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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..
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