COVID-19 morbidity decreases with tixagevimab–cilgavimab preexposure prophylaxis in kidney transplant recipient nonresponders or low-vaccine responders

Abstract: Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. letters to the editor COVID-19 morbidity decreases with tixagevimab–cilgavimab preexposure prophylaxis in kidney transplant recipient nonresponders or low-vaccine responders To the editor: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with high mortality in kidney transplant recipients (KTRs).1 Unfortunately, they display a poor humoral immune response following coronavirus disease 2019 (COVID-19) mRNA vaccination.2 The use of anti–SARS-CoV-2 monoclonal antibodies was therefore proposed for preexposure prophylaxis in individuals who did not exhibit a significant antibody response following vaccination. Tixagevimab–cilgavimab (Evusheld; AstraZeneca) was found to be effective in preventing COVID19 during Alpha and Delta waves.3 Because it retained a neutralizing activity against the Omicron variants BA.1 and BA.2, it was approved in many countries for preexposure prophylaxis of KTRs with a low anti–SARS-CoV-2 antibody response after vaccination.4,5 A recent study of Bertrand et al. revealed the potential clinical efficiency of tixagevimab– cilgavimab against Omicron in KTRs with weak or no response to vaccine.6 At the same time, Benotmane et al. reported serious Omicron infections despite prophylactic therapy using tixagevimab–cilgavimab.7 In light of these conflicting data, we report herein the impact of this preexposure prophylaxis on the incidence of symptomatic COVID-19; COVID-19–related hospitalizations, including intensive care unit hospitalizations; and death in a cohort of KTRs during the Omicron wave. KTRs from Bordeaux University Hospital (France) were considered as nonresponders or low responders if they had an anti-spike antibody level of <7 binding antibody units/ml (threshold of detection) or between 7 and 264 binding antibody units/ml, respectively, after at least 3 doses of mRNA vaccines. All patients were to receive i.m. prophylactic injections of tixagevimab–cilgavimab (150 mg tixagevimab and 150 mg cilgavimab) between December 28, 2021, and February 28, 2022 (COVID-19 incidence of 779 of 100,000). This period corresponded to the peak of the Omicron wave observed on January 27, 2022 (COVID-19 incidence of 4021 of 100,000) in our region (https://www.santepubliquefrance.fr/). During this study period, BA.1 was the predominant variant until February 14, 2022, when the BA.2 variant became predominant. The last follow-up was on May 5, 2022. Diagnosis of COVID-19 was based on the reverse transcriptase–polymerase chain reaction of nasopharyngeal swabs, and genome sequencing was 936 www.kidney-international.org performed when suitable samples were available. All the data were recovered from our database (Réseau Aquitain..