Challenges and Opportunities for Signal Detection During Public Health Emergencies: An Historical Re-evaluation of the Disproportionality Analysis of the ADR Reporting of Anti-COVID-19 Monoclonal Antibodies in Vigibase

Luxi et al., Drug Safety, doi:10.1007/s40264-026-01705-2, Jul 2026
24th treatment shown to reduce risk in May 2021, now with p = 0.00049 from 22 studies, recognized in 11 countries. Efficacy is variant dependent.
No treatment is 100% effective. Protocols combine treatments.
6,600+ studies for 220+ treatments. c19early.org
Disproportionality analysis of 15,250 de-duplicated individual case safety reports from VigiBase (February 2020–December 2023) identifying potential cardiovascular and neurological safety signals for monoclonal antibodies (mAbs) used in early COVID-19 treatment. Bamlanivimab showed disproportionate reporting of serious cardiac events including acute myocardial infarction and cardiac arrest. Tixagevimab/cilgavimab similarly showed signals for acute myocardial infarction and atrial fibrillation. Casirivimab/imdevimab showed disproportionate reporting of neurological events including seizure-like phenomena and Guillain-Barré syndrome. Regdanvimab showed higher hypokalemia. Of 83 unique drug-adverse reaction pairs with statistically significant RORs, 56 (67%) were not listed in the respective Summaries of Product Characteristics.
Efficacy is highly variant dependent. In Vitro research suggests a lack of efficacy for omicron1-5.
Study covers bamlanivimab/etesevimab, tixagevimab/cilgavimab, casirivimab/imdevimab, regdanvimab, and sotrovimab.
Luxi et al., 22 Jul 2026, peer-reviewed, 16 authors.
Abstract: ## ORIGINAL RESEARCH ARTICLE Challenges and Opportunities for Signal Detection During Public Health Emergencies: An Historical Re-evaluation of the Disproportionality Analysis of the ADR Reporting of Anti-COVID-19 Monoclonal Antibodies in Vigibase Nicoletta Luxi 1 · Chiara Bellitto 1 · Francesco Ciccimarra 1 · Fabio Scapini 1 · Elena Arzenton 1 · Francesco Maccarrone 1 · Ugo Moretti 1 · Emanuel Raschi 2 · Elisabetta Poluzzi 2 · Daniele Focosi 3 · Jacopo Angelini 4,5 · Pasquale De Nardo 6 · Alessia Savoldi 6 · Evelina Tacconelli 6 · Gianluca Trifirò 1 · Marco Tuccori 1 Received: 12 February 2026 / Accepted: 6 July 2026 © The Author(s) 2026 Abstract Introduction Anti-spike monoclonal antibodies (mAbs) for early treatment of COVID-19 represented a significant improvement in the pharmacological management of the SARS-COV-2 pandemic, especially in early phases, but the continuous emergence of novel virus variants of concern (VoC) required a rapid and continuous benefit-risk assessment. Objective To identify possible unexplored safety signals of anti-SARS-CoV-2 mAbs through disproportionality analysis using VigiBase, the World Health Organization (WHO) global pharmacovigilance database. Methods We conducted a disproportionality analysis of VigiBase (February 2020-December 2023). All de-duplicated individual case safety reports (ICSRs) for bamlanivimab, bamlanivimab/etesevimab, casirivimab/imdevimab, regdanvimab, sotrovimab, and tixagevimab/cilgavimab were retrieved. Descriptive analyses of ICSRs and distribution of suspected adverse drug reactions across VoC-defined periods (Alpha, Delta, Omicron) were performed. Disproportionality analysis was conducted and reported in accordance with the READUS-PV guideline. Reporting odds ratios (RORs) with 95% confidence intervals (CI) were calculated at the MedDRA Preferred Term (PT) level, using the entire database as reference (excluding vaccines). Statistically significant drug-adverse reaction pairs included in the EMA Important Medical Event (IME) list and not described in the Summary of Product Characteristics (SmPC) were identified as potential safety signals. Results Among 15,250 de-duplicated ICSRs, casirivimab/imdevimab accounted for the majority of reports (33.5%). Most cases involved female patients aged 45-64 years, predominantly reported from the Americas. Overall, 42,799 drug-adverse reaction pairs were identified, 33,948 (79.3%) of which were identified after filtering out, and 3047 (9.0%) were IMEs. Eighty-three unique drug-adverse reaction pairs had a statistically significant RORs, among which 56 (67.5%) were not listed in the SmPC. Bamlanivimab, as both monotherapy and in combination with etesevimab, showed increased reporting of several cardiac adverse events, including acute myocardial infarction (MI) and cardiac arrest. For tixagevimab/cilgavimab, disproportionality was found for acute MI ( N = 6; ROR 12.7, 95% CI 5.7-28.4) and atrial fibrillation ( N = 29; ROR 9.0, 95% CI 6.2-13.0). For regdanvimab, disproportionality emerged for hypokalemia ( N = 13; ROR 5.8, 95% CI 3.4-10.1). For casirivimab/imdevimab, 5 out of 15 PTs were classified as adverse event of special interest: seizure-like phenomena ( N = 8; ROR, 44.2; 95% CI 21.9-89.1), Guillain-Barré syndrome ( N = 6; ROR 13.4, 95% CI 6.0-30.0), encephalopathy ( N = 13; ROR 5.4, 95% CI 3.1-9.3), generalized tonic-clonic seizure ( N = 9; ROR 5.0, 95% CI 2.6-9.7), and seizure ( N = 57; ROR 3.1, 95% CI 2.4-4.0). Conclusion This..
