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Real-world Assessment of 2,879 COVID-19 Patients Treated with Monoclonal Antibody Therapy: A Propensity Score-Matched Cohort Study

Cooper et al., Open Forum Infectious Diseases, doi:10.1093/ofid/ofab512
Oct 2021  
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0 0.5 1 1.5 2+ Mortality 77% unadjusted Improvement Relative Risk ICU admission 48% unadjusted Hospitalization 52% unadjusted Casirivimab/i..  Cooper et al.  EARLY TREATMENT Is early treatment with casirivimab/imdevimab beneficial for COVID-19? Retrospective 9,682 patients in the USA Lower hospitalization with casirivimab/imdevimab (p<0.000001) Cooper et al., Open Forum Infectious D.., Oct 2021 Favors casirivimab/im.. Favors control
16th treatment shown to reduce risk in March 2021
*, now known with p = 0.000055 from 29 studies, recognized in 45 countries. Efficacy is variant dependent.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,200+ studies for 70+ treatments.
Retrospective 2,879 patients and matched controls in the USA, showing significantly lower mortality and hospitalization with bamlanivimab, bamlanivimab/etesevimab, and casirivimab/imdevimab. There was significantly lower hospitalization with casirivimab/imdevimab compared to bamlanivimab or bamlanivimab/etesevimab. PSM and multivariate analysis is only provided for all treatments combined.
Efficacy is variant dependent. In Vitro research suggests a lack of efficacy for many omicron variants1-6.
This study is excluded in the after exclusion results of meta analysis: unadjusted results with no group details.
Study covers casirivimab/imdevimab and bamlanivimab/etesevimab.
risk of death, 77.5% lower, RR 0.23, p = 0.18, treatment 1 of 1,148 (0.1%), control 33 of 8,534 (0.4%), NNT 334, unadjusted.
risk of ICU admission, 47.5% lower, RR 0.52, p = 0.14, treatment 6 of 1,148 (0.5%), control 85 of 8,534 (1.0%), NNT 211, unadjusted.
risk of hospitalization, 52.4% lower, RR 0.48, p < 0.001, treatment 45 of 1,148 (3.9%), control 703 of 8,534 (8.2%), NNT 23, unadjusted.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Cooper et al., 8 Oct 2021, retrospective, USA, peer-reviewed, 9 authors.
This PaperCasirivimab/i..All
Real-world Assessment of 2,879 COVID-19 Patients Treated with Monoclonal Antibody Therapy: A Propensity Score-Matched Cohort Study
PharmD Megan H Cooper, Paul A Christensen, Eric Salazar, Katherine K Perez, Edward A Graviss, Duc Nguyen, James M Musser, Howard J Huang, Michael G Liebl
We assessed the outcomes of 2,879 SARS-CoV-2-positive patients transfused with one of three available monoclonal antibody (mAbs) treatments compared to a propensity-matched control cohort. We found that administration of mAbs significantly reduced 28-day hospitalizations and mortality.
A c c e p t e d M a n u s c r i p t 14 Monoclonal antibodies are susceptible to the evolution of viral resistance mutations in target epitopes, and the EUA for bamlanivimab was revoked due to demonstrated resistance of emerging variants ( Similarly, the EUA for bamlanivimab and etesevimab was recently revoked (June 25, 2021), due to the increasing prevalence of the P.1 and B.1.351 variants ( that have been shown to escape certain mAbs. 23, 26 Combination mAbs that bind non-overlapping epitopes reduce the risk of resistance and have a clear advantage, and continued monitoring and assessment of emerging variants and their susceptibility to natural or induced immunity and therapeutic antibodies remains crucial. In summary, our propensity score-matched analysis confirms that early infusion of neutralizing mAbs to COVID-19 patients significantly reduced hospitalization and mortality among a large cohort of high-risk individuals. These data support continued widespread efforts to make early passive immune therapy available to COVID-19 patients. Potential Conflicts of Interest All authors report no conflicts of interest related to this study. A c c e p t e d M a n u s c r i p t 15 The study was reviewed and approved by the Houston Methodist Research Institute Institutional Review Board (IRB PRO00029666). Given the study design, patient's written consent was not required. However, verbal and written..
