 may occur among vaccinated individuals with a high number of medical comorbidities, especially during the SARS-CoV-2 Delta surge. Anti-spike monoclonal antibody treatment was associated with significantly lower rates of hospitalization, particularly among highrisk persons.
Conflict of Interest Statement: Dr. Razonable is principal investigator of research funded by Regeneron, Roche, Gilead (all funds provided to his institution), and is a member of Data Safety Monitoring Board of Novartis, on projects not directly related to this submission. Dr. Razonable received research funds from the Mayo Clinic for studies on monoclonal antibodies for COVID-19. All other no conflict to report.
Results The total population consisted of 1395 fully vaccinated patients (mean age, 54.3 years; 39.6% male) with breakthrough COVID-19 and were screened for monoclonal antibody therapy, under US FDA EUA guidance. The majority of breakthrough SARS-CoV-2 infections (n=1002; 71.8%) occurred during a 6-week period from July 1 to August 16, 2021, when the Delta variant was predominant in our region (Supplemental Figure). The most common medical comorbidities were hypertension (34.5%), cardiovascular disease (13.8%), chronic pulmonary disease (13.6%), and chronic kidney disease (10.2%) (Table 1 ). A total of 170 (12.2%) patients were immunocompromised, including 149 patients (10.7%) with solid cancer and hematologic malignancies and 35 (2.5%) transplant recipients. Most patients (69.8%) received the Pfizer-BioNTech SARS-CoV-2 mRNA vaccine. Breakthrough COVID-19 occurred at median of 124 days (mean, 120 days) after full completion of the vaccination series. At 28 days after breakthrough COVID-19 diagnosis, 107 patients (7.7%) had progressed to require hospitalization...
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