DOI record: { "DOI": "10.1007/s40264-026-01705-2", "ISSN": [ "0114-5916", "1179-1942" ], "URL": "http://dx.doi.org/10.1007/s40264-026-01705-2", "alternative-id": [ "1705" ], "assertion": [ { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Received", "name": "received", "order": 1, "value": "12 February 2026" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Accepted", "name": "accepted", "order": 2, "value": "6 July 2026" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "First Online", "name": "first_online", "order": 3, "value": "22 July 2026" }, { "group": { "label": "Declarations", "name": "EthicsHeading" }, "label": "Conflicts of Interest", "name": "Ethics", "order": 1, "value": "Marco Tuccori is an Editorial Board member of\n Drug Safety\n . Marco Tuccori was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions. Gianluca Trifirò is an Editorial Board member of\n Drug Safety\n . Gianluca Trifirò was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions. Over the last three years, Gianluca Trifirò has served on advisory boards/seminars funded by Egualia, Biogen, GSK, Fidia, Sanofi, Eli Lilly, Novo Nordisk, Bayer, Pfizer, AlfaSigma and Takeda on topics not related to content of this paper. He is also the scientific coordinator of the academic spin-off “INSPIRE srl”, which over the past three years has conducted or is conducting observational studies and other scientific activities funded by Sanofi, Gruenenthal, PTC Therapeutics, Kyowa Kirin, Novo Nordisk, and Molteni Farmaceutici. INSPIRE has also organized an annual multi-sponsor symposium over the past three years on the role of RWE in supporting drug policy, funded by several pharmaceutical companies. Additionally, Gianluca Trifirò is currently a consultant for Viatris in a legal case concerning a topic not related to the content of this paper. All the above-mentioned activities are not related to the topic of the manuscript. The other authors have no conflict of interest to disclose." }, { "group": { "label": "Declarations", "name": "EthicsHeading" }, "label": "UMC Statement", "name": "Ethics", "order": 2, "value": "VigiBase, the WHO global database of ICSRs, is the source of our information. The information comes from a variety of sources, and the probability that the suspected adverse event is drug related is not the same in all cases; the information does not represent the opinion of the UMC or WHO." }, { "group": { "label": "Declarations", "name": "EthicsHeading" }, "label": "Data Availability", "name": "Ethics", "order": 3, "value": "The datasets generated and/or analyzed in the current study are available in the VigiBase repository. The data presented in this study are obtainable on request from the corresponding author." }, { "group": { "label": "Declarations", "name": "EthicsHeading" }, "label": "Ethical Approval", "name": "Ethics", "order": 4, "value": "The analysis used data from VigiBase, which is an anonymized database and consent for publication is not applicable." }, { "group": { "label": "Declarations", "name": "EthicsHeading" }, "label": "Consent to Participate", "name": "Ethics", "order": 5, "value": "Not applicable." }, { "group": { "label": "Declarations", "name": "EthicsHeading" }, "label": "Consent for Publication", "name": "Ethics", "order": 6, "value": "Not applicable." }, { "group": { "label": "Declarations", "name": "EthicsHeading" }, "label": "Author Contributions", "name": "Ethics", "order": 7, "value": "MT and GT conceived and designed the study. NL and CB wrote the first draft of the manuscript, supervised by MT. NL, CB, FC, UM and EA performed the search and collected the data. FS performed the analyses. FC, EA, FM, UM, ER, EP, DF, JA, PDN, AS, ET, GT and MT reviewed the manuscript critically for important intellectual content. All authors read and approved the final manuscript." }, { "group": { "label": "Declarations", "name": "EthicsHeading" }, "label": "Code Availability", "name": "Ethics", "order": 8, "value": "The cleaned dataset used in the analysis and the code for the analysis is available from the corresponding author upon reasonable request." } ], "author": [ { "affiliation": [], "family": "Luxi", "given": "Nicoletta", "role": [ { "role": "author", "vocabulary": "crossref" } ], "sequence": "first" }, { "affiliation": [], "family": "Bellitto", "given": "Chiara", "role": [ { "role": "author", "vocabulary": "crossref" } ], "sequence": "additional" }, { "affiliation": [], "family": "Ciccimarra", "given": "Francesco", "role": [ { "role": "author", "vocabulary": "crossref" } ], "sequence": "additional" }, { "affiliation": [], "family": "Scapini", "given": "Fabio", "role": [ { "role": "author", "vocabulary": "crossref" } ], "sequence": "additional" }, { "affiliation": [], "family": "Arzenton", "given": 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Please send us corrections, updates, or comments. c19early involves the extraction of 200,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. IMA and WCH provide treatment protocols.
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