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0 0.5 1 1.5 2+ Hospitalization, MV -95% Improvement Relative Risk Hospitalization, PSM -105% Hospitalization, delta -100% Hospitalization, omicron -111% Casirivimab/i..  Gershengorn et al.  EARLY TREATMENT Is early treatment with casirivimab/imdevimab beneficial for COVID-19? Retrospective 6,284 patients in the USA Higher hospitalization with casirivimab/imdevimab (not stat. sig., p=0.09) Gershengorn et al., PLOS ONE, December 2022 Favors casirivimab/im.. Favors control

The clinical effectiveness of REGEN-COV in SARS-CoV-2 infection with Omicron versus Delta variants

Gershengorn et al., PLOS ONE, doi:10.1371/journal.pone.0278770
Dec 2022  
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17th treatment shown to reduce risk in March 2021
*, now known with p = 0.000018 from 28 studies, recognized in 42 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.
4,000+ studies for 60+ treatments.
Retrospective 2,083 outpatients in the USA, showing higher risk of hospitalization with casirivimab/imdevimab, without statistical significance. There may be significant unadjusted confounding by indication.
Efficacy is variant dependent. In Vitro research suggests a lack of efficacy for many omicron variants Haars, Liu, Pochtovyi, Sheward, Tatham, VanBlargan.
This study is excluded in the after exclusion results of meta analysis: substantial unadjusted confounding by indication possible.
risk of hospitalization, 95.0% higher, OR 1.95, p = 0.09, treatment 369, control 5,915, adjusted per study, multivariable, day 30, RR approximated with OR.
risk of hospitalization, 104.9% higher, RR 2.05, p = 0.009, treatment 21 of 369 (5.7%), control 41 of 1,476 (2.8%), propensity score matching, day 30, Figure 2, PSM cohort.
risk of hospitalization, 100% higher, RR 2.00, p = 0.07, treatment 11 of 213 (5.2%), control 22 of 852 (2.6%), delta, propensity score matching, day 30, Figure 2, PSM cohort.
risk of hospitalization, 110.5% higher, RR 2.11, p = 0.06, treatment 10 of 156 (6.4%), control 19 of 624 (3.0%), omicron, propensity score matching, day 30, Figure 2, PSM cohort.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Gershengorn et al., 2 Dec 2022, retrospective, USA, peer-reviewed, 6 authors. Contact:,
This PaperCasirivimab/i..All
The clinical effectiveness of REGEN-COV in SARS-CoV-2 infection with Omicron versus Delta variants
Hayley B Gershengorn, Samira Patel, Tanira Ferreira, Sankalp Das, Dipen J Parekh, Bhavarth Shukla
PLOS ONE, doi:10.1371/journal.pone.0278770
Background In vitro studies suggesting that REGEN-COV (casirivimab plus imdevimab monoclonal antibodies) had poor efficacy against Omicron-variant SARS-CoV-2 infection led to amendment of REGEN-COV's Emergency Use Authorization to recommend use only in regions without high Omicron prevalence. REGEN-COV's relative clinical effectiveness for Omicron is unknown. Methods and findings We conducted a retrospective cohort study of non-hospitalized adults who tested positive for SARS-CoV-2 by polymerase chain reaction at the
Supporting information S1 Table .
Brehm, Pfefferle, Possel, Karolyi, Zoufaly et al., Clinical efficacy and in vitro neutralization capacity of monoclonal antibodies for SARS-CoV-2 delta and omicron variants, J Med Virol, doi:10.1002/jmv.27916
Cao, Wang, Jian, Song, Yisimayi, Omicron escapes the majority of existing SARS-CoV-2 neutralizing antibodies, Nature, doi:10.1038/s41586-021-04385-3
Chen, Winkler, Case, Aziati, Bricker et al., In vivo monoclonal antibody efficacy against SARS-CoV-2 variant strains, Nature, doi:10.1038/s41586-021-03720-y
Deyo, Cherkin, Ciol, Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases, J Clin Epidemiol, doi:10.1016/0895-4356%2892%2990133-8
Falcone, Tiseo, Valoriani, Barbieri, Occhineri et al., Efficacy of Bamlanivimab/ Etesevimab and Casirivimab/Imdevimab in Preventing Progression to Severe COVID-19 and Role of Variants of Concern, Infect Dis Ther, doi:10.1007/s40121-021-00525-4
Hachmann, Miller, Collier, Ventura, Yu et al., Neutralization Escape by SARS-CoV-2 Omicron Subvariants BA.2.12.1, BA.4, and BA.5, N Engl J Med, doi:10.1056/NEJMc2206576
Keating, Dong, Meko, Visualizing the omicron wave striking and rolling across the country, The Washington Post
Lusvarghi, Pollett, Neerukonda, Wang, Vassell, SARS-CoV-2 BA.1 variant is neutralized by vaccine booster-elicited serum but evades most convalescent serum and therapeutic antibodies, Sci Transl Med, doi:10.1126/scitranslmed.abn8543
Shaughnessy, Emergency Use Authorization 091
Tao, Tzou, Pond, Ioannidis, Shafer, Susceptibility of SARS-CoV-2 Omicron Variants to Therapeutic Monoclonal Antibodies: Systematic Review and Meta-analysis, Microbiol Spectr, doi:10.1128/spectrum.00926-22
Vanblargan, Errico, Halfmann, Zost, Crowe et al., An infectious SARS-CoV-2 B.1.1.529 Omicron virus escapes neutralization by therapeutic monoclonal antibodies, Nat Med, doi:10.1038/s41591-021-01678-y
Ward, Bermingham, Ayoubkhani, Gethings, Pouwels et al., Risk of covid-19 related deaths for SARS-CoV-2 omicron (B.1.1.529) compared with delta (B.1.617.2): retrospective cohort study, BMJ, doi:10.1136/bmj-2022-070695
Weinreich, Sivapalasingam, Norton, Ali, Gao et al., REGEN-COV Antibody Combination and Outcomes in Outpatients with Covid-19, N Engl J Med, doi:10.1056/NEJMoa2108163
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