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The effect of casirivimab with imdevimab on disease progression in nonsevere COVID-19 patients in a single hospital in Japan

Komagamine et al., Journal of General and Family Medicine, doi:10.1002/jgf2.516
Dec 2021  
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Ventilation 77% Improvement Relative Risk ICU admission 92% Progression 68% primary Hospitalization time 29% Casirivimab/i..  Komagamine et al.  EARLY TREATMENT Is early treatment with casirivimab/imdevimab beneficial for COVID-19? Retrospective 128 patients in Japan Lower ICU admission (p=0.041) and progression (p=0.006) Komagamine et al., J. General and Fami.., Dec 2021 Favorscasirivimab/im.. Favorscontrol 0 0.5 1 1.5 2+
17th treatment shown to reduce risk in March 2021
*, now with p = 0.000055 from 29 studies, recognized in 45 countries. Efficacy is variant dependent.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,400+ studies for 79 treatments.
Combined retrospective/prospective study in Japan with 53 casirivimab/imdevimab patients and 75 control patients, showing significantly lower progression with treatment.
Efficacy is variant dependent. In Vitro research suggests a lack of efficacy for many omicron variants1-6.
risk of mechanical ventilation, 77.3% lower, RR 0.23, p = 0.51, treatment 0 of 53 (0.0%), control 2 of 75 (2.7%), NNT 38, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm).
risk of ICU admission, 92.3% lower, RR 0.08, p = 0.04, treatment 0 of 53 (0.0%), control 7 of 75 (9.3%), NNT 11, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm).
risk of progression, 67.8% lower, RR 0.32, p = 0.006, treatment 8 of 53 (15.1%), control 33 of 75 (44.0%), NNT 3.5, adjusted per study, odds ratio converted to relative risk, multivariable, primary outcome.
hospitalization time, 28.9% lower, relative time 0.71, p < 0.001, treatment 53, control 75.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Komagamine et al., 19 Dec 2021, retrospective, Japan, peer-reviewed, 4 authors, average treatment delay 5.0 days.
This PaperCasirivimab/i..All
The effect of casirivimab with imdevimab on disease progression in nonsevere COVID‐19 patients in a single hospital in Japan
MD | Junpei Komagamine, MD | Taku Yabuki, MD Satsuki Yoshihara, MD Nao Tanaka
Journal of General and Family Medicine, doi:10.1002/jgf2.516
Background: Recent randomized trials have revealed that neutralizing monoclonal antibodies can reduce disease progression in mild-moderate COVID-19 patients. However, no studies have investigated the effect of neutralizing monoclonal antibodies on clinical outcomes in Japan. Methods: A single-center retrospective and prospective cohort study was conducted. All consecutive febrile nonsevere COVID-19 patients with at least one risk factor were included. The primary outcome was progression to severe COVID-19. Severe COVID-19 cases were defined as patients requiring oxygen therapy and dexamethasone. The differences in the primary outcomes between the patients who were treated with casirivimab with imdevimab (treatment group) and those who were not (control group) were compared using the chi-squared test. Results: A total of 128 patients were included. Of those, the mean age was 53.6 years old (SD 9.9), and 52 (40.6%) were women. Fifty-three patients were treated with casirivimab with imdevimab, and 75 patients were given the standard treatment only. The primary outcome occurred in eight (15.1%) of the 53 patients in the treatment group and 33 (44.0%) of the 75 patients in the control group (odd ratio [OR] 0.23, 95% CI 0.09 to 0.55). The multivariate analysis revealed that the use of casirivimab with imdevimab (OR 0.21, 95% CI 0.08 to 0.54) was the only independent risk factor associated with progression to severe COVID-19. No patients died during hospitalization in either group. Conclusion: Similar to other countries, casirivimab with imdevimab significantly reduced disease progression in early nonsevere COVID-19 patients with fever and risk factors in Japan.
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Cohen, Nirula, Mulligan, Novak, Marovich et al., Effect of bamlanivimab vs placebo on incidence of COVID-19 among residents and staff of skilled nursing and assisted living facilities: a randomized controlled trial, JAMA
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