Real-world effectiveness of casirivimab and imdevimab among patients diagnosed with COVID-19 in the ambulatory setting: a retrospective cohort study using a large claims database
et al., BMJ Open, doi:10.1136/bmjopen-2022-064953
, Real-world effectiveness of casirivimab and imdevimab among patients diagnosed with COVID-19 in the ambulatory.., BMJ Open, doi:10.1136/bmjopen-2022-064953
Retrospective 73,759 outpatients treated with casirivimab/imdevimab, showing lower mortality with treatment. This result is subject to potentially substantial confounding by indication - patients with more severe cases may be more likely to receive treatment, and severity information was unavailable in the database.Efficacy is variant dependent. In Vitro research suggests a lack of efficacy for omicron [Liu, Sheward, Tatham, VanBlargan].
This study is excluded in the after exclusion results of meta
analysis:
substantial unadjusted confounding by indication possible.
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.
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risk of death/hospitalization, 60.0% lower, HR 0.40, p < 0.001, NNT 35, propensity score matching, Cox proportional hazards, day 30.
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| Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates |
Hussein et al., 19 Dec 2022, retrospective, USA, peer-reviewed, 9 authors, study period 1 December, 2020 - 30 September, 2021.
Abstract: Original research
Real-world effectiveness of casirivimab
and imdevimab among patients diagnosed
with COVID-19 in the ambulatory setting:
a retrospective cohort study using a large
claims database
Mohamed Hussein , Wenhui Wei, Vera Mastey, Robert J Sanchez,
Degang Wang, Dana J Murdock, Boaz Hirshberg, David M Weinreich,
Jessica J Jalbert
To cite: Hussein M, Wei W,
Mastey V, et al. Real-world
effectiveness of casirivimab
and imdevimab among
patients diagnosed with
COVID-19 in the ambulatory
setting: a retrospective
cohort study using a large
claims database. BMJ Open
2022;12:e064953. doi:10.1136/
bmjopen-2022-064953
► Prepublication history and
additional supplemental material
for this paper are available
online. To view these files,
please visit the journal online
(http://dx.doi.org/10.1136/
bmjopen-2022-064953).
Received 19 May 2022
Accepted 28 November 2022
© Author(s) (or their
employer(s)) 2022. Re-use
permitted under CC BY-NC. No
commercial re-use. See rights
and permissions. Published by
BMJ.
Regeneron Pharmaceuticals Inc,
Tarrytown, New York, USA
Correspondence to
Dr Mohamed Hussein;
mohamed.hussein@r egeneron.
com
ABSTRACT
Objective To assess the real-world effectiveness
of casirivimab and imdevimab (CAS+IMD) versus no
COVID-19 antibody treatment among patients diagnosed
with COVID-19 in the ambulatory setting, including
patients diagnosed during the Delta-dominant period prior
to Omicron emergence.
Design Retrospective cohort study.
Setting Komodo Health closed claims database.
Participants 13 273 128 patients diagnosed with
COVID-19 (December 2020 through September 2021)
were treated with CAS+IMD or untreated but treatment
eligible under the Emergency Use Authorization (EUA). Each
treated patient was exact and propensity score matched
without replacement to up to five untreated EUA-eligible
patients.
Interventions CAS+IMD.
Primary and secondary outcome measures Composite
endpoint of 30-day all-cause mortality or COVID-19-
related hospitalisation. Kaplan-Meier estimators were used
to calculate outcome risks overall and across subgroups:
age, COVID-19 vaccination status, immunocompromised
status, and timing of diagnosis (December 2020 to June
2021, and July to September 2021). Cox proportional
hazards models were used to estimate adjusted HRs
(aHRs) and 95% CIs.
Results Among 75 159 CAS+IMD-treated and 1 670
338 EUA-eligible untreated patients, 73 759 treated
patients were matched to 310 688 untreated patients;
matched patients were ~50 years, ~60% were women
and generally well balanced across risk factors. The
30-day risk of the composite outcome was 2.1% and
5.2% in the CAS+IMD-treated and CAS+IMD-untreated
patients, respectively; equivalent to a 60% lower risk (aHR
0.40; 95% CI, 0.38 to 0.42). The effect of CAS+IMD was
consistent across subgroups, including those who received
a COVID-19 vaccine (aHR 0.48, 95% CI, 0.41 to 0.56), and
those diagnosed during the Delta-dominant period (aHR
0.40, 95% CI, 0.38 to 0.42).
Conclusions The real-world effectiveness of CAS+IMD
is consistent with the efficacy for reducing all-cause
mortality or COVID-19-related hospitalisation reported
STRENGTHS AND LIMITATIONS OF THIS STUDY
⇒ This retrospective cohort study assessed the real-
world effectiveness of casirivimab and imdevimab
(CAS+IMD) versus no COVID-19 antibody treatment
among patients diagnosed with COVID-19 in the
ambulatory setting, including patients diagnosed
during the Delta-dominant..
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