Austin, Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples, Stat Med
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Weinreich, Sivapalasingam, Norton, REGEN-COV Antibody Cocktail in Outpatients with Covid-19, medRxiv
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Widera, Wilhelm, Hoehl, Limited neutralization of authentic SARS-CoV-2 variants carrying E484K in vitro, J Infect Dis
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The objective of this study was to report ' 'the outcomes of high-risk, SARS-CoV-2-positive patients infused with one of the three mAb ' 'available through FDA emergency use authorization (EUA).</jats:p>\n' ' </jats:sec>\n' ' <jats:sec>\n' ' <jats:title>Methods</jats:title>\n' ' <jats:p>A total of 4,328 SARS-CoV-2-positive patients that satisfied EUA ' 'criteria for eligibility for receiving mAb therapy were infused with bamlanivimab or ' 'combination therapies bamlanivimab-etesevimab or casirivimab-imdevimab from November 22, ' '2020, to May 31, 2021, at six infusion clinics and multiple emergency departments within the ' 'eight Houston Methodist Hospitals in Houston, Texas. The primary outcome of hospital ' 'admission within 14- and 28-days post-infusion was assessed relative to a propensity-score ' 'matched cohort, matched based on age, race/ethnicity, median income by zip code, body mass ' 'index, comorbidities, and positive PCR date. Secondary outcomes included ICU admission and ' 'mortality.</jats:p>\n' ' </jats:sec>\n' ' <jats:sec>\n' ' <jats:title>Results</jats:title>\n' ' <jats:p>A total of 2,879 infused patients and matched controls were ' 'included in the analysis, including 1,718 patients infused with bamlanivimab, 346 patients ' 'infused with bamlanivimab-etesevimab, and 815 patients infused with casirivimab-imdevimab. ' 'Hospital admission and mortality rates were significantly decreased overall in mAb-infused ' 'patients relative to matched controls. Among the infused cohort, those who received ' 'casirivimab-imdevimab had significantly decreased rate of admission relative to the other two ' 'mAbs groups (aRR = 0.51, p=0.001).</jats:p>\n' ' </jats:sec>\n' ' <jats:sec>\n' ' <jats:title>Conclusions</jats:title>\n' ' <jats:p>Treatment with bamlanivimab, bamlanivimab-etesevimab, or ' 'casirivimab-imdevimab significantly decreased the number of patients who progressed to severe ' 'COVID-19 disease and required hospitalization.</jats:p>\n' ' </jats:sec>', 'DOI': '10.1093/ofid/ofab512', 'type': 'journal-article', 'created': {'date-parts': [[2021, 10, 9]], 'date-time': '2021-10-09T01:52:08Z', 'timestamp': 1633744328000}, 'source': 'Crossref', 'is-referenced-by-count': 9, 'title': 'Real-world Assessment of 2,879 COVID-19 Patients Treated with Monoclonal Antibody Therapy: A ' 'Propensity Score-Matched Cohort Study', 'prefix': '10.1093', 'author': [ { 'ORCID': '', 'authenticated-orcid': False, 'given': 'Megan H', 'family': 'Cooper', 'sequence': 'first', 'affiliation': [ { 'name': 'Department of Pharmacy, Houston Methodist Hospital, Houston, ' 'Texas, USA'}]}, { 'given': 'Paul A', 'family': 'Christensen', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Pathology and Genomic Medicine, Houston Methodist ' 'Hospital, Houston, Texas, USA'}]}, { 'given': 'Eric', 'family': 'Salazar', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Pathology and Genomic Medicine, Houston Methodist ' 'Hospital, Houston, Texas, USA'}]}, { 'given': 'Katherine K', 'family': 'Perez', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Pharmacy, Houston Methodist Hospital, Houston, ' 'Texas, USA'}, { 'name': 'Department of Pathology and Genomic Medicine, Houston Methodist ' 'Hospital, Houston, Texas, USA'}]}, { 'given': 'Edward A', 'family': 'Graviss', 'sequence': 'additional', 'affiliation': [ { 'name': 'Center for Molecular and Translational Human Infectious Diseases ' 'Research, Houston Methodist Research Institute, Houston, Texas, ' 'USA'}]}, { 'given': 'Duc', 'family': 'Nguyen', 'sequence': 'additional', 'affiliation': [ { 'name': 'Center for Molecular and Translational Human Infectious Diseases ' 'Research, Houston Methodist Research Institute, Houston, Texas, ' 'USA'}]}, { 'given': 'James M', 'family': 'Musser', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Pathology and Genomic Medicine, Houston Methodist ' 'Hospital, Houston, Texas, USA'}, { 'name': 'Center for Molecular and Translational Human Infectious Diseases ' 'Research, Houston Methodist Research Institute, Houston, Texas, ' 'USA'}]}, { 'given': 'Howard J', 'family': 'Huang', 'sequence': 'additional', 'affiliation': [ { 'name': 'Division of Pulmonology, Pulmonary, Critical Care & Sleep ' 'Medicine, Houston Methodist Hospital, Houston, TX, USA'}]}, { 'given': 'Michael G', 'family': 'Liebl', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Pharmacy, Houston Methodist Hospital, Houston, ' 'Texas, USA'}]}], 'member': '286', 'published-online': {'date-parts': [[2021, 10, 8]]}, 'container-title': 'Open Forum Infectious Diseases', 'original-title': [], 'language': 'en', 'link': [ { 'URL': '', 'content-type': 'application/pdf', 'content-version': 'am', 'intended-application': 'syndication'}, { 'URL': '', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2021, 10, 9]], 'date-time': '2021-10-09T01:52:10Z', 'timestamp': 1633744330000}, 'score': 1, 'resource': { 'primary': { 'URL': ''}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2021, 10, 8]]}, 'references-count': 0, 'URL': '', 'relation': {}, 'ISSN': ['2328-8957'], 'subject': ['Infectious Diseases', 'Oncology'], 'published': {'date-parts': [[2021, 10, 8]]}}
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